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
Here are simplified situations where flumazenil can be given for a benzodiazepine overdose:
-
Child accidentally takes benzodiazepines and can’t breathe properly:
- Flumazenil can help reverse the overdose if the child’s breathing is compromised.
-
Overdose causes breathing problems where intubation isn’t possible:
- Flumazenil may be used when there’s no access to intubation equipment to help restore normal breathing.
-
Too much benzodiazepine given by mistake:
- Flumazenil can be administered to counteract the excessive dose.
-
Older patient with breathing issues; avoid intubation if possible:
- Flumazenil can help an elderly patient with respiratory disease by reversing the overdose effects without needing intubation.
Cocain overdose treatment
1st: Sub-lingual nitro-glycerine
2. Benzodiazepines
NOTE: BB and aspirin are contraindicated
Gram -ve organisms
KEPH
H influenzae
P aeruginosa,
K pneumoniae,
Escherichia coli
Gram +ve organisms
SS
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
An overdose of aspirin can cause a range of metabolic effects that change over time:
- Early primary respiratory alkalosis: Initially, aspirin stimulates the brain to cause rapid breathing, leading to a loss of carbon dioxide and resulting in respiratory alkalosis (higher pH due to lower CO2).
- Late metabolic acidosis: As the overdose progresses, the body accumulates acidic substances (like lactic acid and salicylic acid from the breakdown of aspirin), leading to metabolic acidosis (lower pH due to increased acids).
- Hypokalaemia: Aspirin overdose can cause low potassium levels in the blood (hypokalaemia), which can affect muscle and heart function.
- Hypoglycaemia or sometimes hyperglycaemia: Blood sugar levels can drop (hypoglycaemia) due to increased metabolic demands, but in some cases, they may rise (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
The key diagnostic difference between hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) is the presence of ketones and blood acidity:
- HHS: Very high blood sugar (usually above 600 mg/dL) with little to no ketones and normal or mildly increased blood acidity.
- DKA: High blood sugar (usually between 250-600 mg/dL) with high levels of ketones and significantly increased blood acidity.
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
Pulmonary contusion is a form of lung injury characterized by bruising of the lung tissue, typically resulting from blunt chest trauma. This injury leads to bleeding and swelling within the lungs, which can impair gas exchange and cause respiratory distress. Here are some key points about pulmonary contusion:
- Causes: Commonly results from blunt trauma, such as car accidents, falls, or sports injuries. It can also occur in situations involving blast injuries or severe compressive forces.
- Symptoms: May include chest pain, shortness of breath, coughing (sometimes with blood), and reduced oxygen levels in the blood. The severity of symptoms can vary depending on the extent of the injury.
- Diagnosis: Typically diagnosed using imaging studies like chest X-rays or CT scans, which can reveal areas of lung bruising and other associated injuries.
- Treatment: Management depends on the severity of the contusion. Mild cases may require only supportive care, such as oxygen therapy and pain management. Severe cases might necessitate mechanical ventilation and intensive care to ensure adequate oxygenation and ventilation.
- Prognosis: Varies based on the extent of the injury and the presence of any other associated injuries or complications. Most mild to moderate contusions resolve with appropriate treatment, but severe cases can lead to significant morbidity or even mortality, especially if not promptly and properly managed.
- Complications: Can include pneumonia, acute respiratory distress syndrome (ARDS), and respiratory failure, particularly in more severe cases or if the contusion is part of a broader traumatic injury.
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). After attack
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
Digoxin immune Fab is used to treat severe digoxin toxicity. Digoxin toxicity happens when there’s too much digoxin, a heart medication, in your body, which can cause dangerous heart problems. Digoxin immune Fab works by binding to the excess digoxin, making it inactive and helping your body safely get rid of it. This treatment quickly reduces the toxic effects and helps stabilize the heart.
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
cardiac arrest core body temperature risk
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