The Child Involved in Accident or Injury Flashcards
What general considerations might you have for a patient suspected of poisoning/overdose?
- Resuscitate patient (ABCDE)
- Call Poisons hotline 131126
- Remove poison if indicated (GI decontamination)
- Only if likely to succeed and benefit to patient more than potential damage
- If conscious state depressed, likely to cause aspiration
- Administer an antidote if one exists
How might you establish the severity of a poisoning?
- Established and expected effects
- Quantity of poison
- Preparation of poison
- Interval since exposure
When might you consider use of activated charcoal in a poisoning? When is it contraindicated?
- “Universal antidote” - adsorbs most poisons
- Does not work for heavy metals, corrosives or pesticides
- Contraindicated if decreased conscious state or ileus
- Aspiration can cause fatal bronchiolitis obliterans
When might you consider gastric lavage in a poisoning? When is it contraindicated?
- Only efficacious if performed under 60 min from ingestion
- Psychologically traumatic, risk of aspiration with decreased conscious state
- Contraindicated for corrosives, hydrocarbons or petrochemicals
In a poisoning, when is a whole bowel irrigation useful? What is used for it?
- Polyethylene glycol with electrolytes
- Useful in delayed presentations and when the above are ineffective/contraindicated
What is the antidote for amphetamine poisoning?
Esmolol for tachyarrhythmias, labetalol for hypertension
What is the antidote for benzodiazepine poisoning?
Flumazenil
What is the antidote for beta-blocker poisoning?
Isoprenaline
What is the antidote for calcium-channel blocker poisoning?
Calcium chloride
What is the antidote for carbon monoxide poisoning?
100% O2
What is the antidote for cyanide poisoning?
- Hydroxycobalamin (chelator) OR sodium nitrate AND
- Sodium thiosulfate (detoxifier)
What is the antidote for digoxin poisoning?
Digoxin FAb
What is the antidote for ergotamine poisoning?
- Sodium nitroprusside (against vasoconstriction)
- Heparin (against coagulopathy)
What is the antidote for acute lead poisoning?
Dimercaprol then EDTA (only latter if mild)
What is the antidote for heparin poisoning?
Protamine sulfate
What is the antidote for acute iron poisoning?
Desferrioxamine (care with anaphylaxis)
What is the antidote for acute methanol/ethylene glycol poisoning?
Ethanol in 5% glucose
What is the antidote for opiate poisoning?
Naloxone
What is the antidote for organophosphate poisoning?
Atropine or pralidoxine
What is the antidote for paracetamol poisoning?
N-acetyl-cysteine
What is the antidote for acute tricyclic poisoning?
Na2CO3
What is the management of someone with paracetamol toxicity?
- Activated charcoal - if presenting within 4 hours of ingestion and conscious
- Gastric lavage - if < 1 hour after ingestion
- nAC - according to nomogram or if dose ingested > 150 mg/kg (lethal dose)
What are the components of management of a person with tricyclic overdose?
- Monitor ECG for QT prolongation, arrhythmias
- Alkalinisation of blood (sodium bicarbonate)
- Anticonvulsant therapy (diazepam)
- Antidysrhythmia therapy (phenytoin)
- Vasopressor (noradrenaline)
What are the major biochemical effects of salicylate overdose?
Respiratory alkalosis then metabolic acidosis. Hyperkalaemia
What important structures are at risk in a supracondylar fracture?
- Median, radial, ulnar nerves
- Brachial artery
What kind of supracondylar fracture can be managed in ED, and how? Which require orthopaedic consult?
- Type I - aligned fractures
- Above elbow backslab in 90deg flexion
- Sling 3 weeks with GP-follow up at this time
- Type II - angulated and type III - displaced require orthopaedic consultation
What is a Monteggia fracture?
Dislocation of the radial head proximally and ulnar fracture
What is a Galeazzi fracture?
Fracture of the distal third of the radius with a disruption of the distal radioulnar joint
