Emergencies

Question 1

How do you determine if a patient requires treatment for paracetamol OD?

Answer 1

Nomograms

Question 2

If >4 hours post ingestion what weight should you use in an obese patient who has taken a paracetamol OD?

Answer 2

110kg

Question 3

What dose would make you consider antidotes in a patient who has taken a paracetamol OD?

Answer 3

> /= to 150mg/kg

Question 4

What is the mx of a paracetamol OD?

Answer 4

NAC IV (NB anaphylactic rxns)
Methionine PO second line
Activated charcoal up to 1 hour later

Question 5

What is the mx of aspirin OD within the hour?

Answer 5

Activated charcoal up to 1 hour

Question 6

What is the mx of aspirin OD after 1 hour?

Answer 6

Urinary alkalisation with NaHCO3- aim for urinary pH 7.5-8.5

Haemodialysis in severe cases

Remember possible clotting defects, hypoglycaemia

Question 7

What is the mx of TCA OD?

Answer 7

Activated charcoal- for delayed gastric emptying

No prophylactic anti-arrhythmics

Bicarb might reverse arrhythmias even if not acidotic

Fits- lorazepam, diazepam

Question 8

Mx acute asthma?

Answer 8

Contact ITU if life threatening

Immediate: nebulised salbutamol 5mg with ipratropium bromide 0.5mg via O2-driven neb, 4-6 hourly

Then: Discuss with senior if not improving
Neb salbutamol + ipratropium every 15 minutes
Add IV Mg- over 20 minutes
Consider IV salbutamol or aminophylline and ITU referral

Question 9

Mx DKA?

Answer 9

Fluid replacement- ~1L/hour, more if BP low

IV insulin- 0.1 units/kg/hour

K- give early if not raised and good renal function

Bicarb- if severe acidosis

Stabilise glucose around 14mmol/L, then give IV 10% glucose

Possible LMW heparin

Find trigger condition if any

Question 10

Mx HONKC?

Answer 10

Correct fluid and K deficit

Give insulin in small doses- may not always be required

Usually give anticoag

Question 11

Mx hypoglycaemia?

Answer 11

Oral glucose if possible

IV 20% glucose (50ml), [not 50%]

IM glucagon 1mg

All of above for acute event

Question 12

Mx status epilepticus?

Answer 12

Lorazepam (or diazepam) IV first line

Diazepam rectal or midazolam via buccal mucosa

Phenytoin if not successful

Early referral to ITU-IV GA such as thiopentone propofol midazolam

High mortality

Question 13

Mx SVT?

Answer 13

Vagal stimulation e.g. carotid sinus massage

IV adenosine if unsuccessful

IV verapamil if still no response (avoid if on B-blockers)

If patient not responding, haemodynamically unstable- synchronised DC cardioversion