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Year 5 > emergency > Flashcards

emergency Flashcards

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1
Q

what is anaphylaxis?

A

IgE mediated mast cell and basophil type 1 hypersensitivity reaction

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2
Q

adrenaline in anaphylaxis

A

0.5mg IM (0.5ml 1:1000)

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3
Q

other than adrenaline what other medication is given in anaphylaxis

A

chlorphenamine 10mg IV

hydrocortisone 200mg IV

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4
Q

what can be measured to identify anaphylaxis

A

serum tryptase

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5
Q

how long should anaphylaxis be monitored for?

A

up to 12 hours to look for biphasic reaction

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6
Q

how soon can you repeat adrenaline if no effect in anaphylaxis?

A

5 mins

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7
Q

causes of shock

A

obstructive- reduced cardiac flow (PE/ tension)/ reduced cardiac filling (tamponade)
distributive- sepsis, anaphylaxis, neurogenic
cardiogenic- MI, dysrhythmia
hypovolaemic- burns, haemorrhage, pancreatitis

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8
Q

what is a SOFA score

A

sequential organ failure assessment score

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9
Q

What is qSOFA score

A

quick SOFA
2+ refer to CCU outreach
used to diagnose sepsis

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10
Q

What is SIRS

A 
systemic inflammatory response syndrome 2+ of:
temp <36/ >38
HR >90
RR >20
WCC <4/>12
sepsis= SIRS + infection
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11
Q

what is septic shock

A

Sepsis + req vasopressive medication to maintain MAP >65 + serum lactate >2

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12
Q

stage I (compensated) blood loss

A 
<1000ml loss
HR <100
BP normal
RR normal
UO >30ml/ hour
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13
Q

stage II (Mild) Blood loss

A 
1000-1500ml
HR>100
CRT>2
posts hypotension
20-30ml/hr UO
Anxious/ agitated
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14
Q

stage III (moderate) blood loss

A 
1500-2000ml
HR>120
SBP<90
CRT >3
UO <20ml/hr
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15
Q

Stage IV (severe) blood loss

A 
>2000ml
HR>140
SBP<80
anuria
Reduced AVPU
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16
Q

hypovolaemic shock

A

preload decreased
CO increased
afterload increased
tx IV fluids

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17
Q

cardiogenic shock

A

preload increased
CO decreased
afterload increased
tx Inotropes and revascularisation

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18
Q

distributive shock

A

preload decreased
CO increased
afterload decreased
tx pressors, IV fluids

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19
Q

what is acute respiratory failure?

A

PaO2 <8
Type 1 normal PaCO2 due to ventilation:perfusion mismatch
Type 2 raised PaCO2 due to alveolar hypoventilation

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20
Q

flow rate through nasal cannula

A

2L (30%)

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21
Q

flow rate through face mask

A

6L (60%) can be combined with NC

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22
Q

Shockable pulse (VF/ pulseless VT)

A

shock immediately

after 3rd shock amiodarone 300mg IV and adrenaline 10ml of 1:10000 (1mg)

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23
Q

non-shockable (PEA/ Asystole)

A

adrenaline 10ml 1:10000 Asap then after every 3-5 minutes

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24
Q

4Hs and 4Ts

A 
Hypoxia
hypovolaemia
hyperkalaemia
hypothermia
thrombosis
tension
tamonade
toxins
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25
opiate OD
naloxone
26
TCA OD
activated charcoal, diazepam or fits, may require sodium bicarb cardiac monitoring
27
paracetamol OD
N-acetylcysteine
28
salicylate OD
charcoal if <1hr/ gastric lavage if >500mg/kg urine alkalisation correct glucose/ K haemodylasis if no response
29
what time should paracetamol levels be taken
>4 hours <16 hours
30
toxic dose paracetamol
>12g or 150mg/kg, give N-acetylcysteine regardless of normogram
31
what should N-acetylcysteine be given with
5% dextrose | may need chlorphenamine if allergic reaction (common)
32
aspirin OD symptoms
tinnitus deafness confusion/ coma hyperventilation-> late hypoventilation
33
how might a TCA OD present?
``` confusion arrhythmia (prolonged QRS on ECG) headache hypotension dilated pupils/ hyperthermia ```
34
how might iron OD present?
GI bleeds
35
iron OD tx
desferroxamine
36
causes of falls
``` Cardiac – e.g. arrhythmia Neurological – e.g. seizure, stroke, peripheral neuropathy Vasovagal Intoxication / alcohol / pharmacological BPPV Infection Environmental ```
37
investigations following fall
``` CV + resp exam incl skin turgor GALS- hip # lying and standing BP urine dip neuro obs ?subdural basic bloods and imaging ```
38
normal score on MMSE
25+
39
agitation in delirium
holperidol 0.5-1mg lorazepam 0.5-1mg but worsen/ prolong delirium
40
benzo OD
flumezanil
41
BB OD
atropine and glucagon
42
digoxin OD
digibind
43
warfarin OD
phylomenadione
44
amoxicillin AE
rash with infectious mononucleosis
45
co-amox AEs
cholestasis
46
flucloxacillin AEs
cholestasis
47
erythromycin AEs
GI upset, prolonged QT
48
Ciprofloxacin AEs
lowers seizure threshold, tendonitis
49
metronidazole AEs
reaction following alcohol ingestion
50
doxycycline AEs
photosensitivity
51
trimethoprim AEs
rash including photosensitivity, pruritus, suppression of haematopoiesis
52
safe limits of alcohol
<14/ week | <3/ day
53
what effect does alcohol have on the liver?
``` hypooglycaemia predisposes to fatty liver cirrhosis hepatits varices p450 inducer ```
54
alcohol detoxification
``` chlordiazepoxide (benzo, gradually reduce over 7-10 days) thiamine to prevent wernicke's fluid and electrolyte replacement disulfiram- with psychotherapy acamprosate reduces cravings ```
55
which is acute -wernicke's/ korsakov
wernicke- ocular palsy, ataxic gait, memory problems
56
what factors affect motivation to quit
desire need ability reasons
57
benzo abuse
disinhibited/ impression of intoxication | withdrawal-> hypersensitivity, depersonalisation
58
psychostimulant abuse
rapid speech, large pupils, agitation, restlessness, high BP. (note ddx opiate withdrawal)
59
cannabis
addictive weak hallucinogen can cause anxiety and depression
60
opiates
smoking-> skin popping-> injection
61
cocaine
stimulant | cardiotoxic
62
amphetamine
stimulant elation excess energy can be injected
63
crystal meth
strong amphetamine
64
MDMA
serotonin release causes social friendliness | tolerance high
65
LSD
hallucinogenic | not addictive

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