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finals > emergency > Flashcards

emergency Flashcards

1
Q

antidote for benzo OD

A

supportive
flumazenil (has high seizure risk)

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2
Q

features benzo OD

A

low GCS
resp depression
hypothermia

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3
Q

antidote for opioid OD

A

naloxone

repeated doses may be needed

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4
Q

tricyclic antidepressant OD

A

IV bicarbonate - reduces risk of seizure + arrhythmias

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5
Q

lithium OD

A

volume resus
haemodialysis
sodium bicarbonate

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6
Q

warfarin OD antidote

A

VK

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7
Q

heparin OD antidote

A

protamine sulphate

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8
Q

beta blocker OD

A

bradycardic - give atropine
in resistant cases can use glucagon

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9
Q

Ethylene glycol OD (in antifreeze)

A

fomepizole
ethanol

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10
Q

methanol poisoning

A

fomepizole
ethanol
haemodialysis

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11
Q

Organophosphate insecticides OD

A

atropine

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12
Q

digoxin OD

A

Digoxin-specific antibody fragments

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13
Q

iron OD

A

Desferrioxamine, a chelating agent

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14
Q

lead OD

A

Dimercaprol, calcium edetate

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15
Q

CO poisoning

A

100% oxygen
hyperbaric oxygen

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16
Q

cyanine poisoning

A

Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate

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17
Q

Organophosphate insecticide poisoning

A

D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.

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18
Q

presentation of salicylate poisoning (aspirin OD)

A

hyperventilation (centrally stimulates respiration)
tinnitus
lethargy
sweating, pyrexia*
nausea/vomiting
hyperglycaemia and hypoglycaemia
seizures
coma

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19
Q

what does salicylate poisoning cause

A

a mixed respiratory alkalosis and metabolic acidosis.

Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis (w raised anion gap)

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20
Q

tx salicylate poisoning

A

general (ABC, charcoal)
urinary alkalinization with IV sodium bicarbonate - enhances elimination of aspirin in the urine
haemodialysis

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21
Q

what is neutropenic sepsis

A

a neutrophil count of < 0.5 * 10^9 in a px who is having anticancer treatment and has one of the following:
- temp > 38ºC or
- other signs or symptoms consistent with clinically significant sepsis

commonly occurs 7-14 days after chemo

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22
Q

RFs assoc w neutropenic sepsis

A

poor nutrition
mucosal barrier defect
central venous lines
abnormal host colonisation

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23
Q

most common bacteria causing neutropenic sepsis

A

Staphylococcus epidermidis

24
Q

neutropenic sepsis prophylaxis

A

if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 109 as a consequence of their treatment they should be offered a FLUOROQUINOLONE (e.g. ciprofloxacin)

25
Q

mx neutropenic sepsis

A

start IV abx asap
- piperacillin with tazobactam (TAZOCIN)
do not wait for blood test results

switch to oral if improving after 24-48 hrs IV tx
if no imp after 48 hrs add 2nd line abx e.g. meropenem+/- vancomycin
if no imp after 5 days look for opportunistic infections e.g. fungal

26
Q

which cancer px are most likely to get malignant spinal cord compression

A

lung
breast
prostate
myeloma

27
Q

features of malignant spinal cord compression

A

BACK PAIN
- the earliest and most common symptom
- may be worse on lying down and coughing
- worsening
do not weight for neuro deficit if px has this

lower limb weakness

sensory loss + numbness

neurological signs depend on the level of the lesion.
- above L1 -> UMN signs in the legs and a sensory level
- below L1 -> LMN signs in the legs and perianal numbness.
- tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

28
Q

ix malignant spinal cord compression

A

whole MRI spine within 24 hours of presentation

29
Q

tx malignant spinal cord compression

A

high-dose oral dexamethasone
(w PPI + monitor BMs as they can increase)
urgent oncological assessment for consideration of radiotherapy or surgery (once established this sld be done in 24hrs)

