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ED + Tox + Pall care + Haem > Conditions > Flashcards

Conditions Flashcards

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1
Q

Management of shockable rhythm

A

VF and pulseless VT
DC cardioversion
Adrenaline 1mg after 2nd shock and then every 2nd loop
Amiodarone after 3 shocks

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2
Q

Mx non-shockable rhythm

A

PEA/asystole
Adrenaline 1mg immediately then every 2nd loop

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3
Q

High risk features of community-acquired needlestick injury

A

Source known to be infected with blood borne virus
Deliberate assault
Deep large volume injection
Personal hx of IVDU
Needle directly into artery / vein
Device visibly contaminated with blood

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4
Q

Mx of community-acquired needlestick injury

A

Wash with soap / water
Dispose needle
If high risk -> refer to paed ID
If not high risk -> HbsAb, if <10mIU/mL then needs booster vaccine
-> Source; Hep B/C/HIV
Tetanus
HIV PoEP if high risk

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5
Q

Signs of vasovagal

A

Shallow breathing
Bradycardia
Weak peripheral pulse
Loss of consciousness
Generalised pallor
Cool clammy skin
Nausea/vomiting

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6
Q

Anaphylaxis mx

A

Remove allergen
Call for help
Lay flat with legs raised
Monitoring of vitals
Adrenaline 0.5ml 1:1000 mid-lateral thigh and repeat every 5min
- Paed; 10mcg/kg 1:1000 adrenaline IM and repeat after 5min if not improving
Non-sedating antihistamine - cetirizine
Salbutamol MDI/nebule if wheezing + resp distress
Observation
- 4hrs
- 12hrs; biphasic, hx of biphasic, poor asthma control, remote location, anaphylaxis to monoclonal Ab
D/c
- 2x epipen
- Medialert bracelet
- parent/patient information sheet for ASCIA
- Ensure asthma controlled
- referral to immunologist

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7
Q

Causes of syncope in children

A

Vasovagal
Breath holding spells
Orthostatic hypotension
Hypoglycaemia
Arrhythmia
Mimic; seizure, migraine, hysteria, hyperventilation

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8
Q

Clinical features of snake envenomation

A

Nausea, vomiting, diarrhoea, headache, abdominal pain
Coagulopathy (venon-induced and anticoagulant coagulopathy)
Neurotoxicity
Myotoxicity
Thrombotic microangiopathy
AKI
Cardiovascular; hypotension, cardiac arrest

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9
Q

Indications for early snake antivenom

A

Within 2hrs of bite
- Non-specific sx likely headache, vomiting
- Systemically unwell
- CVS collapse
- Ptosis/blurred vision

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10
Q

Funnel-web spider envenomation sx

A

Cholinergic/adrenergic; diaphoresis, salivation, lacrimation, piloerection, HTN, miosis/mydriasis, brady/tachycardia
Neuromuscular; paraesthesia, fasciculation
CVS: MI, HTN,
Resp; pulmonary oedema
CNS; agitation, anxiety, coma
Non-specific; vomiting, abdo pain, headache

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11
Q

Mx funnel-web spider bite

A

Bandage over limb
Immobilise
Urgent transport to ED
Tetanus
Anti-venom; suspect funnel-web spider + signs of sever envenomation
- Funnel-web spider antivenom 2x vials diluted 1:10 0.9% NS
Monitor for 24hrs until sx resolve
If nil signs of envenomation - monitor for 2hrs - if asymp or mild - then observe for 4hrs after bite and 2hrs post bandage removal then discharge

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12
Q

Box jelly fish mx

A

Emergency - sudden cardiopulmonary failure
Wash off tentacles with seawater
Vinegar
Cold pack
Monitor RR/ pulse
IV access
O2 therapy
Antivenom IV 1 vial diluted 1:10 0.9% NS
Lignocaine / fentanyl for analgesia

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13
Q

Sources of lead poisoning

A

Contaminated soil
Lead paint
Lead contaminated recreational drugs
Gun bullets
Occupation; mining, batteries, ammunition, car radiators
Home renovations

