Emergency Medicine Flashcards

Question

ethylene glycol

Answer 1

Found in Anti-Freeze/Carpet fabric cleaners Toxic levels: 100mls - Adults, 20mls - Child 3 stages - CNS depression—> CVS/Resp depression —> Renal failure High anion gap metabolic Acidosis —> Renal Failure 24-36hrs - to be fatal Levels able to be measured

Answer 2

life threatening neorological emerency associated with use of antipsychotic agents Increased body temperature >38°C Confusion, delirium or altered consciousness Fever Rigidity Dysautonomia --> rhabdo, hyperkalemia, AKI, seizures both typical and atypical antipsychotics

Answer 3

CO preferentially binds to haemoglobin (200x higher affinity for Hb compared to O2) reducing its oxygen-binding capacity, it shifts the oxygen dissociation curve to the left thus inhibiting the release of bound oxygen in the periphery and it acts as a direct cellular toxin by impairing aerobic metabolism. myalgia, headache, weakness, clumsiness, blurry vision, flu like illness-> seizure, coma, cardiac arrest COhb >10-40% Rx:100% high flow O2 or hyperbaric O2 to replace carboxyHb and supersaturate blood with O2 D: may cause Parkinsonism **Displaces O2 from haemoglobin as CO has much higher affinity for Hb than O2

Answer 4

Methaemoglobinaemia is the state of excessive methaemoglobin in the blood methaemoglobin is an altered state of Hb where ferrous ions (Fe2+) of haem are oxidised to the ferric state (Fe3+) and rendered unable to bind O2 normal level is < 1.5% Can occur with ingestion of cold packs or nitrites in meat can also be congenital Rx: high flow 100% O2. methylene blue.

Answer 5

non specific signs from chronic ingesiton Fanconi syndrome, microcytic anemia, reduced bone and muscle growth, behavior problems, lower IQ Lead lines on Xray

Answer 6

calcium gluconate Insulin/glucose intralipid

Answer 7

bradycardia hypotension shock

Answer 8

DILATED PUPILS Severe hyperthermia- requiring cooling Rhabdo Seizures Intracranial haemorrhage Hyponatremia Cerebral oedema

Answer 9

WET- secretions everywhere Confusion, coma Pinpoint pupils Wet- salivation, lacrimation,urination, diarrhoea, vomiting Killer Bs- bronchorroea, bradycardia, bronchospasm Hypotension --> cardiovascular collapse Examples- organophosphates, nerve agents, physostigmine, poisonous mushrooms Antidote: ATROPINE Pralidoxime binds organophosphate

Answer 10

hydroxocobalamin dicobalt edetate sodium thiosulphate

Answer 11

Serotonin- abrupt onset, resolves quickly, increased reflexes, myoclonus and tremor, dilated pupils neuroleptic malignant - gradual onset, prolonged course, muscle rigidity, hyporeflexic, normal pupils

Answer 12

digoxin immune Fab- Digibind

Answer 13

fever malaise cervical lymphadenopathy (posterior) headache pharyngitis/tonsilitis with exudate herpangina nausea/vomiting/anorexia splenomegaly (hepatomegaly uncommon) Ix: lymphocytosis, deranged LFTs

Answer 14

ethanol pyridoxine

Answer 15

Onset: Within 30 mins to 4 hours post ingestion Duration of symptoms: usually resolve within 24 hours Dose related toxicity Small ingestions of pure oil can lead to severe symptoms. A dose of 2-3 mL can induce mild CNS depression with drowsiness and/or dizziness and ataxia. A dose of ≥5 mL can induce significant CNS depression with coma miosis/mydriasis myoclonuc CNS depression- drowsiness, dizziness, ataxia, seizures tachycardia hypotension respoiratory depression, bronchospasm, apnoea, aspiration pneumonitis nausea/vominting, epigastric pain, diarrhoea Rx: supportive care

Answer 16

Hyperthermia Tachycardia Hypertension Hallucinations Agitation Dilated pupils Nystamus

