missc. Flashcards
how do you manage paracetamol overdose if the patient presents > 24 hours after dose ?
start acetylcysteine if patient has -
jaundice
hepatic tenderness
elevated ALT
under what circumstances should acetylcysteine be immediately started in the management of paracetamol overdose
- plasma paracetamol concentration is on or above treatment level of 100 mg/ml at 4 hours and 15 mg/ml at 15 hours.
-patients presenting between 8-24 hours after ingestion of >150 mg/kg of paracetamol even if plasma paracetamol concentration is not available.
what is the definition of a staggered overdose?
arterial pH < 7.3, 24 hours after ingestion
what is the criteria for liver transplant after paracetamol ingestion?
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Over how long should Acetylcysteine be given?
1 hour
what type of reaction can acetylcysteine cause ? how is it managed?
anaphylactoid reactions - generally treated by stopping the infusion then restarting at a lower rate
what is the single most important prognostic factor in paracetamol overdose?
ABG Ph
when is azithromycin recommended as COPD prophylaxis
patient no longer smokes
optimisation of non pharmacological management and inhaled therapies
referral to pulmonary rehab
4 exacerbations in the last year
what investigation should be performed before commencing azithromycin
ECG
what is the picture of ALT and AST in paracetamol overdose
10,000s
what is the pathophysiology of an anaphylactoid reaction?
Non IgE mediated mast cell release
what is the diagnostic criteria for suspected COPD
FEV1/FVC < 70% and symptoms suggestive of COPD
what are the three key features of COPD seen on chest-xray
Hyperinflation
flattened hemidiaphragm
hyperlucent lung fields
