Emergency Medicine🆘 Flashcards
mx of ethylene glycol poisoning (anti-freeze)
gastric lavage or NG aspiration if<1 hour
fomepizole
presentation of carbon monoxide poisoning
confusion
tension-type headache
cherry-red skin
tachycardia
100% ox sats on pulse oximetry
ix carbon monoxide poisoning
VBG/ABG
chest x ray
ECG
bloods including CK
mx carbon monoxide poisoning
100% oxygen via face mask
hyperbaric oxygen
in what paracetamol OD patients can NAC be administered immediately
pts on long-term enzyme inducers
regular alcohol excess
pre-existing liver disease
glutathione-deplete states; eating disorders, malnutrition and HIV
mx of status epilepticus (seizure activity lasting longer than 5 mins)
A-E
oxygen
IV access
bloods for glucose
airway management
IV Lorazepam 4mg x2
then futher anti-convulsants can be used:
leviteractem
phenytoin
valporate
Sepsis six
Take bloods
Take blood cultures
Administer oxygen if required
Administer IV abx
Administer IV fluid resuscitation
Monitor urine output
How do you treat septic shock which is unresponsive to fluid resuscitation
Noradrenaline infusion is first line
Empirical treatment for suspected encephalitis
IV acyclovir and IV ceftriaxone
Presentation of acute pulmonary oedema
Extreme dyspnoea
Restlessness
Anxiety
Some pts may produce frothy sputum
May also be signs of fluid overload
Management of acute pulmonary oedema
ABCDE approach
Sit patient up
Administer oxygen
Ensure IV access
IV furosemide
Patients with a pulmonary embolism tend to present as
With pleuritic chest pain
Normal sounding chest
Risk factors such as recent surgery or long haul travel
Initial management of hypoglycaemia below 4 mmol/l if the patient does not have a reliable swallow and in hospital
IV 10% glucose solution
Definition of hypoglycaemia
Blood glucose <3 mmol/L
Clinical features of hypoglycaemia
Shaking
Sweating
Palpitations
Hunger
Headache
Double vision and difficulty concentrating
Slurred speech
Confusion
Coma
Management of mild hypoglycaemia still conscious
ABCDE
Eat/drink fast acting carbs
Avoid chocolate
Eat slower acting after
Management of severe hypoglycaemia e.g seizures or unconscious
ABCDE
200ml 10% dextrose IV
1mg/kg glucagon IM if no IV access
Treat seizure if prolonged or repeated
Interventional management of a PE
Embelectomy may be considered in patients when thrombolysis is contraindicated
Inferior vena cava filter may be considered in patients with recurrent DVTs on warfarin or patients in which anticoagulation is contraindicated
Risk factors for haemorrhagic stroke
Age
Male sex
Family history
Haemophilia
Anticoagulation therapy
Illicit sympathomimetic drugs e,g amphetamine + cocaine
Management of paracetamol overdose
If ingestion less than 1 hour + dose >150mg/kg - ACTIVATED CHARCOAL
if staggered overdose or ingestion >15 hours - N-ACETYLCYSTEINE
If ingestion <4 hours - wait until 4 hours to take a level and then treat with N-ACETYLCYSTEINE
if 4-15 hours ago - take IMMEDIATE level and treat
What increases the risk of toxicity following a paracetamol overdose
Long term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states; eating disorders, malnutrition and HIV
Clinical features of cocaine overdose
Mainly neurological and cardiovascular
Anxiety
Agitation
Aggression
Paranoid psychosis
Hyperthermia
Seizures
non-specific sx of lethargy, nausea, vomiting, diarrhoea and hypotension
biochemical findings : hyponatraemia, hyperkalemia, hypoglycaemia and hypercalcemia
addisonian crisis
mx of addisonian crisis
Fluid resuscitation is hypotensive.
IV hydrocortisone 100mg (Stat and then continue regularly)
IV glucose if hypoglycaemic
Swap back to their oral steroids after 3 days
Consider fludrocortisone if there is adrenal disease
