Emergency Med

Question 1

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

Answer 1

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

Question 2

when prescribing finasteride what also needs to go on the chart

Answer 2

women should not handle crushed or broken tablets

Question 3

how do you determine treatment for paracetamol overdose

Answer 3

nomogram using the time they took the paracetamol

Question 4

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

Answer 4

acetylcysteine

Question 5

how does acetylcysteine work

Answer 5

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

Question 6

what should be a consideration when prescribing acetylcysteine?

Answer 6

need to prescribe all stages of the regimen

Question 7

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

Answer 7

anaphylactoid reaction

Question 8

when does anaphylactoid reaction occur in terms of acetylcysteine therapy

Answer 8

soon/after 1st bag

Question 9

what are symtpoms of anaphylactoid reaction

Answer 9

nausea, vom
flushing
urticarial rash
bronchospasm

Question 10

how to treat anaphylactoid reaction

Answer 10

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

Question 11

what to do if px is prone to anaphylactoid reacs

Answer 11

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

Question 12

what do consider when prescribing PRN medications

Answer 12

indication, max amount in 25 hours, dosing interval

Question 13

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

Answer 13

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

Question 14

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

Answer 14

eye/ear drops
inhalers
injections
creams
contraceptives
herbal meds

Question 15

3 symptoms of hypoglycaemia

Answer 15

sweating
fatigue
pale

Question 16

how do you treat hypoglycaemia when the patient is unconscious

Answer 16

glucose 20% 75-100mL in large vein

Question 17

what to give for hypoglycaemia when you have no IV access

Answer 17

SC glucagon and give larger long acting carb snack

Question 18

when might glucagon be less effective in which px

Answer 18

alcohol use, sulfonylureas, chronic malnourishment

Question 19

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

Answer 19

leads to dosing errors, syringe should be measured in units

Question 20

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

Answer 20

increased

Question 21

t/f never omit regular insulin in T1DM px

Answer 21

true

Question 22

treat all hypoglycaemia (gluc <Xmmol/l) promptly

Answer 22

4

Question 23

should you allow self management w insulin where appropriate and why

Answer 23

yes reduces errors

Question 24

what is a consideration when prescribing insulin?

Answer 24

the type of device, ie pen

Question 25

next steps afetr px safety incident occurs

Answer 25

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

Question 26

what would indicate that someone has been poisoned with insulin?

Answer 26

lower than expected C-peptide

Question 27

// emergency med 2 possible diagnosis for px PC: malaise, sob, r chest pain on inspiration recent long haul flight

Answer 27

cap pneumonia from atypical pathogens PE cancer covid19

Question 28

what wells score would indicate further investigation into a PE diagnosis

Answer 28

4

Question 29

if pe suspected what might be the next steps

Answer 29

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

Question 30

what is a consideration when prescribing enoxaparin

Answer 30

round to the nearest realistic dose

Question 31

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...

Answer 31

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

Question 32

for which px is enoxaparin given BD

Answer 32

high risk px. have risk factors

Question 33

name 3 direct Xa inhibitors

Answer 33

rivaroxaban apixaban edoxaban

Question 34

name a thrombin inhibitor

Answer 34

dabigatran

Question 35

benefit of having no monitoring requirement for DOACs

Answer 35

may improve adherence

Question 36

does rivaroxaban have to be taken with food?

Answer 36

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

Question 37

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

Answer 37

when next LMWH would have been due

Question 38

what about tx w lmwh and warfarin

Answer 38

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

Question 39

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

Answer 39

5

Question 40

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

Answer 40

dabigatran edoxaban

Question 41

what might indicate hypercalcaemia of malignancy? 3

Answer 41

known malignancy, high calcium, high urea

Question 42

what is the first step in treating hypercalcaemia of malignancy

Answer 42

rehydration NaCl 0.9% 4-6L / 24hrs

Question 43

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

Answer 43

SPC

Question 44

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

Answer 44

after 72h post infusion

Question 45

main AEs of bisphosphonate tx

Answer 45

GI: nausea, diarrhoea hypocalcaemia ONJ atypical fmeoral fractures

Question 46

when may ONJ be greater risk

Answer 46

if px on IV bisphos in cancer tx

Question 47

do patients need a dental check up before starting bisphosphonates?

Answer 47

yes if possible

Question 48

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

Answer 48

thigh hip groin pain during tx