EMCC Flashcards
the depletion of stores of which antioxidant amino acid results in organ ( liver and kidney) damage in paracetamol overdose?
glutathione
normally
paracetamol –>. (metabolised to NAPQI)–> liver produces glutathione –> inactivates NAPQI
OD:
too much paracetamol –> glutathione treleased –> inagctiveates some NAPQI –> glutathione stores depleted –> inactivation stops
paracetamol OD Sx are of broad range. considering these Sx, what are the differentials of paracegtamol OD>
Acute gastritis/gastroenteritis: N&V, abdominal pain.
Renal colic: loin pain, haematuria, N&V
Liver diseases (hepatitis or cirrhosis): jaundice, abdo pain, coma.
Metabolic acidosis: caused by conditions like kidney disease, lactic acidosis or diabetic ketoacidosis. ( metabolic acidosis is paracetampol DO Sx
what graph is used to plot paracreetamol levels
nomogram
give paracetamol management at
<1hr ago, dose >150mg/kg
<4hrs ago
4-8 hrs, dose >150mg/kg
8-24hrs >150mg/kg
>24hrs
staggered OD
<1hr ago,>150mg/kg
Activated charcoal
<4hrs ago
take para level @4hrs, tx as appropriate
4-8 hrs, >150mg/kg
start N-Acetylecysteine if there will be a >8hr delay in obtaining para level
8-24hrs >150mg/kg
N-Acetylcysteine immediately
> 24hrs
N-Acetylcysteine immediately if pt:
- jaundiced
- RUQ tenderness
-raised ALT
INR >1.3
Paracetamol concentration is detectable
staggered OD
N-Acetylcysteine immediately
also start immediately if pt at risk of toicity (e.g. alcoolic, malnutrition etc.)
give 5 signs of TCA OD
- Drowsiness
- Confusion
- Cardiac arrhythmias
- Seizures
- Vomiting
- Headache
- Flushing
- Dilated pupils
What ECG finding is suggestive of TCA OD
QT interval prolongation
TCA OD Mx
Administer IV Sodium Bicarbonate
Consider activated Charcoal within 2-4 hours of the overdose
Consider invasive ventilation, IV Fluids, ICU
what progression of cardiac changes is typical in TCA OD
classic progression: sinus tachycardia, to widened QRS and then ventricular arrhythmias.
Key aspirin overdose Sx
respiratory alkalosis ( stimulating the respiratory centres in the brain) followed by a metabolic acidosis
- Nausea and vomiting
- Tinnitus
- Fever
- Confusion
- Tachycardia
what 2 investigations are important in aspirin overdose?
(VBG): acid-base imbalance. (start off with respiratory alkalosis, progresses to metabolic acidosis
Salicylate levels: blood test for excess aspirin
4 steps in managing aspirin overdose
- Activated charcoal: ( if ingestion <1hr)
- IV fluids: sodium bicarbonate, potassium chloride.
(a. good kidney function b.alkalise the urine to increase salicylate excretion.)
- Dialysis: extremely high blood levels of aspirin.
- Monitor for complications: renal function, pulmonary and cerebral oedema.
what 2 OD should be managed with activated charcoal where OD <1hr?
paracetamol
aspirin
opioid drugs ( except tramadol) are to be avoided in people with which organ damage?
renal disease , renally cleared so risk of toxicity higher in ESKF
tramadol is primarily cleared through the live so is a safer alternative
5 S&S of opiate toxicity
- Sedation
- Confusion
- Respiratory depression
- Hypotension
- Constipation
opioiod overdose triad
miosis, resp depression, reduced conciousness
opiod OD Mx
AtoE
Nalaocone ( IV/IM/SubCut/Intranasal)
S/E of drhug used to manage acute opioid OD
Naloxone - acute withdrawal syndrome ( N&vV)
A pt states that she took 50 tables over 6 hours with the last tablet taken around 3 hours ago. What is the appropriate management?
staggered dose = Start N-acetylcysteine immediately
do not wait for monogram: may not give true indicagtion of toxicity because amount of paracetamol in GI tract is unknown
1st line status Mx (dose and route)
4mg IV Lorazepam
what are the Sx of cardiac tamponade
Becks triad ( raised JVP, HYPOTENSION, MUFFLED HEART SOUNDS)
Kussmauls sign ( raids JVP with inspiration)
pulsus paradoxus ( dropped systolic BP with inspiration)
dyspnoea
fatigue
what triad is found in cardiac tamponade
Becks triad
raised JVP, hypotension, muffled heart sounds
main cause of cardiac tamponade
traumatic injuries
others: pericarditis, malignancies, SLE, myocardial rupture after MI
what ECG finding is suggesting of pericardial effusion
alternating height of QRS complexes
primary tx of cardiac tamponade
pericardiocentesis (aspiration and draiage of pericardial fluid)
