EMERGENCY MEDICINE Flashcards
(112 cards)
1
Q
what are the airway features of anaphylaxis?
A
- Throat and tongue swelling.
- Difficulty breathing and swallowing.
- Hoarse voice.
- Stridor.
2
Q
what are the breathing features of anaphylaxis?
A
- Tachypnoea.
- Wheeze.
- Hypoxia.
- Confusion.
- Fatigue.
- Cyanosis.
- Respiratory arrest.
3
Q
what are the circulatory features of anaphylaxis?
A
- Signs of shock (patient appear pale and clammy).
- Tachycardia.
- Signs of low blood pressure (dizziness, collapse).
- Decreased loss of consciousness.
- Chest pain.
- Cardiac arrest.
4
Q
what are the skin features of anaphylaxis?
A
- Flushing.
- Urticaria.
- Angio-oedema.
- Erythema.
5
Q
how is anaphylaxis managed?
A
- Start cardiopulmonary resuscitation and advanced life support if the patient is in cardiorespiratory arrest
- IM adrenaline
- positional changes according to most prominent symptoms
- remove the trigger
- oxygen
- IV fluid challenge with crystalloid
- IM or IV antihistamine
- Corticosteroid to prevent biphasic reaction
6
Q
what are the clinical features of skull fractures?
A
- Fall from height, motor vehicle accident, assault or gunshots to the head
- Palpable discrepancy in bone contour
- Battle’s sign: bruising over the mastoid which is a sign of basilar fracture, or fracture of the petrous part of the temporal bone
- Periorbital bruising
- Bloody otorrhoea
- CSF rhinorrhoea
- Facial paralysis, nystagmus or paraesthesia
7
Q
how are skull fractures diagnosed?
A
-Perform cranial CT: detects skull fractures and intracranial pathology
8
Q
how are closed non-depressed skull fractures managed?
A
-observe and monitor the patient with conservative management
9
Q
how are closed depressed skull fractures managed?
A
- observe and monitor
- offer operative elevation and repair of dura if the fracture >1cm, there is gross cosmetic deformity or an intracranial lesion
10
Q
how are open skull fractures managed?
A
- observe and monitor
- prompt debridement and operative dural repair and cranioplasty
11
Q
how is major haemorrhage managed?
A
- clear clots
- direct pressure
- indirect pressure
- tourniquet
- TXA
- blood
12
Q
what are the absolute indications for intubation in major trauma?
A
- Inability to maintain and protect own airway
- Inability to maintain adequate oxygenation with less invasive manoeuvres (PaO2<10kPa)
- Inability to maintain normocapnia (PaCO2 <4 or >6)
- Deteriorating conscious level (>2 points on motor scale)
- Significant facial injuries
- Seizures
13
Q
what are the relative indications for intubation in major trauma?
A
- Haemorrhagic shock, particularly in the presence of an evolving metabolic acidosis
- Agitated patient (often caused by hypoxia or hypovolaemia)
- Multiple painful injuries
- Transfer to another area
14
Q
define flail chest
A
-consecutive, segmental (i.e., multiple fractures in the same rib) ipsilateral rib fractures.
15
Q
what are the clinical features of rib fractures?
A
- Pain
- Dyspnoea
- Signs of impaired ventilation
- Paradoxical chest wall motion in flail chest
16
Q
how are rib fractures managed?
A
- Ensure that associated parenchymal injury (pneumothorax) is treated as appropriate
- Offer analgesia appropriate for the level of pain e.g. paracetamol and an opioid
- Provide chest physiotherapy for ventilation impairment
- Mechanical ventilation may be required in major trauma, with difficulty weaning from this being an indication for rib fixation, particularly in flail chest
17
Q
what are the clinical features of shoulder dislocation?
A
- Anterior shoulder dislocations present with the arm in a characteristic position of external rotation and slight abduction.
- Posterior shoulder dislocations are rare and present with the arm held in adduction and internal rotation; the shoulder cannot be externally rotated, either actively or passively.
- Inferior shoulder dislocations present with the arm fully abducted and elbow commonly flexed on or behind the head.
- pain
- inability to move
- swelling
18
Q
what are the clinical features of patellar dislocation?
A
-Patellar dislocation often presents with a swollen knee held in flexion with an obvious lateral prominence.
19
Q
what are the clinical features of elbow dislocation?
A
-Elbow dislocation typically presents with the elbow held in flexion.
20
Q
what are the clinical features of hip dislocation?
A
- The classic appearance of posterior hip dislocation is with the hip in a position of flexion, internal rotation, and adduction.
- With anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.
