emergency Flashcards
what is anaphylaxis?
IgE mediated mast cell and basophil type 1 hypersensitivity reaction
adrenaline in anaphylaxis
0.5mg IM (0.5ml 1:1000)
other than adrenaline what other medication is given in anaphylaxis
chlorphenamine 10mg IV
hydrocortisone 200mg IV
what can be measured to identify anaphylaxis
serum tryptase
how long should anaphylaxis be monitored for?
up to 12 hours to look for biphasic reaction
how soon can you repeat adrenaline if no effect in anaphylaxis?
5 mins
causes of shock
obstructive- reduced cardiac flow (PE/ tension)/ reduced cardiac filling (tamponade)
distributive- sepsis, anaphylaxis, neurogenic
cardiogenic- MI, dysrhythmia
hypovolaemic- burns, haemorrhage, pancreatitis
what is a SOFA score
sequential organ failure assessment score
What is qSOFA score
quick SOFA
2+ refer to CCU outreach
used to diagnose sepsis
What is SIRS
systemic inflammatory response syndrome 2+ of: temp <36/ >38 HR >90 RR >20 WCC <4/>12 sepsis= SIRS + infection
what is septic shock
Sepsis + req vasopressive medication to maintain MAP >65 + serum lactate >2
stage I (compensated) blood loss
<1000ml loss HR <100 BP normal RR normal UO >30ml/ hour
stage II (Mild) Blood loss
1000-1500ml HR>100 CRT>2 posts hypotension 20-30ml/hr UO Anxious/ agitated
stage III (moderate) blood loss
1500-2000ml HR>120 SBP<90 CRT >3 UO <20ml/hr
Stage IV (severe) blood loss
>2000ml HR>140 SBP<80 anuria Reduced AVPU
hypovolaemic shock
preload decreased
CO increased
afterload increased
tx IV fluids
cardiogenic shock
preload increased
CO decreased
afterload increased
tx Inotropes and revascularisation
distributive shock
preload decreased
CO increased
afterload decreased
tx pressors, IV fluids
what is acute respiratory failure?
PaO2 <8
Type 1 normal PaCO2 due to ventilation:perfusion mismatch
Type 2 raised PaCO2 due to alveolar hypoventilation
flow rate through nasal cannula
2L (30%)
flow rate through face mask
6L (60%) can be combined with NC
Shockable pulse (VF/ pulseless VT)
shock immediately
after 3rd shock amiodarone 300mg IV and adrenaline 10ml of 1:10000 (1mg)
non-shockable (PEA/ Asystole)
adrenaline 10ml 1:10000 Asap then after every 3-5 minutes
4Hs and 4Ts
Hypoxia hypovolaemia hyperkalaemia hypothermia thrombosis tension tamonade toxins
opiate OD
naloxone
TCA OD
activated charcoal, diazepam or fits,
may require sodium bicarb
cardiac monitoring
paracetamol OD
N-acetylcysteine
salicylate OD
charcoal if <1hr/ gastric lavage if >500mg/kg
urine alkalisation
correct glucose/ K
haemodylasis if no response
what time should paracetamol levels be taken
> 4 hours <16 hours
toxic dose paracetamol
> 12g or 150mg/kg, give N-acetylcysteine regardless of normogram
what should N-acetylcysteine be given with
5% dextrose
may need chlorphenamine if allergic reaction (common)
aspirin OD symptoms
tinnitus
deafness
confusion/ coma
hyperventilation-> late hypoventilation
how might a TCA OD present?
confusion arrhythmia (prolonged QRS on ECG) headache hypotension dilated pupils/ hyperthermia
how might iron OD present?
GI bleeds
iron OD tx
desferroxamine
causes of falls
Cardiac – e.g. arrhythmia Neurological – e.g. seizure, stroke, peripheral neuropathy Vasovagal Intoxication / alcohol / pharmacological BPPV Infection Environmental
investigations following fall
CV + resp exam incl skin turgor GALS- hip # lying and standing BP urine dip neuro obs ?subdural basic bloods and imaging
normal score on MMSE
25+
agitation in delirium
holperidol 0.5-1mg
lorazepam 0.5-1mg
but worsen/ prolong delirium
benzo OD
flumezanil
BB OD
atropine and glucagon
digoxin OD
digibind
warfarin OD
phylomenadione
amoxicillin AE
rash with infectious mononucleosis
co-amox AEs
cholestasis
flucloxacillin AEs
cholestasis
erythromycin AEs
GI upset, prolonged QT
Ciprofloxacin AEs
lowers seizure threshold, tendonitis
metronidazole AEs
reaction following alcohol ingestion
doxycycline AEs
photosensitivity
trimethoprim AEs
rash including photosensitivity, pruritus, suppression of haematopoiesis
safe limits of alcohol
<14/ week
<3/ day
what effect does alcohol have on the liver?
hypooglycaemia predisposes to fatty liver cirrhosis hepatits varices p450 inducer
alcohol detoxification
chlordiazepoxide (benzo, gradually reduce over 7-10 days) thiamine to prevent wernicke's fluid and electrolyte replacement disulfiram- with psychotherapy acamprosate reduces cravings
which is acute -wernicke’s/ korsakov
wernicke- ocular palsy, ataxic gait, memory problems
what factors affect motivation to quit
desire
need
ability
reasons
benzo abuse
disinhibited/ impression of intoxication
withdrawal-> hypersensitivity, depersonalisation
psychostimulant abuse
rapid speech, large pupils, agitation, restlessness, high BP. (note ddx opiate withdrawal)
cannabis
addictive
weak hallucinogen
can cause anxiety and depression
opiates
smoking-> skin popping-> injection
cocaine
stimulant
cardiotoxic
amphetamine
stimulant
elation
excess energy
can be injected
crystal meth
strong amphetamine
MDMA
serotonin release causes social friendliness
tolerance high
LSD
hallucinogenic
not addictive
