Presentations Flashcards
What is the management of paracetamol overdose?
- Activated charcol if <1 hour ago
- N-acetylcysteine
- liver transplant
What is the management of an opioid overdose?
Naloxone
What is the managment of a tricyclic antidepressant overdose?
- IV bicarbonate
What is the managment of a lithium overdose?
- normal saline fluid resus
- haemodialysis if severe
What is the management of a warfarin overdose?
- vitamin K
- prothrombin complex
What is the management of a heparin overdose?
Protamine sulphate
What is the management of lead toxicity?
- Dimercaprol
- calcium edetate
What is the management of carbon monoxide poisoning?
- 100% oxygen
- hyperbaric oxygen
What are the features of a salicylate overdose?
- hyperventilation
- tinnitus
- lethargy
- sweating, pyrexia
- nausea/vomiting
- hyper and hypo glycaemia
- seizure
- coma
What is the presentation of anaphylaxis?
- swelling of the throat and tongue causing hoarse voice and stridor
- respiratory wheeze
- dyspnoea
- hypotension
- tachycardia
- pruritis, widespread erythematous or urticarial rash
MAnagement of anaphylaxis in under 6 months
Adrenaline 100-150 micrograms (1 in 1000)
Management of anaphylaxis in 6 month to 6 year olds
150 micrograms (0.15ml of 1 in 1000)
Management of anaphylaxis in 6-12 year olds
300 micrograms (0.3ml 1 in 1000)
Management of anaphylaxis in >12
500 micrograms (0.5ml 1in 1000)
Where is the best site for IM adrenaline injection?
Anterolateral aspect of the middle third of the thigh
What is refractory anaphylaxis?
- respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline
What are the causes of syncope?
Reflex:
- vasovagal: emotion, pain, stress
- situational
- carotid sinus syncope
Orthostatic
- Primary: parkinsons, lewy body dementia
- Secondary: diabetic neuropathy, amyloidosis, uraemia
- drug induced
- volume depletion: diarrhoea, haemorrhage
Cardiac:
- arrhythmia
- structural
- PE
What are the primary autonomic failure causes of syncope?
- Parkinsons
- Lewy body dementia
What are the secondary autonomic failure causes of syncope?
- diabetic neuropathy
- amyloidosis
- uraemia
What are the drug induced causes of syncope?
- diuretics
- alcohol
- vasodilators
What is the evaluation of syncope?
- Cardiovascular examination
- postural BP reading
- ECG
- carotid sinus massage
- tilt table test
- 24 hour ECG
Post fall
- history
- collateral history
- underlying cause: postural hypo, med review, infection
Define a fall
Sudden, unintentional change in position from a higher surface to a lower surface coming to rest on the floor, an object, or the ground.
Define a fall with harm
Any fall needing radiological intervention or resulting in harm
What are the types of continence?
Stress or urge
What is stress incontinence?
Cough/sneeze/laugh/increased pressure, are not able to control the bladder, weak pelvic floor and sphincter muscles
What is urge incontinence?
Feel the need to go to the toilet but cannot make it on time. over activity of the detrusor muscle
What are the risk factors for incontinence?
- age
- bmi
- cognitiive impairment
- neurological impairement
- pregnancy
- pelvic floor prolapse
- post-menopausal
How to you assess continency?
- bi manual exam
- urine dipstick - no acute cause
- bladder scan: post void residual volume
- urodynamic test - catheter
What is the management of stress continency
- Avoid triggers
- weight loss
- reduced fluid intake
- supervised pelvic floor exercise
What is the management of urge continence?
- anticholinergics - oxybutynin
- bladder retraining
What is the treatment of alzheimers
Donepezil
What is delerium?
An acute transient state of confusion
Anticipatory care plan
Dynamic record developed over time through evolving conversations, collaborative actions and shared decision making.
- level of intervention preferred
- resus status
- preferred place of care
- post death wishes
Just in case meds
- pain relief morphine
- breathlessness and agitation medazolam
- anti emetic: based on cause (brain mets: dex cyclozine)
- hyoscine bromide for secretion
What are the types of pain?
- nociecptive: injury, pressure, inflammation
*somatic: skin muscle tendon bone
*Visceral: pain arising from infiltration or compression of the viscera (liver capsule pain) - Neuropathic pain: damage to the central or peripheral nervous system
Symptoms of dying phase
- reduced GCS
- low mood
- withdrawn
- profound weakness
- poor appetite
- difficulty swallowing
- temperature change at extremities
- terminal restlessness
What is palliative care
An approach that improves the quality of life of patients and families facing problems associated with life threatening illness through prevention and relief of suffering
chemo
Ondansetron
Brain mets
cyclozine or dex
Hypercalcaemia
Halliperidol
Constipation related nausea
metoclopramide
What makes you feel sick
- vestibulocochlear
- chemotactic: chemical or biochemical
- gut
- limbic
Anterior artery stroke
lower more than upper
Middle artery stroke
upper more than lower
Anterior inferior cerebellar stroke
ipsillateral facial paralysis and deafness
Nephrotic sydrome complications
- infection: immunoglobulin
- VTE: antithrombin III,
- hyperlipidaemia
- CKD
- hypocalcaemia
