Emergency department - rotation Flashcards
What is anaphylaxis ?
and
When should you suspect anaphylaxis ?
ANA - against
Phylaxis - protection
Anaphylaxis - Severe allergic reaction which is potentially life threatening affecting ( 2 or more )multiple organ systems .
severe , generalised or systemic hypersensitivity (allergic )reaction associated with development of life - threatening airway , breathing & circulation problems
CHARCTERISTCS
0 Sudden airway / breathing / circulation problems
0 Skin changes ( itchy rash (uriticaria ) , flushing , angioedema )
SYMPTOMS - MORE DETAILED
0 Angiodema ( swelling under the skin ) - may be seen all over body.
0 Respiratory issues
- SOB
- Cough
- Wheeze
0 GI issues
- abominal cramps ( fluid leakage + SM contraction causes this )
- Vomiting
- diarrhrea
0 Circulation - widespread vasodilation ( causing sudden drop in BP)—-> as result can feel dizzy
- pale & clammy
- significant tachycardia
- hypotension
- dizzness
- arrythmia
- cardiac arrest
symptoms usally peak within - 30 mins
ANAPHYLATCI SHOCK —–> organs dont have enough oxygen —-> can cause MI or loss of conciousness.
What are the two types of anaphylaxis reactions ?
Immunological vs non immunological
Both result in the degranulation of basophils & mast cell degranulation releasing these pro - inflamatory molecules into circulation.
However non - immunological anaphylaxis happens in the absence of immunoglobulins —-> the allergen does not activate the immune system ——–> directly causes degranulation of mast cells & basophils.
Overall release of pro - inflammatory molecules e.g:
- Histamine - cause smooth muscle contraction ———–> SM around airways e.g bronchi& GI tract e.g oesphagus become narrowed (tougher for air & food to get in )
- Histamine causes blood vessel dilation ————————————> Increased blood flow to injured area ————————–> leaky BV causes : oedema & hives (uriticara )
( hives / uriticaria —> histamine release causing leaky BV so affected area becomes red & the extra fluid causing skin to be itchy and swollen. - Tryptase (protease) —. causes tissue damage
- Cytokines
What is anaphylatic shock ?
Anaphylatic shock happens as a result of anaphylaxis ————————–> when the BP drops so low that the cells / organs do not get enough oxygen.
effect on organs :
- Heart —–> MI ( especially in those with underlying heart condition)
- Brain —> loss of consciousness
What is Biphasic anaphylaxis ?
What is protracted prophylaxis reactions ?
Biphasic - Treatment of anaphylaxis and symptoms resolve , however come back without additional exposure to allergen.
Protracted - last for days.
How to treat anaphylaxis ?
ABCDE approach
IM adrenaline in anteriomedial thigh ——–> if after 5 mins no improvement give another dose.
give IV fluid bolus if
After 2 doses —–> follow refractory anaphylaxis pathway.
for refactotu anaphylaxis pathway look at one note.
Signs and symptoms of a wrist fracture ?
0 Wrist pain
0 Tenderness over distal radius , ulna , carpus
0 Swelling
0 Deformity ex - dinner fork
0 Tenderness in anatomical snuffbox - scaphoid
UNCOMMON
0 Numbness in fingers- damage (injury or compression) to median nerve ( radial 3 digits - thumb and 3 nearest digits (last one only half )
( can also feel tingling if the nerve is stretched)
- if numbness felt - hypo - esthesia ( loss of sensation0 can br elicited in median nerve distribution)
- Open wound (may accompany high impact injuries)
RISK FACTORS -
- Trauma
- Osteoporosis
Diagnosis / investigation of wrist fracture ?
0 X - ray of wrist
CONSIDER
0 CT of wrist
0 MRI of wrist - may be order if occult fracture (hidden) of the scaphoid
0 DEXA/ DXA - measurement of bone density (do for anyone over the age of 50 who has had a fracture )
T score btw -1.5 to -2.5 - osteopenia
T score below -2.5 - osteoporosis (fragility fracture )
Treatment of long bone injuries ( includes radius , ulna , humerus ) or (Femur , tibia , fibula )? - CLOSED FRACTURES.
Immobilization + Pain relief
- Immobilzation -
0 Traction splint - Femur ( if suspected fracture above the knee)
0 Vacuum splint - all other long bones
Pain relief
Under 16
- Mild to moderate - Oral NSAIDS , Para , ibuprofen
- Moderate to severe - IV or intranasal opiods (use IV if iV access has been established)
Over 16
Mild - Oral para
Moderate - Co -Codamol ( para/ codeine)
Severe - IV para - supplemented by IV morphine.
- Use IV opiods with caution in frail / older adults.
*NSAID use - be cautious - can be used to supplement all of these - but never use in frail or older adults with fractures
( dont know why - maybe bcc NSAIDS block prostaglandins thus prevent bone healing)
when in hosipital :
- May have to do surgery ( fixation , or not (if non -complication & closed)
Treatment of open fractures ?
More pressing than closed fractures .
Pain relief - IV morphine (1ST LINE analgesic ) +
CONSIDER (prophylactic antibiotics - preferably within 1 hr of injury )
and saline soaked dressing covered with an occlusive layer.
FOR OPEN FRACTURES OF THE :
0 Long bone , midfoot & hindfoot - transfer directly to Major trauma centre (MTC) ( if not time or too far local ED , trauma unit)
0 Hand , wrist or toes - transfer to nearest ED or trauma unit .
When in hospital - debribement & irrigation of the wound ——————> then FIXATION (surgery)
(* Do not irrigate open fractures of the hindfoot , midfoot or long bones (but irrigate the rest - helps to prevent infection -irrigate means wash out ) )
(Debribement- cleaning wound - removing thickened skin (callus ) , infected and dead tissue , foreign debris etc. )
What is mean arterial pressure & how do you calculate it ?
The average pressure in a persons ateries in one cycle .
(Diastolic BP X 2) + systolic BP )/ 3
(divided by 3
What do you do if a patient is in shock & has refarctory hypotension despite IV fluids ?
Give vasopressors e.g. adrenaline , noradrenaline , vasopressin , dopamine , terilipressin , phenylephrine
( this rapidly constict the blood vessels to increase BP )
