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Finals > Emergency Med > Flashcards

Emergency Med Flashcards

1
Q

keypoints in toxicology hx of ingestions, what does the acronym MATTERS stand for

A

Medication
Amount
Time taken
Toxicology of drug
Emesis/pill fragments
Reasons for taking
Signs and symptoms

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2
Q

when prescribing finasteride what also needs to go on the chart

A

women should not handle crushed or broken tablets

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3
Q

how do you determine treatment for paracetamol overdose

A

nomogram using the time they took the paracetamol

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4
Q

what is the treatment for paracetamol OD and should be commenced asap in px:
- plasma paracet conc falls on/above tx line
- present within 8hrs of ingestion if 150mg/kg +
- present 8-24 hrs after taking acute OD of >150mg/kg

A

acetylcysteine

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5
Q

how does acetylcysteine work

A

maintains cellular glutathione at a level which inactivates NAPQI which is a toxic metabolite, to reduce hepatic toxicity

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6
Q

what should be a consideration when prescribing acetylcysteine?

A

need to prescribe all stages of the regimen

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7
Q

what is a SE reaction that may occur with IV acetylcysteine therapy

A

anaphylactoid reaction

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8
Q

when does anaphylactoid reaction occur in terms of acetylcysteine therapy

A

soon/after 1st bag

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9
Q

what are symtpoms of anaphylactoid reaction

A

nausea, vom
flushing
urticarial rash
bronchospasm

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10
Q

how to treat anaphylactoid reaction

A

stop infusion
H1 antihistamine eg IV chloramphenamine STAT
nebulised salbutamol if needed

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11
Q

what to do if px is prone to anaphylactoid reacs

A

give prophylactic H1 and H2 antihistamines
pre treat w salbutamol nebulised
give first bag more slowly eg over 2 hrs

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12
Q

what do consider when prescribing PRN medications

A

indication, max amount in 25 hours, dosing interval

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13
Q

when taking a drug hx, what reference sources must you use at least 2 of?

A

px and pod
gp (referral, repeat Rx)
comm pharmacist
elec prescribing records/ med notes
SCR

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14
Q

what aspects of drug hx are often skipped but must be asked about

A

eye/ear drops
inhalers
injections
creams
contraceptives
herbal meds

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15
Q

3 symptoms of hypoglycaemia

A

sweating
fatigue
pale

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16
Q

how do you treat hypoglycaemia when the patient is unconscious

A

glucose 20% 75-100mL in large vein

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17
Q

what to give for hypoglycaemia when you have no IV access

A

SC glucagon and give larger long acting carb snack

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18
Q

when might glucagon be less effective in which px

A

alcohol use, sulfonylureas, chronic malnourishment

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19
Q

when administering insulin why should you not use a syringe with mL

A

leads to dosing errors, syringe should be measured in units

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20
Q

during illness, what should happen to the frequency of insulin admin?

A

increased

21
Q

t/f never omit regular insulin in T1DM px

A

true

22
Q

treat all hypoglycaemia (gluc <Xmmol/l) promptly

A

4

23
Q

should you allow self management w insulin where appropriate and why

A

yes reduces errors

24
Q

what is a consideration when prescribing insulin?

A

the type of device, ie pen

25
Q

next steps afetr px safety incident occurs

A

document incident in px notes
inform px and family/ care and apologise
report incident via local reporting system
REFLECT and LEARN from error

26
Q

what would indicate that someone has been poisoned with insulin?

A

lower than expected C-peptide

27
Q

// emergency med 2

possible diagnosis for px PC: malaise, sob, r chest pain on inspiration
recent long haul flight

A

cap
pneumonia from atypical pathogens
PE
cancer
covid19

28
Q

what wells score would indicate further investigation into a PE diagnosis

A

4

29
Q

if pe suspected what might be the next steps

A

CXR
bloods: biochem, haematology, ABGa
12 lead ECG
imaging - US duplex, CTPA

30
Q

what is a consideration when prescribing enoxaparin

A

round to the nearest realistic dose

31
Q

enoxaparin 1.5mg/kg every 24hrs is given for low risk but 1.5mg/kg for 24 hrs (and given BD) for high risk px such as…

A

treatment of PE w RISK FACTORS: obesity, symptomatic pr, cancer, or recurrent vte

32
Q

for which px is enoxaparin given BD

A

high risk px. have risk factors

33
Q

name 3 direct Xa inhibitors

A

rivaroxaban
apixaban
edoxaban

34
Q

name a thrombin inhibitor

A

dabigatran

35
Q

benefit of having no monitoring requirement for DOACs

A

may improve adherence

36
Q

does rivaroxaban have to be taken with food?

A

yes, potential lack of efficacy (thromboembolic events) when taken on mpty stomach

37
Q

for treatment of PE and switching from LMWH to DOAC, when should you adminsiter the DOAC dose

A

when next LMWH would have been due

38
Q

what about tx w lmwh and warfarin

A

5 days lmwh + warfarin until inr in therap range for 2 consec days

39
Q

x days tx with lmwh needed PRIOR to starting dabigatran and edoxaban (DOACs)

A

5

40
Q

for treatment of PE which DOACs need prior treatment with LMWH?

A

dabigatran
edoxaban

41
Q

what might indicate hypercalcaemia of malignancy? 3

A

known malignancy, high calcium, high urea

42
Q

what is the first step in treating hypercalcaemia of malignancy

A

rehydration
NaCl 0.9% 4-6L / 24hrs

43
Q

where can you find dosing for pamidronate in hypercalcaemia of malignancy according to the serum calcium level

A

SPC

44
Q

when should you recheck calcium levels after initial treatment for hypercalcaemia of malignancy

A

after 72h post infusion

45
Q

main AEs of bisphosphonate tx

A

GI: nausea, diarrhoea
hypocalcaemia
ONJ
atypical fmeoral fractures

46
Q

when may ONJ be greater risk

A

if px on IV bisphos in cancer tx

47
Q

do patients need a dental check up before starting bisphosphonates?

A

yes if possible

48
Q

atypical femoral fractures- risk of bisphos, what should px report

A

thigh hip groin pain during tx

Finals (29 decks)

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