Medical emergencies (ED) Flashcards
What doses of adrenaline are used for anaphylaxis?
- < 6 months: 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)
- 6 months - 6 years: 150 micrograms (0.15 ml 1 in 1,000)
- 6-12 years: 300 micrograms (0.3ml 1 in 1,000)
- Adult and child > 12 years: 500 micrograms (0.5ml 1 in 1,000)
What can be measured to establish whether a patient had a true episode of anaphylaxis?
- Serum tryptase levels
- Remain elevated for up to 12 hours following an acute episode of anaphylaxis
How can hypothermia be classified?
- Mild hypothermia: 32-35°C
- Moderate or severe hypothermia: < 32°C
What are common causes of hypothermia?
- Exposure to cold in the environment is the major cause
- Inadequate insulation in the operating room
- Cardiopulmonary bypass
- Newborn babies
What are complications of rapid re-warming in hypothermia?
Peripheral vasodilation and shock -> cardiac arrest
What is the immediate management of burns caused by heat?
- Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes
- Cover the burn using cling film, layered, rather than wrapped around a limb
What is the immediate management of chemical burns?
- Brush any powder off then irrigate with water
- Attempts to neutralise the chemical are not recommended
What is the modern terminology for first, second and third degree burns?
- First = superficial epidermal
- Second = superficial/deep dermal
- Third = full thickness
When are IV fluids required for burns?
- Children with burns > 10% of total body surface area
- Adults with burns > 15% of total body surface area
What does smoke inhalation lead to?
- Airway lumen narrowing or blockage through bronchospasm
- Increased mucus production
- Oncreased airway blood flow
What should you assume in a patient who has suffered smoke inhalation?
- That they have CO poisoning
- Treat with high flow 100% O2 until the carboxyhaemoglobin is less than 10% of total haemoglobin
What are features of CO poisoning?
- Headache
- N+V
- Vertigo
- Confusion
- Subjective weakness
- ‘Pink’ skin and mucosa in severe toxicity
Why can pulse oximetry be falsely high in CO poisoning?
Due to similarities between oxyhemoglobin and carboxyhaemaglobin
What are typical carboxyhaemoglobin levels in:
1. Non-smokers
2. Smokers
3. Severe toxicity
- <3%
- <10%
- > 30%
What features indicate benzodiazepine overdose?
- Drowsiness
- Dysarthria
- Ataxia
- Nystagmus
- Resp depression
- Coma
What features indicate amphetamine overdose?
- Initially excessive activity + wakefulness
- Hallucinations, paranoia
- HTN
- Later convulsion, hyperthermia, exhaustion, coma
What features indicate cocaine overdose?
- Agitation
- HTN
- Tachycardia
- Dilated pupils
- Hyperthermia
- Hypertonia, hyper-reflexia
- Cardiac effects - chest pain, arrhythmias
What features indicate opioid overdose?
- Drowsiness
- Coma
- Resp depression
- Pin point pupils
What antidotes are available for certain poisons?
- Acetylcysteine - paracetamol
- Flumazenil injection - benzodiazepines
- Naloxone - opioids
What are causes of metabolic acidosis?
- GI bicarb. loss - diarrhoea
- Renal tubular acidosis
- Addison’s
- DKA
- Alcohol
- Shock/hypoxia
What are causes of metabolic alkalosis?
- Vomiting
- Diuretics
- Hypokalaemia
- Primary hyperaldosteronism
- Cushing’s syndrome
- CAH
What are causes of respiratory acidosis?
- COPD
- Decompensation in life-threatening asthma/pulmonary oedema
- Sedative drugs - benzos, opiate overdose
What are causes of respiratory alkalosis?
- Anxiety -> hyperventilation
- PE
- Salicylate poisioning
- CNS disorders - stroke, SAH, encephalitis
- Altitude
- Pregnancy
How can blood product transfusion reactions be classified?
- Immunological - acute haemolytic, non-haemolytic febrile, anaphylaxis
- Infection
- Transfusion-related acute lung injury (TRALI)
- Transfusion-associated circulatory overload (TACO)
