Emergency Medicine Flashcards
Which groups of patients are at higher risk of poisoning?
Mental health, IVDU, renal failure, elderly, those in abusive households, industrial workers
What is the toxidrome seen with opioid toxicity?
Low respiratory rate, hypotension, pinpoint pupils, CO2 retention
Why is hypotension seen in opioid toxicity?
Opioids causes venodilatation
What is the toxidrome associated with anticholinergics? (Red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, full as a flask)
Flushing, anhydrosis, dry mucous membranes, mydriasis, Hyperactive delirium (confusion, restlessness, picking at imaginary objects), fever and urinary retention
What is the treatment for Anticholinergic poisoning?
Pyridostigmine
What is the cholinergic toxidrome? SLUDGE
Salivation
Lacrimation
Urination
Diarrhoea
Gastrointestinal cramps
Emesis
What is the treatment for cholinergic toxidrome?
Atropine
Contact with what substances can commonly cause cholinergic toxidrome
Pesticides and insecticides
Contact with what substances can commonly cause cholinergic toxidrome
Pesticides and insecticides
How would a patient presenting after 1 hour of single ingestion paracetamol overdose be treated?
Activated charcoal and anti emetic if nauseous
How would a patient presenting between 1-4 hours after paracetamol overdose be treated?
Admit, monitor.
Take paracetamol level before the 4 hour mark ready to initiate NAC treatment if necessary
Why do we do a VBG and coagulation screen in patients presenting with paracetamol overdose?
Low bicarbonate may indicate patient is going into renal failure
Changes to INR and prothrombin time may indicate a referral is necessary to hepatology
How would you manage a patient presenting with paracetamol overdose over 4 hours after ingestion?
Start N-acetylcysteine and stop treatment when plasma paracetamol levels fall below the treatment line
How is a significant ingestion of paracetamol defined?
> 75mg/kg/24h
How does serotonin syndrome typically present?
Sweating, tremor, confusion, hyperreflexia, hypertension, pyrexia, clonus
What is the management of serotonin syndrome?
Supportive
More severe cases- cyproheptadine and chlorpromazine
Following an ACS what combination of medications should be prescribed to risk risk of future cardiac events?
Dual antiplatelet therapy, ACE inhibitor, beta-blocker, statin
What metabolic abnormality is seen initially on ABG following salicylate poisoning?
Respiratory alkalosis- stimulation of respiration centre in brainstem.
Later followed by metabolic acidosis due to uncoupling of oxidative phosphorylation
How is salicylate poisoning managed?
Charcoal
Urinary alkalinization with IV sodium bicarbonate
Haemodialyis
What is the initial step in managing tension pneumothorax in a patient who is haemodynamically unstable?
Needle thoracostomy- inserting a large bore cannula into the second intercostal space in the mid clavicular line on the affected side
What is the next step after needle thoracostomy in tension pneumothorax management?
Placement of a chest drain in the safe triangle of the chest
What follow-up imaging show be done for cases of pneumonia?
Repeat CXR in 6 weeks after clinical resolution
What is refractory anaphylaxis?
An ongoing anaphylactic reaction that persists despite being given 2 doses of IM adrenaline
What is biphasic anaphylaxis?
A secondary anaphylaxis;arctic reaction that occurs 1-72 hours after resolution of the initial symptoms