Answer 17

<20 mg/kg: asymptomatic 20-40 mg/kg: GI symptoms only. Symptoms usually last <6hrs 40-60 mg/kg: GI symptoms, systemic toxicity not expected. Symptoms usually last <8hrs 60-120 mg/kg: potential for systemic toxicity >120 mg/kg potentially lethal Presentation Initial GI symptoms Quiescent/latent period 6-24 hrs with improvement in GIT symptoms Cardiogenic shock and acidosis - multi system organ failure, coma Hepatic necrosis --> acute liver failure Bowel obstriction after 2-8 weeks Ix: AXR if tablet ingestion FBE: leukocytosis UEC,LFT VBG- high anion gap metabolic acidosis, hypoglycemia Serum iron immediately and at 4 hours Coags- coagulopathy secondary to liver injury Management Antidote- desferrioxamine WBI if desferrioxamine doesnt work

Answer 18

pyridoxine

Answer 19

intralipid

Answer 20

sodium bicarbonate if ventricular dysrythmias 2' sodium channel blockade intralipid 20% - severe cardiovascular toxicity methylene blue for methaemoglobinaemia

Answer 21

Coagulopathy DIC Neurotoxicity- rare, nil myotoxicity abnormal INR, high aPTT, fibrinogen very low, D-dimer high

Answer 22

Consumptive coagulopathy Neurotoxicity - 30% Myotoxicity- 20%

Answer 23

ypoglycemia Alcohol poisoning – drowsiness, dysarthria, ataxic and hypoglycemia. Alcohol inhibits gluconeogenesis but plasma glucose can usually be maintained from glycogen breakdown

Answer 24

dantrolene bromocriptine in mild cases - starts with benzos (loraz or diaz)

Answer 25

fever tachycardia labile BP tachypnoea confusion agitated delirium dilated pupils muscle rigidity rhabdomyolysis hyperkalaemia renal and liver failure Ix: increased WCC, CK, LFTs, hypocalcemia and hypomagnesemia, hyperkalemia, metabolic acidosis high mortality, 10-20% caused by antipsychotics and antiemetics (eg domperidone, droperidol, metoclopramide, promethazine) central dopamine receptor blockade usually first 2 weeks of antipsychotic therapy higher risk with rapid dose escalation, switch from one agent to another, IM administration

Answer 26

Constricted pupils CNS depression Low temp, HR, BP, RR Hyporeflexia Eg heroin, morphine, methadone, oxycodne, codeine

Answer 27

octreotide

Answer 28

when foreskin is retracted past the coronal sulcus and the prepuce cannot be pulled back over the glans, resulting in venous stasis and severe oedema

Answer 29

inability to retrace prepuce usally physiological becomes retractable by age of 3 years in 90%

Answer 30

Annular – most common in newborns/infants. Cresenteric- most commmon early childhod Fimbriated – i.e. redundant hymen. More common in newborns (or pubertal adolescents) due to effect of oestrogen (maternal oestrogen in the case of newborns). Septated – normal variant in about 5% of cases only.

Answer 31

everything goes down Hypothermia Bradycardia Bradypnoea Hypotension CNS depression/confusion/coma Constricted pupils Hyporeflexia

Answer 32

introduction or increase of single seritonergic drug drug interaction between 2 seritonergic drugs- most common SSRIs/SNRIs MAOIs TCAs Lithium Tramadol Pethidine Fentanyl MDMA LSD Amphetamines Cocaine Ondansatron Metoclopramide Sumatriptan St Johns wart

Answer 33

IV benzodiazepine Serotonin antagonist if symptoms refractory Cyproheptadine Chlorpromazine

Answer 34

octreotide- somatostatin analogue. suppresses insulin release from pancreatic cells but first give IV glucose bolus -->10% glucose infusion if hypoglycemic

Answer 35

Fever Tachycardia Hypertension Mydriasis - but briskly reactive Diaphoresis Psychomotor agitation, paranoia, psychosis Increased energy Hyperactive bowel sounds Reduced pain response ***can only differentiate from sedative/ETOH withdrawal with history

Answer 36

Supportive IV Benzodiazepines Cooling for hyperthemia

Answer 37

one pill can kill signs usually within an hour of ingestion Anticholinergic syndrome CVS- reduced cardiac contractility and hypotension, widened QRS ---> VT/VF, prolonged QT CNS depression/coma, seizures tachycardia vomiting blurred vision ataxia delirium urinary retention ileus Ix: VGG (acidosis), TCA levels, ECG, Rx: Doses >10-15mg/kg need to be intubated, ventilated and given charcoal If QRS widened--> sodium bicarbonate bolus