21
Q
how is a shoulder dislocation managed?
A
- Perform manual reduction with local anaesthesia and sedation
- Each of the reduction methods works by abduction and external rotation to disengage the humeral head from the glenoid, with axial traction to reduce it
- Follow up with AP and lateral x-rays to confirm reduction
- Immobilise with a sling
- Refer anyone under 25 to an orthopaedic surgeon
- Offer physiotherapy
22
Q
how is a finger dislocation managed?
A
- Perform manual reduction with 1% lidocaine anaesthesia
- Perform a neurovascular examination following reduction
- Dorsal PIP AND DIP: hyperextension
- Volar DIP and PIP: mild axial traction and then pressure at the base
- MCP: Flex the wrist and hyperextend the digit, before applying a volar directed pressure to the dorsum
- Splint the affected finger to a non-affected finger
- Offer physiotherapy
23
Q
how is a patellar dislocation managed?
A
- Perform manual reduction with local anaesthesia and sedation: seat the patient, flex the knee and then apply medial directed force to the lateral patella while extending the leg
- Perform confirmatory x-rays, immobilise and offer physiotherapy
24
Q
how is an elbow dislocation managed?
A
- Perform manual reduction with local anaesthesia and sedation: position patient supine, extend the arm to 30 degrees flexion and then manipulate the gross alignment so that the olecranon is central, before flexing to 90 degrees with longitudinal traction to the forearm and countertraction on the humerus. Continuing flexing until there is a plapable clunk
- Perform confirmatory x-rays, immobilise and offer physiotherapy
25
how is a hip dislocation managed?
- Perform manual reduction with local anaesthesia and sedation using allis' method or stimsons gravity technique
- Perform confirmatory x-rays, immobilise and offer physiotherapy
26
what are the clinical features of a neck of femur fracture?
- History of fall or trauma
- Pain in the affected hip, groin or thigh
- Inability to weight bear or move the hip
- Shortened, externally rotated leg
27
how is pain managed in a hip fracture?
- paracetamol
- additional opioids
- Nerve blocks
28
what is a first degree burn?
- Erythema involving the epidermis only
- Usually dry and painful
- Typical of severe sunburn.
29
what is a second degree burn?
- Superficial partial-thickness burns involving the epidermis and upper dermis
- Deep partial-thickness burns involving the epidermis and dermis
- Usually wet and painful
- Typical of scalding injury.
30
what is a third degree burn?
- Full-thickness burns involving the epidermis and dermis and damage to appendages
- Usually dry and insensate
- Typical of flame or contact injury.
31
what is a fourth degree burn?
- Involve underlying subcutaneous tissue, tendon, or bone
| - Typical of high-voltage electrical injury.
32
what are the clinical features of burns?
- Erythema
- Dry and painful if 1st degree
- Wet and painful if 2nd degree
- Dry and insensate burns if 3rd degree
- Burns affecting subcutaneous tissue, tendon or bone if 4th degree
- Cellulitis
- Clouded cornea
33
how are 1st and 2nd degree burns managed?
- stop the burning
- irrigate with cool water for 20-30 minutes
- offer paracetamol
34
how should 2nd degree burn wounds be managed?
- cleaning
- debridement of necrotic tissue
- leave blisters intact, unless more than 1cm or likely to rupture, when they should be deroofed
- dress the wound
- if infected, clean with normal saline and prescribe flucloxacillin or clarithromycin
35
how are 3rd and 4th degree burns managed?
- ABCDE
- intubate if hypoxaemia or hypercapnia, deep facial burns or full thickness neck burns
- fluid resus
- analgesia with opioids
- surgical debridement and grafting
36
what are the clinical features of a dental abscess?
- Dental pain/toothache
- Thermal sensitivity of teeth
- Fever
- Intra-oral or extra-oral oedema, erythema or discharge
- Trismus
- Tooth percussion sensitivity
- Mobile teeth.
- Deep periodontal pockets, bleeding, gingival recession
- Bone loss around teeth
- Elevated or extruded tooth
- Halitosis
37
how is a dental abscess managed?
- removal of the source of infection
- analgesia
- broad spectrum antibiotics e.g. phenoxymethylpenicillin, amoxicillin or clindamycin
38
how is a pelvic fracture managed?
- pelvic binder
- manage arterial pelvic bleeding with interventional radiology
- give IV morphine
39
when can a pelvic binder be removed?
- there is no pelvic fracture
- a pelvic fracture is identified as mechanically stable
- the binder is not controlling the mechanical stability of the fracture
- there is no further bleeding or coagulation is normal.
- within 24 hours of application.
