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MD3 > The Child Involved in Accident or Injury > Flashcards

The Child Involved in Accident or Injury Flashcards

1
Q

What general considerations might you have for a patient suspected of poisoning/overdose?

A
  • 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
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2
Q

How might you establish the severity of a poisoning?

A
  • Established and expected effects
  • Quantity of poison
  • Preparation of poison
  • Interval since exposure
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3
Q

When might you consider use of activated charcoal in a poisoning? When is it contraindicated?

A
  • “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
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4
Q

When might you consider gastric lavage in a poisoning? When is it contraindicated?

A
  • Only efficacious if performed under 60 min from ingestion
  • Psychologically traumatic, risk of aspiration with decreased conscious state
  • Contraindicated for corrosives, hydrocarbons or petrochemicals
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5
Q

In a poisoning, when is a whole bowel irrigation useful? What is used for it?

A
  • Polyethylene glycol with electrolytes
  • Useful in delayed presentations and when the above are ineffective/contraindicated
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6
Q

What is the antidote for amphetamine poisoning?

A

Esmolol for tachyarrhythmias, labetalol for hypertension

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7
Q

What is the antidote for benzodiazepine poisoning?

A

Flumazenil

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8
Q

What is the antidote for beta-blocker poisoning?

A

Isoprenaline

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9
Q

What is the antidote for calcium-channel blocker poisoning?

A

Calcium chloride

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10
Q

What is the antidote for carbon monoxide poisoning?

A

100% O2

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11
Q

What is the antidote for cyanide poisoning?

A
  • Hydroxycobalamin (chelator) OR sodium nitrate AND
  • Sodium thiosulfate (detoxifier)
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12
Q

What is the antidote for digoxin poisoning?

A

Digoxin FAb

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13
Q

What is the antidote for ergotamine poisoning?

A
  • Sodium nitroprusside (against vasoconstriction)
  • Heparin (against coagulopathy)
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14
Q

What is the antidote for acute lead poisoning?

A

Dimercaprol then EDTA (only latter if mild)

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15
Q

What is the antidote for heparin poisoning?

A

Protamine sulfate

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16
Q

What is the antidote for acute iron poisoning?

A

Desferrioxamine (care with anaphylaxis)

17
Q

What is the antidote for acute methanol/ethylene glycol poisoning?

A

Ethanol in 5% glucose

18
Q

What is the antidote for opiate poisoning?

A

Naloxone

19
Q

What is the antidote for organophosphate poisoning?

A

Atropine or pralidoxine

20
Q

What is the antidote for paracetamol poisoning?

A

N-acetyl-cysteine

21
Q

What is the antidote for acute tricyclic poisoning?

A

Na2CO3

22
Q

What is the management of someone with paracetamol toxicity?

A
  • 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)
23
Q

What are the components of management of a person with tricyclic overdose?

A
  • Monitor ECG for QT prolongation, arrhythmias
  • Alkalinisation of blood (sodium bicarbonate)
  • Anticonvulsant therapy (diazepam)
  • Antidysrhythmia therapy (phenytoin)
  • Vasopressor (noradrenaline)
24
Q

What are the major biochemical effects of salicylate overdose?

A

Respiratory alkalosis then metabolic acidosis. Hyperkalaemia

25
Q

What important structures are at risk in a supracondylar fracture?

A
  • Median, radial, ulnar nerves
  • Brachial artery
26
Q

What kind of supracondylar fracture can be managed in ED, and how? Which require orthopaedic consult?

A
  • 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
27
Q

What is a Monteggia fracture?

A

Dislocation of the radial head proximally and ulnar fracture

28
Q

What is a Galeazzi fracture?

A

Fracture of the distal third of the radius with a disruption of the distal radioulnar joint

MD3 (133 decks)

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