Emergency by Dr Cintia Flashcards
Snakes CLINICAL FEATURES
Bleeding, headache, muscle damage, nausea, vomiting, abd pain
Snakes TREATMENT (4)
- Pressure Immobilisation Bandage.
-Don’t clean the wound
-Don’t apply PIB if more than 1 hour has passed since bite,
2.IV line
3.Take blood
4.Give antivenom (Monovalent of most common snakes in area
preferred)
- Admit all cases for at least 12 hours
- Remove PIB when pt is stable
Jellyfish TREATMENT
- In Queensland: Vinegar + Antivenom, Morphine for Irukandji - In Victoria: Hot water (45C for 20 mins)
Human, cat, dogs Bites TREATMENT (5)
1.Wound care (Wash, elevate, immobilisation)
2.Tetanus prophylaxis
3.Post-Exposure prophylaxis: HIV,
HBV (Vaccine+Ig)
4.Atb Prophylaxis (Amoxi/Clav): Indicated if >8hrs delay presentation, bite in hands, feet, face, genitalia, bones, joints, immunocompromised.
5.Review in 24-48 hours
Deadly Sidney Funnel Web CLINICAL FEATURES
Resp depression, salivation, numbness, tingling around mouth
Deadly Sidney Funnel Web TREATMENT
Tx=snakebite
Victorian Funnel Web Spider CLINICAL FEATURES
Headache, nausea
Victorian Funnel Web Spider TREATMENT
Wash area, apply cold pack and give simple analgesic.
Red back spider (Black widow) CLINICAL FEATURES
Progression type
Slow progression
Diaphoresis
The venom from a Red Back Spider causes localized pain at the bite site, along with systemic symptoms like sweating and nausea due to the neurotoxic effects.
Pain and sweating at the bite site are characteristic symptoms of envenomation, helping to distinguish it from other conditions like cellulitis or allergic reactions.
Applying ice packs and providing analgesia helps to manage pain and reduce local inflammation, which are the immediate concerns after a bite.
Red black spider (Black widow) TREATMENT
-Wash area, apply cold pack and give simple analgesic.
-No improvement, rest and reassure, immobilise w/ splint, antihistamine IM for 15 mins, give antivenom IM
Lyssavirus CLINICAL FEATURES
Bats. Incubation: 3-8w
Lyssavirus, particularly the Rabies virus, is a genus of viruses that cause rabies, a severe and often fatal encephalitis. Clinical features of lyssavirus infection can be categorized into several stages:
-
Incubation Period:
- This period can vary widely, typically ranging from a few weeks to several months, occasionally even longer. The duration depends on factors like the location and severity of the bite, the amount of virus introduced, and the proximity of the bite to the central nervous system.
-
Prodromal Phase:
- Duration: 2-10 days.
- Symptoms are non-specific and can include fever, headache, malaise, anorexia, and nausea.
- Patients might experience pain, paresthesia, or itching at the site of the bite, which is a hallmark of rabies infection.
-
Acute Neurologic Phase:
- Duration: 2-7 days.
- This phase presents with severe symptoms and can be divided into two forms: encephalitic (furious) rabies and paralytic (dumb) rabies.
- Hydrophobia: Intense spasms of the throat muscles triggered by attempts to drink, sometimes even by the sight or thought of water.
- Aerophobia: Spasms triggered by drafts of air.
- Hyperactivity and Agitation: Patients can exhibit confusion, hallucinations, and aggressive behavior.
- Seizures: Convulsions are common.Paralytic (Dumb) Rabies:
- Muscle Weakness: Begins at the site of the bite and spreads, leading to paralysis.
- Areflexia: Absence of reflexes.
- Coma: Progressive weakness eventually leads to coma. -
Coma and Death:
- Without intensive care, coma typically occurs within 7-10 days after the onset of symptoms.
- Death usually follows shortly due to respiratory failure or secondary infections.
Diagnosis:
- Diagnosis is confirmed by laboratory tests such as PCR (polymerase chain reaction) to detect viral RNA, direct fluorescent antibody testing, and serology for antibodies.
- Samples can include saliva, serum, cerebrospinal fluid, and skin biopsies.
Management and Prevention:
- Post-Exposure Prophylaxis (PEP): Prompt administration of rabies immunoglobulin and a series of rabies vaccinations after potential exposure can prevent the onset of symptoms.
- Vaccination: Pre-exposure vaccination is recommended for high-risk individuals, such as veterinarians and travelers to endemic areas.
- Wound Care: Immediate and thorough washing of the bite site with soap and water is critical.
Rabies is almost invariably fatal once clinical symptoms appear, emphasizing the importance of immediate post-exposure prophylaxis and preventive measures.