Answer 38

vit k FFP prothrombinex

Answer 39

(age /4 ) +4

Answer 40

- Product of the reaction between carbon Monoxide and haemaglobin - Affinity of CO for Hb is 200 x greater than for O2 - Causes Hb dissociation curve to shift to left - --> hypoxia - Also binds to intracellular cytochromes, impairing aerobic metabolism in carbon monoxide poisoning, carboxyhaemoglobin levels provide an approximate guide to status. Between 10-20%: headache and dyspnoea on exertion; above 20%: confusion and irritability; above 50%: unconsciousness, with death likely if exposure is prolonged; above 70%: death is rapid. NOT cyanotic RX: high low O2 via non rebreather, or hyperbaric O2

Answer 41

* methaemoglobin is an altered state of Hb where ferrous ions (Fe2+) of haem are oxidised to the ferric state (Fe3+) and rendered unable to bind O2 Main inherited cause: cytochrome B5 reductase deficiency * normal level is < 1.5% * S/S: cyanosis, chest pain, altered mental state * Blood has chocolate brown hue * Ix: high metHb * Rx: high flow O2 via non rebreather * Methylene blue

Answer 42

O2 and increase ventilation to normalise CO2 level

Answer 43

risk of mutliorgan dysfunction when >400mg/kg taken (normal dose is 10mg/kg so 40 x normal dose) Should observe all kids ingesting >200 mg/kg for mild GI and CNS side effects

Answer 44

Initial hyperventilation with respiratory alkalosis ---> metabolic acidosis (High anion gap) Only symptomatic >150mg/kg (needs monitoring). Severe symptoms >300mg/g Can use activated charcoal if massive overdose within 1 hour of ingestion Antidote: IV SODIUM BICARBONATE for urinary alkalisation ; need to correct metabolic acidosis to limit CNS penetration Apnoea associated with intubation may worsen acidosis and lead to cardiac arrest. Consider pre-loading with sodium bicarbonate

Answer 45

Shock 4J/kg immediately Recommence CPR 15:2 for 2 minutes Assess rhythm Shock if shockable Adrenaline 10mcg/kg (1:10,000) after 2nd shock, then every 2nd loop (ie after 2nd, 4th, 6th) Amiodorone 5mg/kg after 3rd shock Adrenaline 10mcg/kg = 0.01 mg/kg = 0.1ml/kg

Answer 46

Recommence CPR Adrenaline 10mcg/kg (1:10000) immediately then every 2nd loop (1st, 3rd, 5th cycle) Recommence CPR 2 minutes Then assess rhythm

Answer 47

Cardiac arrest -> cardiac arrest algorithm No cardiac arrest: Position flat (or slightly tilted if resp distress worse when lying) IM adrenaline 10mcg/kg (1:1000) or 0.01ml/kg (max 0.5ml)

Answer 48

Adrenaline 10mcg/kg Atropine if vagal overactivity

Answer 49

Airway High flow O2 BSL (if <2.6, give glucose 10% 2ml/kg) At 5 mins: Midaz 0.15mg/kg IV/IM OR Midaz 0.3 mg/kg buccal/intranasal At 10 mins: 2nd dose as above At 15 mins: Levetiracetam 40-60mg/kg (over 5 min) or phentoin 20 mg/kg (over 20 min) 5 mins after infusion finished if still fitting: give whatever not given prior 5 mins later: rapid sequence induction and intubation **phenytoin contraindicated in Dravet syndrome (sodium channel blocker)**

Answer 50

If shock: Oxygen via NRB Vagal manouvre if not delaying other steps If has vascular access--> IV adenosine 100mcg/kg If no vascular access --> synchronous DC shock 1J/kg --> 2J/kg Consider amiodrone **adenosine via rapid push into large vein** If no shock of IV access faster than obtaining defib Adenosine 100mcg/kg, 200, 300, 400 mcg/kg (max 300mg/kg in neonate) Consider synchronous DC shock or amiodorone

Answer 51

stimulates release and inhibiting reuptake of serotonin increases release of nerepinepthine and dopamine and blocks their reuptake to a lesser extent ie indirect stimulation of serotonin and dopamine receptor

Emergency Medicine Flashcards

(75 cards)