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14
Q

Acute lead poisoning sx

A

CNS; fatigue, weakness, headache, encephalopathy, cerebral oedema, coma
GIT; abdo pain, vomiting, constipation
Other; haemolytic anaemia, hepatitis

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15
Q

Chronic lead poisoning

A

CNS; poor concentration, headache, aggression, intellectual impairment in children
GIT; abdo pain, constipation, weight loss
Renal; nephropathy, AKI
CVS; HTN
Other; chronic anaemia, arthralgia, reduced fertility

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16
Q

Ix of suspected lead poisoning

A

Blood lead concentration
FBC; normochromic normocytic anaemia
LFT
U+ E
Iron
Zinc + Copper

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17
Q

Causes of lithium toxicity

A

Interaction; ACEI, thiazide, NSAID
Dehydration
Nephrogenic diabetes insipidus
Acute illness
Thyroid dysfunction

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18
Q

Acute lithium toxicity sx

A

Vomiting/diarrhoea
Tremor/seizures/hyperreflexia/myoclonus
Hypotension, bradycardia

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19
Q

Chronic lithium toxicity sx

A

Tremor, hyperreflexia, rigidity, myoclonus
QT prolongation, bradycardia
Nausea, vomiting

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20
Q

Serotonin syndrome signs

A

SHIVERS
Shivering
Hyperreflexia
Increased temp
Vital instability
Encephalopathy
Restlessness
Sweating

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21
Q

Serotonin syndrome mx

A

Mild; supportive, cease drugs
Moderate
- Diazepam 5-20mg and repeat 30min later - max 120mg per day
- If no improvement -> cyproheptadine 12mg PO stat as antidote

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22
Q

Toxic paracetamol dose

A

10g or 200mg/kg in pt under 50kg over 24hrs

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23
Q

How to mx drug seeking patient

A

Check Qscript
Contact prev GP
Contact pharmacy to confirm frequency of dispensing
Follow practice policy
Explain limitation on Schedule 8 prescribing in non-judgemental manner
Offer opioid contract
Plan tapering or ceasing oxycodone

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24
Q

Opioid toxicity mx

A

Monitor vitals
O2 if <90%
Naloxone 0.2mg IV/IM every 2-3min OR 1.8mg nasal spray each nostril

