Emergency Medicine Flashcards
What is the dose of adrenaline given to adults and children in anaphylaxis?
adults-12 = IM 500micrograms (1:1000) and if no response give again after 5mins
6-11 years = 300 micrograms
6months-5years = 150 micrograms
<6 months = 100-150 micrograms
IV adrenaline and IV fluids can be given in refractory anaphylaxis
What is the treatment for an overdose of sodium nitrate?
Methylene blue
How do you treat an overdose of paracetamol if you treat it less than an hour?
N-acetylcysteine AND charcoal
SNAP protocolIn paracetamol overdose, NAC (more than 1 hour) is given over 12 hours using two bags.
-1st bag = 100mg/kg over 2 hours using 5% dextrose
-2nd bag = 200mg/kg over 10 hours using 5% dextrose
-bloods taken before and after treatment (charcoal can be given in any overdose less than an hour)
how can the effects of opiates (e.g. morphine) be reversed?
emergency: 400mcg Naloxone
detoxification: methadone
-miosis
What is salicylate overdose and what is shown on blood gas results for this?
overdose of aspirin:
hyperventilation
tinnitus
lethargy
sweating
seizures
coma
shown by primary respiratory alkalosis with high anion gap metabolic acidosis
give: charcoal within 1hr
IV sodium bicarb
haemodialysis
When are sutures removed?
Face = 5 days
Head/scalp = 7 days
Arms/legs/hands/fingers = 7-10 days
Abdomen 7-10
over Joints = 10-14 days
Back 10-14 days
anything else = 7-10 days
What are the rules for advanced life support (cardiac arrest)?
**CHECK IF THEY HAVE A DNACPR **
Shockable rhythms: pulseless ventricular tachycardia/VF
Nonshockable rhythms: asyetole/pulseless asystole (flatline) –> give adrenaline instead
-chest compressions (30:2)
-defib (shock then 2mins CPR)
-IV adrenaline 1mg every 3-5mins if it persists after 3 shocks (if can’t get IV then use intraosseous)
-amiodarone 300mg in VF/pulseless VT after 3 shocks (use lidocaine if no available)
ATROPINE NOT USED
What must a patient have before being discharged if they have had a head trauma and on anticoagulants?
a CT head within 8hrs, even if there is no vomiting and no LOC
What is the difference between blood transfusion anaphylaxis, TACO, TRALI and acute haemolytic reaction?
anaphylaxis = Hypotension, dyspnoea, wheezing, angioedema –> adrenaline
TACO = Pulmonary oedema, hypertension –> IV diuretics e.g. furosemide
TRALI = Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension –> oxygen
Acute haemolytic reaction = fever, abdominal pain, hypotension —> send for Coombs test, fluid resus
How do you treat hypercalcaemia and what are the symptoms?
Usually seen in people with cancer
-EMERGENCY admission to hospital
-give IV fluids and THEN IV bisphosphonates (pamidronate or zoledronate)
-feeling more tired than usual
-feeling weak
-not wanting to eat much
-constipation
-loss of concentration and interest in doing things
-mild confusion
-low mood
-irritability
What’s more painful/sharper pain: haemorrhoids or anal fissures?
anal fissures
What kind of reaction can giving N-acetylcysteine cause?
anaphylactoid (non-IgE mediated mast cell release)–> stop the infusion, then restart at a slower rate
What is the most useful test look at to establish if the patient’s presentation was due to anaphylaxis?
Serum tryptase Can stay elevated for up to 12 hours after anaphylaxis
How would you treat the 4 different types of shock?
-Hypovolaemia: IV fluid or blood
-Cardiogenic shock: antiarrhythmics, coronary revascularisation, valve replacement
-Obstructive: embolectomy, thrombolysis, chest drain etc
-Distributive: antibiotics, adrenaline, vasopressors
How do you reverse adrenaline i.e. accidentally injecting adrenaline in to finger?
Phentolamine