40
How are open fractures managed?
- IV morphine
- prophylactic IV antibiotics
- saline soaked dressing
- limb salvage or amputation
- debridement, fixation and cover
41
what are the clinical features of a long bone fracture?
- Pain
- Soft tissue swelling
- Ecchymosis
- Expanding haematoma
- Impaired limb function
- Inability to bear weight
- Point tenderness
- Deformity
- Guarding
- Wound overlying site of injury
- Signs of an ischaemic limb
- Hypotension/hypovolaemic shock
42
how are long bone fractures initially managed?
- legs: splint
- analgesia
- assess neuromuscular status
43
how are femur fractures managed in children?
- harness or traction
| - surgical repair
44
how are humerus fractures managed in adults?
- offer non-surgical management for definitive treatment of uncomplicated injuries
- consider surgery for injuries complicated by an open wound, tenting of the skin, vascular injury, fracture dislocation or a split of the humeral head.
45
what are the clinical features of an ankle fracture?
- Recent trauma
- Ankle pain and swelling
- Inability to weight bear
- Medial and/or lateral malleolus is swollen and tender to palpation
- Pop heard on fall
- Ankle deformity
- Crepitus
- Tenderness of the proximal fibula
- Tenting of the skin over the medial malleolus
46
how are ankle fractures managed?
- analgesia
- unrestricted weight bearing as tolerated
- orthopaedic follow up
- surgery
47
how are pilon fractures managed/
-surgery
48
what are the clinical features of a distal radius fracture?
- History of trauma or osteoporosis
- Wrist pain
- Tenderness over the distal radius
- Swelling
- Dinner fork deformity
49
how are radial fractures managed in children?
- analgesia
- surgery
- re-displacement
- if dorsally displaced with manipulation, offer below elbow cast or K wire fixation
50
how are radial fractures managed in adults?
- analgesia
- surgery
- re-displacement
- Consider manipulation and a plaster cast in young people and adults (skeletally mature) with dorsally displaced distal radius fractures.
- When surgical fixation is needed for dorsally displaced distal radius fractures in young people and adults (skeletally mature): consider k-wire fixation or open reduction
51
how does a strain differ from a sprain?
-Strain is an injury to the muscle or musculotendinous junction, whereas sprain is an injury to the ligament
52
what are the clinical features of a muscle strain?
- Acute onset of symptoms
- Severe pain
- Swelling
- Bruising
- Palpable gap in the normal position of the Achilles tendon (Ruptured Achilles)
- Positive calf squeeze test (Achilles tendon rupture)
- Positive Matles test (Achilles tendon rupture)
- Positive biceps squeeze test (Biceps tendon rupture)
- Positive Hook test (biceps tendon rupture)
- Limited range of movement
- Weakness
53
how are muscle sprain managed?
- If the patient presents within the first 24 to 48 hours with an incomplete rupture, recommend rest, ice, compression and elevation, followed by gentle mobilisation with simple analgesia
- If the patient presents within the first 24 to 48 hours with a complete rupture, offer physiotherapy or surgical repair alongside simple analgesia
- If pain worsens, or there is no functional improvement within 1 week, investigate further and consider for surgical referral
54
what are the clinical features of aspirin poisoning?
- Confusion, disorientation and agitation
- Coma
- Convulsions
- Fever, sweating, warm extremities and bounding pulse
- Dyspnoea
- Tachypnoea, hyperventilation and Kussmaul’s respirations
- Tinnitus and deafness
- Nausea and vomiting
- Epigastric pain
- Malaise
- Dizziness
- Dehydration
55
what is seen on ABG in aspirin poisoning?
- a mixed respiratory alkalosis and metabolic acidosis
- normal or high arterial pH (normal or reduced hydrogen ion concentration)
- serum anion gap is usually increased in severe cases
56
what is seen on ECG in aspirin poisoning?
- tachycardia is common
- may show prolonged QRS or QT interval
- ventricular dysrhythmias may occur
- monomorphic ventricular tachycardia and torsades de pointes may be present
asystole may occur
57
how is aspirin poisoning managed?
- treat hypokalaemia
- give sodium bicarbonate to alkalinise urine and increase excretion
- cooling measures
- activated charcoal if presentation within 1 hour
- gastric lavage within 1 hour if >500mg/kg
- haemodialysis
58
what are the clinical features of a benzodiazepine overdose?
- Impaired mental status
- Drowsiness
- Slurred speech
- Ataxia
- Coma
- Respiratory depression
- Decreased deep tendon reflexes
59
how is a benzodiazepine overdose managed?
