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Emergency Medicine > Self Harm and Substances > Flashcards

Self Harm and Substances Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

ABC of self harm patients

A

A - assessment and analgesia
B - bloods and other physical investigations and treatments
C - circulation referring to family and wider network
DEFG - don’t ever forget safe Gaurding

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2
Q

What is the 4 area approach to mental health assessment

A

Suicidal intent
Mental state
Risk factors and warning signs
Protective factors and suicidal mitigation
Physical health
Stop the stigma

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3
Q

What mnemonic can health with taking a psychosocial history with children

A

HEEADSSS

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4
Q

Aids to help with assessing an adults mental state

A

MMSE

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5
Q

Drugs commonly seen in overdose

A

Opiates, benzos, beta blockers, aspirin, TCAs, SSRIs, CO

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6
Q

Three main features to look out for in opiate overdose

A

Miosis (pinpoint pupils), respiratory depression, coma

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7
Q

Findings that may help you identify opiate overdose

A

Assessment of patient, history of chronic pain with chronic opioid use, illicit drug use/dependency, needle marks

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8
Q

Treatment of opiate overdose

A

Naloxone

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9
Q

How does naloxone work

A

Competitively binds to same opioid receptors, short duration of action

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10
Q

What can high doses of naloxone cause

A

Cardiotoxicity increased risk

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11
Q

Which receptos do benzodiazepines work on

A

Enhance GABA action at GABA receptors

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12
Q

What are benzodiazepines used for

A

Status epilepticus, spasticity, anxiety

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13
Q

Presentation of benzodiazepine overdose

A

Drowsiness, ataxia, dysarthria, nystagmus, respiratory depression, coma, can have normal vital signs

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14
Q

Which drugs can benzos increase the effects of

A

Opiates or alcohol

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15
Q

Treatment of benzo overdose if present within 1 hour of ingestion

A

Give activated charcoal

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16
Q

Treatment of benzo overdose if present after 1 hour of ingestion

A

IV Flumazenil

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17
Q

How does activated charcoal work

A

Decreasing rate your stomach and bowel absorb a drug

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18
Q

How does flumazenil work

A

Benzodiazepine antagonist

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19
Q

What are beta blockers used for

A

HTN, HF, MI, tachycaardia, glaucoma, pregnancy, anxiety, essential tremor, hyperthyroidism

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20
Q

Response produced by beta-1-adrenoceptors

A

Increase in HR, contractlity and blood pressure

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21
Q

Response produced by beta-2-adrenoceptors

A

Bronchodilation

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22
Q

Cardiac features in beta blocker overdose

A

Bradycardia, hypotension, heart block, syncope and HF

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23
Q

What does sotalol cause

A

QTc prolongation

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24
Q

What does propanolol cause

A

QRS complex prolongation

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25
Q

Non-cardiac features in beta blocker overdose

A

Bronchospasm, respiratpry depression
Hallucinations, coma, convulsions, confusion, depression, drowsiness
Hypoglycaemia, hyperkalaemia

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26
Q

What is an important bedside investigation which needs to be perfomed in beta blocker overdose

A

ECG

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27
Q

What to give in beta blocker overdose if present to ED within 1 hour

A

Activated charcoal

28
Q

What to give in beta blocker overdose if present to ED after 1 hour

A

None needed unless complications have occured - treat complications

29
Q

What to give in beta blocker overdose if present to ED after 1 hour

A

None needed unless complications have occured - treat complications

30
Q

Treatment of QRS prolongation on ECG

A

IV sodium bicarbonate

31
Q

Uses of aspirin

A

Secondary prevention of MI, stroke, DVT or PE, management of ACS and TIA

32
Q

Features of aspirin overdose

A

Hyperventilation, tinnitus, deafness, vasodilation, sweating

33
Q

Investigations into suspected aspirin overdose

A

Plasma salicyclate levels, paracetemol levels, ABG

34
Q

How does aspirin cause overdose features in patients

A

Stimlates respiratory centre but inhibits citric acid cycle - less oxidative phosphorylation and increased production of lactic acid –> metabolic acidosis

