Emergency Medicine Flashcards
When do you request for a CT scan within 1 hour when a patient has head injury?
GCS < 13 on initial assessment at the ED
GCS < 15 2 hours after injury on initial assessment in the ED
More than 2 episodes of vomiting
Post-traumatic seizure
Focal neurologic deficits
Suspected open or depressed skull fracture
Any sign of basial skull fracture (battle, racoon, CSF rhinorrhea, hemotypanum)
When do you request for a CT scan within 8 hours when a patient has head injury?
>65 y/o Any history of bleeding or clotting disorders On anticoagulation treatment Dangerous mechanism of injury >30 mins of retrograde amnesia
When do you request for a CT scan within 1 hour when a child has head injury?
GCS < 14 on initial assessment in the ED (GCS<15 if less than 1 year old)
GCS < 15 2 hours after injury
Post-traumtic seizure without epilepsy
Focal neurologic deficit
Suspected open or depresed skull fracture
Any sign of basal skull fracture
A child gets involved in a road traffic accident. A CT scan is indicated within 1 hour if TWO of the following is present:
Amnesia lasting more than 5 minutes High-speed RTA 3 or more episodes of discreet vomiting Loss of consciousness for more than 5 mins Abnormal drowsiness Fall from a height > 3 meters
Expected pupillary response in a patient with space-occupying lesion (abscess, tumor, hematoma)
UNILATERALLY DILATED PUPIL
Expected pupillary response in a patient with stimulants or TCA overdose
BILATERAL MYDRIASIS
Expected pupillary response in a patient with opiate OD
BILATERAL MIOSIS
Expected pupillary response in a patient with BRAINSTEM STROKE
BILATERAL MIOSIS
Manifestations of patient with Paracetamol OD
RUQ pain
Vomiting
Jaundice
Liver failure
Management for Paracetamol OD in less than 1 hour
Activated Charcoal
Presentation of a patient with Aspirin overdose
Hyperventilation Tinnitus Vertigo Vomiting Respiratory Alkaloses -> Metabolic Acidosis
When do you advise for dialysis in a patient who presents with ingestion of an unknown medication with the following features: tinnitus, vertigo, vomiting, hyperventilation and ABG of RAlk then MetAc?
If Salicylate level > 700
This is a probable aspirin overdose
Antidote for opioid OD
IV Naloxone
What is the most appropriate initial management if there is doubt over the time of ingestion of paracetamol irrespective of plasma concentration?
Start NAc immediately
When should you arrange for an imediate liver transplant with a paracetamol overdose?
pH < 7.3 (24 hrs after ingestion)
Or all of the following criteria:
- Prothrombin time > 100 seconds - Creatinine > 300 umol/L - Grade III or IV encephalopathy
Which commonly prescribed OTC drug initially causes respiratory alkalosis then later a metabolic acidosis?
ASA
WET SLUD of Organophosphate poisoning
Salivation
Lacrimation
Urination
Diarrhea
Treatment for Organophosphate Poisoning
Atropine
Pralidoxime
Treatment for TCA (Amitriptyline) OD
Sodium bicarbonate
0.9% NS (for hypotension)
Features of a patient with TCA OD
Widened QRS + broad-complex tachycardia
What is the difference between naloxone and naltrexone in terms of opioid treatment?
nalOXone - OX stands for treatment for overdose
nalTREXone - REX stands for relapse prevention
Naloxone
Naltrexone
Methadone
Functions in terms of opioid
Naloxone - OD
Naltrexone - relapse prevention
Methadone - detox (metadox)
IM glucagon is given as management for hygpoglycemia except for the following population:
Chronic Alcoholism or Alcohol intoxication
Liver Failure
Hypoglycemia sec to Sulfonylureas
What laboratory findings would you expect in a chronic alcoholic who is vomiting profusely?
Hypoglycemia
Hypokalemia
In a suspected variceal bleed, what is the INITIAL management?
Resuscitate with IV Fluids
In a suspected variceal bleed, what medications should be started?
Terlipressin
Prophylactic antibiotics
Vitamin K if prolonged INR
Definitive management for a confirmed variceal bleed
Band ligation
What can be offered to a patient with confirmed variceal bleed and the definitive management still did not achieve symptom control?
TIPS - transjugular intrahepatic portosystemic shunt
WHat is the most important presentation of a patient with BDZ OD?
Respiratory depression (ABG can show resp acidosis)
Treatment for BDZ OD
Flumazenil
What is an important presentation of a patient with cocaine OD?
Perforated nasal septum
Also, MI
Also, high BP, HR, RR
Treatment for cocaine OD
BDZ
SEPSIS SIX
Blood culture
FBC. U&E. Clotting, Lactate
I&O monitoring
HIgh-flow oxygen
IV fluids
IV antibiotics
Most important step in the management of severe GI bleeding
Fluid resuscitation