- Offer supportive management with airway maintenance, cardiorespiratory monitoring and IV fluids
- Give flumazenil to reverse CNS depression
60
what are the clinical features of an orbital fracture?
- Diplopia on upward gaze
- Derangement of globe position
- Intercanthal distance increased
- Oculovagal symptoms (bradycardia, hypotension, nausea and vomiting)
- Visual disturbance
- Peri-orbital bruising and oedema
- Nerve sensory loss
- Subconjunctival haemorrhage
61
how is an orbital fracture diagnosed?
- Perform facial x-rays: teardrop sign; may show fluid
| - Perform a CT scan of the orbit: fracture, may show herniation of orbital contents into adjacent paranasal sinuses
62
how is severe oculovagal response following an orbital fracture managed?
-IV atropine
63
what are the clinical features of a wound infection following an animal bite?
- Induration
- Fluctuance
- Purulent drainage
- Regional adenopathy
- Necrotic tissue
64
Describe the initial wound management of an animal bite
- remove FB
- encourage bleeding
- irrigate
- debride
- analgesia
- closure if indicated
65
which animal bites should not have formal closure?
- Bite wounds over 24 hours old.
- Infected bite wounds.
- Deep puncture wounds.
- Crush injuries.
- Heavy contamination.
- Uncertain adequacy of debridement.
- Bites to the limbs, hands, and feet.
66
how is an infected animal bite managed?
- co-amoxiclav
| - doxycycline and metronidazole
67
what are the clinical features of carbon monoxide poisoning?
- Headache
- Nausea
- Vomiting
- Vertigo
- Altered consciousness
- Dizziness
- Dyspnoea
- Pain
- Sleep changes
- Emotional lability
- Delayed neuropsychiatric features: memory impairment, disorientation, apathy, mutism, irritability, inability to concentrate, personality change, emotional lability, neuropathy, incontinence, chorea, apraxia, psychosis, dementia, and Parkinsonism
68
how is carbon monoxide poisoning diagnosed?
- Measure exhaled carbon monoxide levels using a breath test if it is available — this must be done as soon as poisoning is suspected, as levels of carbon monoxide decline once the person is away from the source.
- Perform an ABG: Raised carboxyhaemoglobin; elevated lactate
- Perform a 12 lead ECG: Sinus tachycardia
69
how is carbon monoxide poisoning managed?
- Give 100% oxygen using a tight fitting mask with an inflated seal, until the person is asymptomatic and carboxyhaemoglobin levels are 3% or less in non-smokers, and 10% or less in smokers
- Observe for at least 4 hours after exposure
70
what are the clinical features of a medial collateral ligament injury?
- Injury due to excessive or repetitive valgus loading of MCL
- Medial knee pain
- Joint effusion
- Tenderness
- Laxity on valgus stress testing
- Ecchymosis
71
what are the Ottawa knee rules?
- Age >55 years
- Isolated patella tenderness
- Tenderness at head of the fibula
- Inability to flex knee 90 degrees
- Inability to bear weight
72
what is seen on x-ray in MCL injury?
- may show associated fracture of the tibial plateau, patella, or distal femur; calcification adjacent to the adductor tubercle is typical of a Pellegrini-Stieda lesion in chronic situations
- Perform stress x-rays of knee: greater than normal opening on the medial side of the knee joint is commonly seen; physeal fractures may be seen in adolescents; in adults, a greater than 3.2 mm side-to-side difference of medial gapping is suggestive of a grade III MCL injury
73
how is a grade 1-2 MCL injury managed?
-advise rest, ice, elevation, compression and physiotherapy with a hinged knee brace, and NSAID analgesia
74
how is a grade 3 MCL injury managed?
-MCL repair
75
what are the clinical features of a meniscal tear?
- Knee swelling
- Sensation of knee instability or buckling/catching
- Knee pain
- Tenderness at joint line and joint line crepitation
- Positive McMurray’s and Apley’s test
- Positive hyperextension test
76
how is a meniscal tear managed?
- Advise rest, ice, compression and elevation with physiotherapy and analgesia
- If the meniscal tear is <1cm refractory to conservative measures or >1cm or with root involvement, offer arthroscopic surgery
77
what are the clinical features of a retropharyngeal abscess?
- Spiking fever
- Neck pain or torticollis
- Odynophagia
- Dysphagia
- Neck swelling, mass or lymphadenopathy
- Oropharyngeal swelling
- Malaise and irritability
78
how is a retropharyngeal abscess diagnosed?
- Perform CT neck with contrast: ring enhancing lesion in retropharyngeal space
- Perform neck x-ray: increased swelling of pre-vertebral space
79
how is a retropharyngeal abscess managed?