VTE proph + pressure sore prevention

30
Q

mx of malignant hypercalcaemia

A

correct dehydration
- 0.9% saline
IV bisphosphonates - zolendronic acid / pamidronate
- inhibit osteoclasts so reduce bone turnover

if persistent / relapsed
- denosumab (inhibs RANK ligand)

31
Q

presentation of SVCO

A

dyspnoea
chest pain - often at rest
cough
neck + face swelling
arm swelling
dizzy, headache, visual dist, nasal stuffy, syncope

dilated veins over arms, neck + anterior chest wall
oedema of upper torso, arms, neck + face
cyanosis
engorged conjunctiva
convulsions + coma

32
Q

SVCO

A

superior vena cava obstruction (by tumour)
usually provides the venous drainage for the head, neck, upper limbs + upper thorax
when obstructed, collateral pathways form to provide an alt route for blood to return to the RA

33
Q

mx SVCO

A

elevations of the head + O2 therapy for sx relief
high dose steroids
endovascular stenting
anticoag if central vein thrombosis

tx of tumour that caused it

34
Q

What is an acute transfusion reaction?

A

occurs during, or up to 24 hours following, blood transfusion

35
Q

Febrile, Allergic and Hypotensive Reactions (FAHR) presentation

A

increase in temperature by 1-2°C above baseline, or absolute temperature ≥ 38°C in isolation (mild)
An increase in temperature >39°C or a rise ≥ 2°C from baseline (moderate)
may also have chills/rigors

isolated rash (mild)
angioedema, dyspnoea, hypoxia, urticaria (moderate)
allergic features + airway comp/haem unstability (severe)

hypotension

36
Q

Acute haemolytic transfusion reaction AHTR) presentation + how is dx confirmed

A

rise in temp
pain at infusion site
anxiety
if severe: hypotension, decreased UO, spontan bleeding due to DIC

dx confirmed by lab testing - evidence of haemolysis w falling Hb in the presence of a red cell antibody

37
Q

Transfusion assoc circulatory overload (TACO) presentation

A

resp comp (exc allergy/anaphylaxis)

pulmonary oedema

unexpected changes in cardiovasc status - HTN, tachy, increased JVP, enlarged heart CXR, peripheral oedema

objective signs of left atrial hypertension - new/worsening cardiac failure on echo, NT-proBNP 1.5x risk on pre and pst trans sample (normal excludes TACO)

fluids - imp in resp status after diuretic tx , was the fluid balance signif +ve

38
Q

what is the most common cause of morbidity in patients undergoing transfusion

A

Transfusion assoc circulatory overload (TACO)

39
Q

what is transfusion related acute lung injury (TRALI)

A

a clinical syndrome in which there is acute, noncardiogenic pulmonary edema associated with hypoxia that occurs during or after a transfusion

usually due to HLA antibodies in the donor

40
Q

when to suspect transfusion related acute lung injury (TRALI)

A

px devs acute dyspnoea w hypoxia + bilateral pulmonary infiltrates during, or within six hours of, transfusion

41
Q

what is transfusion assoc dyspnoea (TAD)§

A

characterised by respiratory distress, not due to the patient’s underlying condition, within 24 hours of transfusion and does not meet the criteria of TRALI, TACO or allergic reaction

42
Q

Presentation of transfusion transmitted infection (TTI)

A

rare and bacterial contamination is usually the only TTI to present as an acute reaction

sx v shortly after trans:
Rise in temperature, rigors;
Hypotension;
Tachycardia.

43
Q

presentation of delayed haemolytic transfusion reaction (DHTR) + dx

A

A fever;
and/or a failure to increment to the transfusion as expected (i.e. minimal rise or subsequent rapid fall) in Hb;
and/or otherwise unexplained increase in bilirubin.

dx lab testing (evidence of haemolysis in the presence of a red cell antibody)

44
Q

what is post transfusion purpura + when to suspect

A

severe but rare immune mediated complication which can occur 5-12 days after transfusion of red cells or platelets

Any unexplained platelet drop > 50% following transfusion should be discussed with a haematologist

45
Q

what is transfusion assoc graft-versus host disease (TA-GvHD) + what increases its risk

A

In patients with impaired T cell function, lymphocytes from the transfused blood can engraft, mounting an immune response against the recipient’s cells.