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25
Drug-seeking behaviours
Asking specific drugs Injecting oral formulation Doctor shopping Resistant behaviour; refusing other drugs Manipulation; claiming they can't afford other treatment
26
Mx of amphetamine toxicity
IV sedation with benzo Fluid resuscitation Hyperthermia tx
27
Signs of nicotine dependence
<30min of waking Withdrawal sx >10 cig per day
28
Harms of smoking
Child; SIDs, asthma Adult; everything!! Pregnancy - low birthweight - preterm - Perinatal death - Placental abruption
29
Smoking mx general steps
Quit date Strategies for smoking triggers Motivational interviewing Social support
30
NRT mx
<30min awakening - <=10/day; 21mg/24hr patch PLUS 2mg gum - >10 cig/day; 21mg/24hr patch PLUS 4mg gum >30min awakening - <=10/day; 2mg gum - >10/day; 21mg/24hr patch PLUS 2mg gum Aim to stop tx by 12 weeks by reducing strength of patches
31
Bupropion for smoking
Bupropion 150mg 3/7 -> 150mg BD 9/52 Contra; seizure, eating disorder, MOAI Quit date after 2/52
32
Varenicline for smoking
Varenicline 0.5mg 3/7 -> 0.5mg BD 4/7 -> 1mg BD for remainder of 12/52 course - can repeat 12/52 if relapse Function; reduce craving/withdraw, reduce rewarding effect ADR; nausea Monitor if have pre-existing mental illness Avoid pregnant/breastfeeding/adolescents
33
Nortriptyline for smoking
Nortriptyline 25mg up to 75mg daily ADR; arrhythmia, dry mouth, nausea
34
Haematological complications of alcohol use
Macrocytic anaemia thrombocytopaenia AST:ALT >2 elevated GGT Folate/B12 deficiency Elevated INR
35
ETOH intoxication signs
Nystagmus Incoordination Ataxia Memory impairment Disinhibited behaviour Hypotension/tachycardia Resp depression
36
ETOH withdrawal sx
Minor (12hrs post last drink) - Anxiety - Tremor - Insomnia - Vomiting Major - Visual/auditory hallucinations - HTN - Diaphoresis - Seizures 48hrs
37
Indication for inpatient detoxification ETOH
Prev withdrawal seizures / delirium tremens Risk of suicide Inadequate social support/supervision Prev drug misuse Severe liver disease Advanced age
38
Disulfiram for ETOH
Disulfiram 100mg 2/52 Can't have any ETOH Must have supervising person Blocks alcohol metab -> flushing, sweating, tachycardia, impending sense of doom cardioresp failure as rare risk
39
Acamprosate
Acamprosate 666mg TDS Reduce withdrawal sx
40
Naltrexone for ETOH
Naltrexone 50mg PO daily Blocks euphoria - but doesn't avoid impairment
41
Signs of CO poisoning
Headache Dizziness Drowsiness Nausea/vomiting Palpitations Mood swings SOB chest pain Ix; carboxyhaemoglobin VBG, breath test to measure CO
42
Mx bone pain in pall care
1st line; opioids Bisphosphonates good for breast Ca + myeloma
43
Opioids in pall care
1st line - Morphine IR 2-5mg q1hrly max 6 doses / 24hrs - Consider Morphine MR 5mg daily Oxycodone; good if delirium/cognitive impairment Transdermal; buprenorphine patch or fentanyl patch
44
FIVE core medications of pall care
- Morphine 2.5-5mg subcut q1hrly - Metoclopramide 10mg subcut q4hrly - Haloperidol 0.5mg subcut q4hrly PRN for agitation/delirium - Clonazepam 1mg injection agitation - Hyoscine butylbromide 20mg subcut q4hrly PRN
45
Indications for syringe driver
Persistent n/v Dysphagia Bowel obstruction Coma Poor absorption of oral drugs Patient preference
46
Mx bowel obstruction pall care
Freq mouthcare to relieve dehydration or dry mouth Dexamethasone 6mg to help reverse obstruction NBM and slow escalation after 24hrs to modified diet (free fluids is good) NGT on free drainage Subcut analgesia
47
PEPSI COLA pall care
Physical; sx management Emotional; mood, coping, sleep Personal needs; culture, religion Social support; carers, welfare Information; MDT, records Control/Autonomy; capacity to decide, AHCD Out of hours; plan for care Living with your illness; rehab support, referral to other agencies, end of life planning After care; bereavement, funeral arrangement, family support
48
Mx of anxiety in pall care
Emotional support Adequate explanation of current and future tx Address fears and concerns Relaxation techniques 1st line; SSRI Short term; oxazepam 7.5mg PRN
