Emergency Medicine Flashcards
Features of serotonin syndrome ?
- Stiff muscles
- Hot and sweaty
- Confused
Neuromuscular abnormalities: tremor, clonus, rigidity, hyperreflexia and upgoing plantars
Autonomic hyperactivity: hyperthermia, tachycardia, hypertension, dilated pupils, diaphoresis, flushing, vomiting and diarrhoea
Altered mental status: e.g. anxiety, agitation and delirium
SSRIs + tramadol = ?
Serotonin syndrome
- tramadol inhibits serotonin uptake
- SSRIs inhibit serotonin uptake
Acute pancreatitis lasting over a week - which biomarker for diagnosis ?
Lipase
- remains elevated for longer than amylase
- amylase measured in acute pancreatitis lasting less than a week
Lipase Long
Amylase Acute
Carbon monoxide poisoning 1st line
Administer 100% oxygen via a non-rebreather mask
In paracetamol overdose, what is the key prognostic indicator of hepatic injury severity?
INR
(represents the synthetic function of the liver)
Polymorphic ventricular tachycardia that has occurs due to QT prolongation - dx + tx ?
- Torsades de pointes
- IV magnesium sulphate
Indications for CT head following head injury ?
- GCS under 13 on initial assessment in the emergency department.
- GCS under 15 two hours after the injury on assessment in the emergency department.
- Suspected open/depressed skull fracture
- Signs of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from ear/nose, Battle’s sign).
- Post-traumatic seizure.
- Focal neurology
- More than 1 episode of vomiting.
Normal range PCO2 during an asthma attack ?
Life-threatening asthma
- should be hypocapnic
- normal PCO2 means the patient is tiring and no longer able to hyperventilate as they should in acute asthma
Shockable rhythms
Pulseless VT and Ventricular Fibrillation
Patient drinks antifreeze
Give IV fomepizole
- ethanol also works but fomepizole preferred
Beta blocker overdose?
Give IV atropine
TCA overdose ?
Give sodium bicarbonate infusion
Haematemesis on warfarin - what to do immediately?
Stop warfarin
Give intravenous vitamin K 5mg and prothrombin complex concentrate.
Reversal agent for carbon monoxide poisoning?
100% oxygen
Reversal agent for calcium channel blocker overdose?
Calcium chloride / calcium gluconate
Management of beta blocker overdose?
Glucagon for heart failure/cardiogenic shock
Atropine for symptomatic bradycardia
ALS: IV access cannot be obtained but an endotracheal tube is inserted - how should medication be delivered?
Intraosseous line
(tracheal route no longer recommended)
Market to indicate acute episode of anaphylaxis (post-episode)
Serum tryptase
- may remain elevated for up to 12 hours following an acute episode of anaphylaxis
Alcohol withdrawal features and peak time incidence ?
Alcohol withdrawal:
- symptoms: 6-12 hours
- seizures: 36 hours
- delirium tremens: 72 hours
MI - do you give oxygen therapy?
Only if SATS are <94%
(oxygen therapy in normoxaemic patients can increase coronary vascular resistance and reduce coronary blood flow)
GCS less than 8?
Intub8
