Emergency Medicine Flashcards
Benzodiazepine overdose management
IV fluids and monitoring
-AVOID Flumazenil
Situation where flumazenil can be given for benzodiazepine OD
- Unintentional lone paediatric benzodiazepine ingestion with compromised airway and breathing
- When benzodiazepine overdose results in compromised airway or breathing in
settings where resources for intubation are not available - Iatrogenic over-treatment with benzodiazepine
- An elderly patient with respiratory disease/ intubation should be avoided
Cocain overdose treatment
1st: Sub-lingual nitro-glycerine
2. Benzodiazepines
NOTE: BB and aspirin are contraindicated
Gram -ve organisms
H influenzae
P aeruginosa,
K pneumoniae,
Escherichia coli
Gram +ve organisms
S pneumoniae
Staphylococcus aureus
paracetamol overdose management
- < 2 hours: activated charcoal
2-8 hours: paracetmaol concentration + ALT and if serum concentration low, no treatment
If concentration high: IV N-acetyl cysteine - > 8 hours: IV N-acetyl cysteine
Metabolic effects of aspirin overdose
– Early primary respiratory alkalosis.
– Late metabolic acidosis.
– Hypokalaemia.
– Hypoglycaemia-sometimes hyperglycaemia
hyperkalaemia treatment
- Calcium chloride
- sodium bicarbonate
- glucose/insulin
- haemodialysis
Tampon + diffuse rash + fever + confusion + hypotension + multiorgan damage
Toxic shock syndrome
- Staph aureus
Anaphylactic shock management
0.01ml/kg adrenaline IM
- IV hydrocortisone + antihistamine
type 2 DM + hyperglycaemia + dehydration with/o
ketoacidosis
hyperosmolar hyperglycaemia
hyperosmolar hyperglycaemia treatment
Sodium (corrected) = Sodium (measured)
+ glucose / 4 (all values in mmol/L)
- if Na > 150 = sodium chloride 0.45%
Diabetic ketoacidosis management
- IV saline 1 to 3 L of 0.9%
- insulin
- Dextrose 5%
gliclazide + reinal impairment fixed by glucose infusion
sulphonylurea-induced hypoglycaemia
- IV glucose (5% dextrose) infusion for several days
haemorrhage + lung Edema with/o
parenchymal disruption + several hours after the initial injury
Pulmonary contusion
Pulmonary contusion management
Supporative
- good oxygenation
- adequate pulmonary toilette
Diabetic ketoacidosis investigation
- Capillary blood sugar level
- Venous or arterial blood gases
- Blood or urinary ketone level
- Other investigations like chest X-ray, blood culture, urine culture, full blood count etc
Chest trauma + Dyspnoea + Hypotension + Hyper-resonance + mediastinal shift
Tension pneumothorax
Tension pneumothorax
needle thoracotomy
- chest tube after patient stable with needle
Difference between pneumothorax vs haemothorax
pneumothorax: high percussion resonance
haemothorax: dull percussion resonance
best indicator of an effective CPR
- Pupil size and reaction to light
- carotid and femoral pulse
Nausea and vomiting + Excessive sweating + severe headache + Coagulation defects (raised INR,
APTT, bleeding)
Snake envenomation
Snake envenomation management
- Apply pressure immobilisation/elastic bandage (PIB)
- Check sign for envenomation
3: No envenomation: topical anaesthetics & swab bites
check labs for envenomation: if no signs release PIB, repeat blood test post removal if PIV, then 6 and 12 hours
4: If clinical envenomation present: 2 IVs + take bloods - Resuscitate
- Prep for anaphylactic reaction
- Give antivenom (1 vial tiger, 1 of brown)
- Release PIB after antivenom
Medication that can cause angioedema
ACE1 30%
ARBs
Angioedema treatment
- Cease offending drug
- steroids, antihistamines and epinephrine
Digoxin immune Fab indication for digoxin toxicity
- Ingested dose (more than 10 mg in adults, more than 4 mg in children).
- Cardiac arrest.
- Potassium concentration above 5.0 mmol/L.
- Life-threatening ventricular arrhythmias.
- Decompensation (hypotension) from bradyarrhythmia’s
severe dyspnoea + distress +
pallor + sweating + tachycardia + poor peripheral perfusion
X-ray: bilateral basal + mid zone whiteout
Acute Pulmonary oedema
Chronic digoxin toxicity
associated with intercurrent illness, (with impaired renal function)
symptoms of insidious onset over days to weeks
features: acute digoxin toxicity features with visual disturbances (e.g. reduced acuity, yellow halos (xanthopsia) and altered color perception (chromatopsia)
Cardiac arrest management
- Acidemic: compressions
- if hyperkaliaemic/ hypocalcaemic/ CCB OD: calcium gluconate injection
- TCA OD: Sodium bicarbonate