Lyssavirus TREATMENT
Wash wound and give rabies vaccine (if immunised) and Igs (within 48hrs)
Cardiac Arrest (Vfib) TREATMENT (4)
- CPR (30:2)
- Shock+CPR for 2 mins
- 2nd Shock
- Adrenaline IM
Bleeding CLINICAL FEATURES (4)
- Class I (<15%): Normal
- Class II (15-30%): HR 100-120
- Class III (30-40%): Low BP
- Class IV (>40%): Very low BP, >140HR
Gunshot Wound - INVESTIGATION (Stable Patient):
- X-ray.
- Triple Contrast CT
Gunshot Wound - INVESTIGATION (Unstable Patient):
- Exploratory Laparotomy
Ramsay Hunt Syndrome CLINICAL FEATURES
Ipsilateral facial palsy, ear pain, vesicles in ear/mouth
Ramsay Hunt Syndrome TREATMENT (3)
1.Control pain: Nortriptyline, amitriptyline, gabapentin
2.Famciclovir, Valacyclovir, Acyclovir (within 72 hrs)
3.Oral Steroids for 7 days (Esp>50yo)
Head Trauma FIRST INVESTIGATION
- CT
Chest Trauma FIRST INVESTIGATION (2)
- CXR
- FAST US (Haem unstable)
Chest Trauma BEST INVESTIGATION (2)
1.CT
2.MRI (For spinal cord, ligamentous injuries, epidural haematoma)
Abdomen Trauma BEST INVESTIGATION
-Haem stable: CT
-Haem unstable: FAST US, dx peritoneal lavage
Spine Trauma CLINICAL FEATURES
Neurogenic shock (Dec BP, Dec HR)
Spine Trauma TREATMENT (5):
1.ABCDE
2.Ox if Sat<94%
3.Trendelemburg position
4.Atropine if HR<40
5.Adrenaline and Dopamine (If resistant)
Flail chest CLINICAL FEATURES
Paradoxical resp
Flail chest TREATMENT (4):
1.Oxygen
2.Pain management & Pulm toilet
3. Intubation & mechanical ventilation (Positive Pressure)
4. Prophylactic bilateral chest tube
Haemothorax CLINICAL FEATURES
Dull resonance
Haemothorax TREATMENT
- Water-sealed chest tube
Pulmonary Contusion CLINICAL FEATURES
Symptoms hours after initial injury (like lucid)
Pulmonary Contusion TREATMENT
- Oxygen & Pulm toilet.
Urethral Injury CLINICAL FEATURES
Blood in urethra, inability to void
Urethral Injury FIRST INVESTIGATION
- Retrograde urethrogram
Urethral Injury TREATMENT
- Suprapubic catheter
Foreign Body Ingestion CLINICAL FEATURES
High Risk: button batteries, >6cms, two magnets, sharp, lead object
Foreign Body Ingestion FIRST INVESTIGATION
- X-ray
Foreign Body Ingestion TREATMENT (High/Low Risk):
- High risk: Referral
- Low risk: Observe
Burns CLINICAL FEATURES
Anterior (Posterior is the same)
- Genitals: 1%
- Face: 4.5%
- Upper limb: 4.5%
- Lower limb: 9%
- Thorax and abdomen: 18%
1st Degree: Erythema
2nd Degree: Erythema + Blister
3rd Degree: Pale, charred skin
Burns TREATMENT (5):
- Analgesia
- Hydration
- Clean with water
- Remove foreign material
- Deroofing blister
Burns around face/neck, hoarseness TREATMENT (2)
- Oxygen by face mask
- Intubation
CO poisoning TREATMENT (2):
1.High flow (10-15L) Normobaric Ox via Non-rebreathing mask
2.Hyperbaric oxygen to comatose, pregnant, MI, seizures.
Dehydration CLINICAL FEATURES (3 levels):
-Mild: Normal
-Mod: Mild hypotension, in kids (>2 refill time)
-Severe: Marked loss of skin turgor, severe hypotension, in kids (>3 refill time)
Dehydration TREATMENT
- Mild-Mod: Oral hydration (2-3Lt in 24 hours)
- Severe: 20mL/kg of IV hydration
(adults). 10-20mL/kg for children - If dehydration + Hypochloremic alkalosis: 0.9% NS+5% dextrose - For colostomy is 3lt for men and 2lt for women.
Alkali Ingestion TREATMENT
Oral fluids. No gastric emptying
Organophosphate Poisoning CLINICAL FEATURES
Diarrhoea, urination, miosis, bronchospasm, bradycardia, sweating, lacrimation
Organophosphate Poisoning TREATMENT
Atropine + Pralidoxime
Anticholinergic syndrome CLINICAL FEATURES
Constipation, urinary retention, mydriasis, bronchodilation, tachycardia, reduced sweat and tears
