MISC Flashcards
Most common cause of conjunctival haemorrhage?
Diabetes and age
- self limited condition if not associated with systemic lllness
- associated conditions: HTN, diabetes, bleeding disorder, high cholesterol, coronary heart disease, medications, valsalva
- usually takes 1-2 weeks to resolve
What is an orf?
- zoonotic viral skin infections
- contracted from sheeps and goats
- generally solitary lesion
- most common on hands
- clinical diagnosis in people handling goats and sheep
ECG features of hyperkalaemia
- peaked T waves
- flat p waveas, PR prolongation, widened QRS
- bradycardia
- sine wave if severe
Management of hyperkalaemia
- ABCD
- calcium 10ml of 10% gluconate
- insulin/dextrose: 10U in 50ml of 50% dextrose
- salbutamol neb/IV
- bicarb infusion: 1mmol/kg IV
If able calcium resonium 15-30g
Q fever
- the most common zoonotic disease
- fever, rigors, chills, headache, fatigue, weight loss
- abnormal LFTs
- coxiella burnetti
- serology or PCR
- main source: cattle, sheep, goats
Clinical signs and symptoms of Q fever
- fever
- headache
- myalgia
- cough
- influenza like illness
- weight loss
- pneumonia
- nausea
- jaundice (rare)
- meningeal signs (rare)
- rash (rare)
Chronic Q fever
- chronic fatigue
- alcohol intolerance common
Complications of Q fever
- Endocarditis
- Pnuemonia
- hepatitis
- meningitis
Common blood finding of Q fever
- LFT derangement
- lymphopenia
- thrombocytopenia
- CRP elevated
Abx for Q fever
100mg doxycycline BD for 14 days
Vaccination for Q fever
- contraindicated if previous Q fever due to risk of reactivity
What are the notifiable zoonotic disease in Australia?
- brucellosis (pigs)
- leptospirosis (infected urine/water)
- Q fever (cattle, goats, sheep)
Brucellosis
- fever, headache, weakness, sweats, chills, myalgia
- inflammation or liver or pleen
- may cause inflammation of testes and epipdymis
- symptoms last 2-4 weeks followed by spontaneous recovery
Leptospirosis
- fever, chills, headache, myalgias, conjunctival suffusion
- Weil’s disease: jaundice, renal failure, haemorrhage, myocarditis
- Meningitis
- pulmonary haemorrhage and ARDS
Common presentation of acute and chronic Q fever
- chronic: endocarditis or hepatitis
- acute: pneumonia, hepatitis, osteomyelitis and meningitis or encephalitis.
Management of brucellosis
- 6 weeks doxycycline + IV gentamicine for 7 days
or
- doxycycline and PO rifampicin (not subsidised on PBS)
What is effort thrombosis?
- Axillosubclavian vein thrombosis
- form of venous thoracic outlet syndrome
- caused by venous injury due to mechanical compression
- chronic repetative venous compression at costoclavicular junction causes inflammatory response hence leading t o thrombosis of subclavian vein
- diagnosis: young, right handed with occupational or athletic history of overhead activity
- acute pain, heavy arm
Main problems in snake bites (4)
- Paralysis: ptosis, diplopia, opthalmoplegia, weakness, resp problems
- coagulopathy: bleeding from bite site, gums and at IVC
- myolysis: muscle pain and weakness, myoglobinuria, AKI, hyperk
- renal damage: coaguloapathy, AKI,
General and local snake bite symptoms
- headache, nausea, vomiting, abdominal pain, collapse, seziures
- local symptoms: local pain, swelling, bruising
Snake bite first aid
- ABCD
- broad compression bandage to the bite site, extended bandage to cover whole of bitten limb including fingers and toes
- splint the limb
Hospital management of snake bite
- ABCD
- IVC + IVF
- admit or transfer for clinical observation and serial labs
- maintain PBI until at a centre with lab
- antivenom indicated if any evidence of envenomation
Clinical evidence of evenomation
- any paralysis (ptosis, opthalmoplegia, resp distress)
- excessive bleeding
- period of LOC, fitting, collapse, arrest
- oliguria, anuria, myoglobinuria
Lab tests of envenomation
- INR, apTT, fibrinogen, d-dimer
- FBC, UEC, CK
If initial tests are normal (pre PBI removal), repeat testing 1 hr post-removal of PBI and then at about 6 & 12 hours post-bite, or more urgently if the patient develops clinical evidence suggestive of envenoming
Antivenom therapy
- give IV
- have adrenaline ready and drawn up in case of anaphylaxis
- most cases give 1 vial of polyvalent
Brown snake
- coagulopathy, renal failure and paralysis
- dominant feature is coagulopathy
Red belly black snack
- haemorrhagic and myolytic
Death adder
Neurotoxic/paralysis
Taipan
Haemorrhagic and neurotoxic
Tiger snake
-haemorrhagic and neurotoxic
Red back spider bites
- common but unlikely lethal
- bite felt, severe localised pain and sometime localised sweating
- pain spreads proximally and causes lymphandopathy
- generalised pain with sweating, hypertension and malaise
Funnel web spider bites
- potentially rapidly lethal, medical emergency
- painful with fang marks present
- systemic envenomatyion: perioral tingling, tongue fasciculation, increased salivation, lacrymation, piloerection, sweating, nausea, vomiting, headache, dyspnoea, pulmonary oedema
Sting rays
- hot water immersion for pain
- ADT
- analgesia + regiona nerve block
- prophylaxtic Abx
Blue ringed octopus
Most bites are minor, but potentially lethal. Bite may be painless. In significant cases, rapid development of systemic envenoming which may include: Perioral tingling. Progressive generalised weakness/paralysis. Respiratory paralysis. Hypotension. Maintain airway, respiration (intubate, ventilate), give IV fluids ± pressors to control hypotension. No antivenom is available.