49
PO iron supplementation
Dose - 100-210mg elemental iron - 3mg/kg/day child Empty stomach Co-admin with vitamin C Duration; 3-6/12 ADR; nausea, bloating, constipation, diarrhoea Absorption reduced by Ca, PPI, H2 antagonists
50
Causes of B12 deficiency
Pernicious anaemia Gastritis Gastrectomy/bariatric surgery Coeliac disease Vegan/vegetarian diet PPI/H2 antag
51
B12 deficiency blood results
Macrocytosis Pancytopaenia Hypersegmented neutrophils
52
B12 deficiency mx
Hydroxocobalamin 1mg IM alternate days 2/52 then every 3/12 Monitor level 3/12 after therapy
53
CLL 4 classic signs
Fatigue Weight loss Fever/night sweats Lymphadenopathy
54
Causes of lymphadenopathy
Cat scratch toxoplasmosis Lyme disease HIV TB Lymphoma Malignancy Leukaemia EBV
55
Multiple myeloma CRAB diagnosis
Calcium; hypercalcaemia; abdo pain, constipation, polyuria Renal failure; uraemia, overload Anaemia/cytopenia; leukopenia/neutropenia, thrombocytopenia Bone pain/fractures
56
Multiple myeloma Ix
Serum protein electrophoresis Serum free light chains Urine Bence Jones protein over 24hr Bone marrow aspirate Imaging - 1st line; whole body XR or CT
57
Multiple myeloma tx
1st line - Bortezomib IV with cyclophosphamide and dexamethasone Autologous stem cell transplant Radiation; good for plasmcytoma May need aspirin 100mg as VTE prevention when on immunomodulators
58
Causes of polycythaemia
Dehydration Polycythaemia vera COPD High altitude
59
Red flag sx of polycythaemia that need urgent inpatient mx
Hypoxia Transient visual disturbance MI Peripheral artery occlusion VTE
60
Polycythaemia initial ix
Pulse oximetry LFT UEC, BUN, glucose EPO level Urinalysis
61
Mx polycythaemia
aspirin 100mg Phlebotomy Cytoreductive therapy if >=60yo or hx thrombosis - Hydroxyurea PO
62
CML 3x classic signs
Fatigue Fever/night sweats Abdo fullness (splenomegaly)
63
Neutropaenia causes
Constitutional Drug Infection Nutritional deficiency Rheumatological disorders Myelodysplasia
64
Work up of neutropaenia
Blood smear B12/folate LFT Hepatitis/HIV serology EBV/CMV ESR/CRP
65
Haemochromatosis complications
Cirrhosis/HCC Arrhythmia DM Bronze skin Restrictive cardiomyopathy Hypogonadism Impotence Joint arthralgia
66
HFE genotype interpretation
C282Y homozygote; highest risk Compound C282Y/H63D heterozygote; only 1% develop HC- monitor iron 2-5 yearly 282Y carrier, H63D homozygous, H63D carrier - 1/8 population has this - keep looking
67
Mx haemochromatosis
Therapeutic venesection 500ml every 2/52 until ferritin 50-100
68
Causes of bleeding disorder
vW disease Haemophilia Platelet function defect Liver/renal disease NSAID Bone marrow failure
69
Mx vW disease
TXA 25mg/kg max 1g QID daily for minor procedures
70
Causes of thrombocytopenia
ETOH B12/Folate deficiency Pregnancy Doxycycline SLE ITP Chronic liver disease HIV/hep B + C
71
ITP sx
Bruising + oral bleeding + epistaxis Petechial rash Preceding viral infection or live vaccine
72
ITP mx
Observe if plt >30 Prednisolone 0.5mg/kg/day IV immunoglobulin Refractory; splenectomy, rituximab
73
ITP patient education
Written information Avoid contact sports Avoid NSAID Safety net red flags; bleeding, signs of ICH
74
Mx subtherapeutic INR
INR 1.5-1.9 - Increase weekly dose by 10%
75
INR 4.5-10 without bleed
Low bleed risk; cease warfarin, INR in 24hr and resume once therapeutic High risk; cease warfarin, Vitamin K 1mg PO and repeat INR in 24hr
76
INR >10 without bleed
Low bleed risk; cease warfarin, Vitamin K 3mg PO, check INR in 24hr High bleed risk; cease warfarin, VK 3mg PO, Prothombinex-VF 15IU/kg and check INR in 12hr
77
INR >=1.5 with life-threatening bleed
Cease warfarin VK 5mg IV PTX-VF 50IU/kg FFP 150ml Repeat INR in 20min
78
INR >=2.0 with clinically significant bleed
Cease warfarin VK 5mg IV PTX-VF 35IU/kg OR FFP 15ml/kg Repeat INR 20min
79
INR >4.5 with minor bleeding or any INR with minor bleeding
Low bleed risk; cease warfarin and repeat INR 24hr High risk; cease, VK 1mg PO and repeat INR in 24hr

ED + Tox + Pall care + Haem (1 decks)

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