35
Q

What to give in aspirin overdose within 1 hour

A

Activated charcoal

36
Q

What to give in aspirin overdose after 1 hour

A

IV sodium bicarb, but if severe acidosis is not responding then haemodialysis

37
Q

Uses of TCAs

A

Anxiety, depression, neuropathic pain, migraine prophylaxis

38
Q

Features of TCA overdose

A

Dry mouth, urinary retention, mydriasis, hypotension, arrhythmias, headache, convulsions, coma, hyperreflexia with extensor plantar response, respitatory failure, drowsiness

39
Q

What investigations to conduct in TCA overdose

A

ABG/VBG, ECG (tachy and QRS prolongation), paracetemol levels

40
Q

How do TCAs work

A

Increase concentration of serotonin and noradrenaline, and cause sedative and antimuscarinic effects

41
Q

Treatment of TCA overdose if present after 1 hour

A

Treat acute complications such as IV sodium bicarb to stop QR prolongation and IV lorazepam for convulsions

42
Q

How do SSRIs work

A

Increase the concentration of serotonin in the synapse by working on SERT proteins

43
Q

Features of acute overdose of SSRIs

A

Agitation, tremor, nausea, vomiting, nystagmus, tachycardia, drowsiness

44
Q

What is serotonin syndrome

A

Severe presentation of SSRI overdose needing immediate intervention

45
Q

Features of serotonin syndrome

A

Hyperthermia, rhabdomyolysis, hyponatraemia, coagulopathy, neuropsychiatric effects, neuromuscular hyperactivity, acute renal failure, autonomic instability

46
Q

Investigations for SSRI overdose

A

ECG, FBCs, U&Es, creatine kinase, clotting screen, paracetemol levels

47
Q

Treatment of SSRI overdose presenting 1 hour after presentation

A

Treat complications such as prolonged QTc with IV magnesium sulphate and status epilepticus with IV lorazepam

48
Q

Acute carbon monoxide poisoning features

A

Flushing of skin, nausea, vomiting, drowsiness, dizziness, headache, myalgia

49
Q

High levels of CO poisoning features

A

Loss of consciousness, MI, confusion, respiratory failure, death

50
Q

Chronic CO poisoning features

A

Dementia, dizziness, vertigo, chronic headaches, lethargy, chronic nausea, vision loss

51
Q

Investigations for suspected CO poisoning

A

Carbon monoxide breath test, ABG/VBG, carboxyhaemoglobin levels, pulse oximeter, chest XR

52
Q

Treatment of CO poisoning

A

Oxygenation - 15L non-rebreath mask, hyperbaric oxygen chamber (GOLD)

53
Q

Complications of CO poisoning

A

Cerebral oedema, respiratory failure

54
Q

Methods of active elimination for patients with poisoning

A

Urinary alkalisation, haemodialysis

55
Q

What does urinary alkalisation do

A

Enhances urinary excretion of weak acids (aspirin, amitriptyline) by giving sodium bicarb 1.5L 1.26% over 2 hours

56
Q

Indications for haemodialysis (SLIME)

A

Salicyclate
Lithium
Isopropanolol
Methanol
Ethylene glycol

57
Q

What to give if there is persistent hypotension

A

Glucagon

58
Q

Criteria for liver transplant in paracetemol overdose

A

pH <7.3, PT > 100, creatinine >300, grade 3 or 4 encephalopathy, lactate >3.5

59
Q

Treatment of paracetamol overdose

A

NAC

60
Q

Presentation of cocaine use

A

Agitated and signs of sympathomimetic toxidrome

61
Q

Types of substances used in toxic alcohol ingestion

A

Ethylene glycol (anti-freeze) or methanol (anti freeze windscreen wiper).

62
Q

Antidote to antifreeze intoxification

A

Fomepizole or haemodialysis

63
Q

VBG of toxic alcohol ingestion

A

High osmolar gap >10, high anion gap metabolic acidosis, normal blood alcohol level

64
Q

Antidote for cyanide

A

Hydroxycobalamin

65
Q

Symptoms of alcohol withdrawal

A

Insomnia, autonomic dysfunction, tremor, nausea and vomiting, agitation, anxiety, seizures, hallucinations

66
Q

Requirement for admission of alcohol withdrawal syndrome

A

Presenting with or at risk of delirium tremens, risk of seizure, frail, vulnerable or co morbidities

67
Q

Complications of alcohol use disorder

A

Delirium tremens, Wernicke-Korsakoffs syndrome, refeeding syndrome, hepatic encephalopathy

Emergency Medicine (17 decks)

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