Random facts

Question 1

Paracetamol overdose….when to give Acetyl cysteine

Answer 1

there is a staggered overdose* or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration

or

the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity

or

any dose >150mg/kg if still waiting for paracetamol levels

Question 2

King’s criteria for liver transplant in paracetamol OD

Answer 2

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

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

Question 3

Oxygen therapy Management of COPD patients

Answer 3

prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

adjust target range to 94-98% if the pCO2 is normal

Question 4

When not to use oxygen therapy if no evidence of hypoxia

Answer 4

myocardial infarction and acute coronary syndromes
stroke
obstetric emergencies
anxiety-related hyperventilation

Question 5

What drugs to use with caution in asthma/COPD

Answer 5

NSAIDs
beta-blockers
adenosine