> 95% mortality and multi-organ failure can occur from a few days up to a few months following transfusion

Risk:
Transfusing irradiated blood to patients with impaired T cell immunity (e.g. post stem cell transplant, but not patients with HIV), prevents proliferation of lymphocytes and thus TA-GvHD.

46
Q

immediate tx of life threatening acute transfusion reaction

A

PAUSE TRANSFUSION
CALL FOR URGENT MEDICAL ASSISTANCE VIA YOUR EMERGENCY NUMBER.
Initiate resuscitation – ABCDE.
Is haemorrhage likely to be causing hypotension?
If SO - CONTINUE transfusion.
If not- disconnect transfusion (keep indicated units).
Maintain venous access.
Frequent vital signs monitoring.

47
Q

2ndary tx of life threatening acute transfusion reaction

A

If likely anaphylaxis/severe allergy - follow anaphylaxis pathway.

If bacterial contamination likely, start antibiotic treatment.

Use BP, pulse, urine output (catheterise if necessary) to guide intravenous 0.9% saline administration.

Inform transfusion laboratory.

Return unit to transfusion laboratory.

If bacterial contamination suspected, contact transfusion laboratory to discuss recall of associated components.

Perform relevant investigations (as recommended on the transfusion reaction form).

Contact haematologist if required.

Document outcome/action taken in notes.
Complete adverse event report form.
Transfusion Practitioners refer to MHRA/SHOT, as appropriate.

48
Q

mx of mild transfusion reactions

A

Treat mild pyrexia with oral paracetamol;
Treat mild allergic reactions with antihistamines;
If the reaction is confirmed as mild, you may restart the transfusion at a slower rate following a full clinical review (including patient ID/component label check) with close observation.

may be start of more severe reaction, observe px closely

49
Q

mx of moderate transfusion reactions

A

Manage the patient symptomatically and according to severity of symptoms e.g. with paracetamol, antihistamines and if needed for respiratory symptoms, inhaled short-acting beta-2 agonists and/or oxygen.

The transfusion may be restarted if:
A full clinical review by medical staff (including patient ID/component label check) has been undertaken; and either:
The patient recovers with only symptomatic intervention or;
There is an obvious alternative explanation for the symptoms/signs.

If the transfusion is resumed, the patient must be closely observed.

50
Q

what to do in the event of an ABO incompatible transfusion

A

Give fluid resuscitation;
Send samples for FBC, PT/APTT/fibrinogen, renal function, G&S;
Monitor urine output closely;
Contact ITU for early review for inotropic, renal, and/or respiratory support;
Discuss urgently with haematology re further treatment e.g. steroids +/- intravenous immunoglobulin.

If checks show ABO incompatibility due to transfusion of a unit intended for another patient, contact your transfusion laboratory immediately to prevent a further incident.

51
Q

what is hyperhaemolysis

A

where there is destruction not just of transfused blood but the patient’s own as well

52
Q

comps of rapid blood transfusion

A

DIC
hypocalcaemia
hypothermia
TACO
VTE
hyperkalaemia

53
Q

features cocaine OD

A

agitation, confusion, delirium
hyperthermia
tachycardia
hypertension
arrythmias
ACS + strokes

54
Q

tx cocaine OD

A

benzo
supportive
CCVs (verapamil), labetalol

55
Q

what is cushing’s triad

A

increased BP
bradycardia
irregular breathing

physiological response that is seen in the context of raised ICP

56
Q

reversible causes of cardiac arrest

A

4 “Hs” and 4 “Ts”

hypoxia
hypokalaemia/hyperkalaemia
hypothermia/hyperthermia
hypovolaemia
tension pneumothorax
tamponade
thrombosis
toxins

57
Q

Local anesthetic toxicity reversal agent

A

IV 20% lipid emulsion

finals (27 decks)

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