Medical Emergencies

Question 1

Give 4 presentations of anaphylaxis?

Answer 1

Angio-oedema 
Rash 
Urticaria 
Hypotension 
N, V, D 
Bronchospasm

Question 2

What are the 3 drugs to used in anaphylaxis?

Answer 2

Adrenaline 0.5mg IM (0.5mls 1:1000)
Chlorphenamine 10mg IV (antihistamine)
Hydrocortisone 200mg IV

Question 3

How would you treat an acute exacerbation of COPD including ix?

Answer 3

ABCDE 
O2 - aiming for 88-92% 
IV access - baseline bloods 
ABG 
CXR 
ECG 
Rx: 
- Salbutamol 5mg nebs 
- Ipratropium bromide 500mcg nebs 
- Hydrocortisone 200mg IV/ PO pred 40mg 
? Abx if infection is the source 
? NIV if type 2 resp failure

Question 4

Give the medication to reverse paracetamol OD and how does it work?

Answer 4

N acetyl cystine = analogue for glutathione reductase
Replaces the glutathione which is needed to detoxify the NAPQ, a toxic metabolite which accumulates in paracetamol OD
There are 2 pathways of paracetamol metabolism. The cytochrome P450 pathway produces NAPQ

Question 5

In paracetamol OD which is the best test to look at?

Answer 5

PT/INR

More sensitive than your LFTs

Question 6

Explain how you manage an anaphalactoid reaction in someone who has just been given N acetyl cystine

Answer 6

Stop the drug
ABCDE
Antihistamine and symptomatic management
Restart but at half the dose

Question 7

Give some of the features you would see in a patient with a base of skull fracture

Answer 7

Panda eyes = circumstantial bruising around the eyes
Bruising or swelling behind the ear
Haemotympany
CSF - rhino ear/otoear

Question 8

Whats the difference between a group and save and crossmatch?

Answer 8

Group and Save = the sampling process, the lab tests for the group and to see if they have atypical abs in the blood. If they do the lab does more tests.
Crossmatch = when the lab actually provides blood for the patients

Question 9

What are the life threatening chest injuries?

Answer 9

ATOM FC 
Airway/aortic disruption 
Tension pneumothorax 
Open pneumothorax 
Massive pneumothorax 
Flail chest (>2 fractures >2 consecutive ribs) 
Cardiac tamponade

Question 10

What drugs + their doseage would you give an adult in anaphylaxis?

Answer 10

Adrenaline 500mcg (5ml 1 in 1000)
Hydrocortisone 200mg
Chlorphenamine 10mg

Question 11

Where is the best place to give the IM injection in anaphalaxis?

Answer 11

The anterolateral aspect of the middle 3rd of the thigh