- If there is airway compromise, give an IV corticosteroid and nebulised adrenaline, before performing surgical drainage
- Give empirical antibiotic therapy with cefuroxime and metronidazole
80
define mild COVID
-People who have any of various signs and symptoms (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, loss of taste and smell) without shortness of breath, dyspnoea, or abnormal chest imaging.
81
define moderate COVID
-People who have evidence of lower respiratory disease by clinical assessment or imaging and an oxygen saturation (SpO₂) ≥94% on room air at sea level.
82
define severe COVID
-People who have respiratory frequency >30 breaths per minute, SpO₂ <94% on room air at sea level, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) <300 mmHg, or lung infiltrates >50%.
83
define critical COVID
-People who have respiratory failure, septic shock, and/or multiple organ dysfunction.
84
what are the clinical features of COVID19?
- Fever
- Cough
- Dyspnoea
- Altered sense of smell/taste
- Fatigue
- Myalgia or arthralgia
- Sputum production/expectoration
- Chest tightness
- GI symptoms: loss of appetite, nausea and vomiting and abdominal pain
- Sore throat
- Headache
- Dizziness
- Confusion and delirium
- Ocular pain, discharge, redness and conjunctivitis
- Chest pain
- Tachypnoea and tachycardia
85
how is moderate COVID19 managed?
- hospital admission
- monitor
- avoid lying on back
- adequate nutrition and dehydration
- improve air circulation
- paracetamol
86
how is severe COVID19 managed?
- hospital admission
- supplemental oxygen
- positional techniques
- fluid management and correct electrolyte abnormalities
- opioid and benzodiazepine for breathlessness
- VTE prophylaxis
- dexamethasone
- paracetamol
87
how is critical COVID19 managed?
- ICU
- fluid and electrolyte management
- Abx
- VTE prophylaxis
- high flow nasal oxygen or NIV
- if deteriorating, intubate and ventilate with a high PEEP
- prone ventilation
- ECMO
- Dexamethasone
88
what are the clinical features of cellulitis?
- Acute onset of red, painful, hot, swollen skin
- Orange peel appearance
- Blistering
- Bleeding
- Lymphangitis
- Unilaterality
- Fever
- Malaise
- Lymphadenopathy
89
how is cellulitis managed?
- If the infection is severe, give IV flucloxacillin or clarithromycin
- Switch to oral antibiotics if the temperature is settling, the redness is reducing and CRP is falling
- Give paracetamol for analgesia
- If MRSA is suspected or confirmed, add vancomycin, teicoplanin or linezolid
- If there is cellulitis near the eyes or nose, give co-amoxiclav or clarithromycin and metronidazole and seek specialist advice
- If the infection is non-severe, give oral flucloxacillin first line, or clarithromycin
90
what are the clinical features or peri-orbital/orbital cellulitis?
- Recent sinus infection or eyelid injury
- Redness and swelling of the eye
- Ocular pain
- Decreased vision
- Proptosis
- Eyelid oedema
- Chemosis
- Tenderness around the eye
- Fever
- Eyelid erythema
- Elevated intraocular pressure
- Headache
- Malaise
91
how is peri-orbital cellulitis managed?
- Give empirical IV antibiotics such as cefotaxime or clindamycin
- If there is a peri-ocular abscess, incise and drain
- Give amphotericin B deoxycholate in children and adults that are immunosuppressed, are in DKA or have viscid, dark brown-black nasal discharge
- If MRSA is suspected, add vancomycin
- When the causative organism is identified, switch to a targeted oral antibiotic
92
how is orbital cellulitis managed?
- Give empirical IV antibiotics such as cefotaxime or clindamycin
- Offer a nasal decongestant such as ephedrine
- Give amphotericin B deoxycholate in children and adults that are immunosuppressed, are in DKA or have viscid, dark brown-black nasal discharge
- If MRSA is suspected, add vancomycin
- If there is high ocular pressure, perform lateral canthotomy and cantholysis
- If there is an orbital abscess, perform orbitotomy and surgical drainage
- When the causative organism is identified, switch to a targeted IV antibiotics
93
what are the clinical features of cocaine overdose?
- Tachycardia
- Hypertension
- Hyperthermia
- Agitation
- Mydriasis
- Diaphoresis
94
what is seen on ECG in cocaine overdose?
- May be normal
- sinus tachycardia
- SVT
- ventricular dysrhythmia
- ischaemic changes
95
how is a cocaine overdose managed?
- Observe and perform cardiac monitoring
- Give a benzodiazepine to manage agitation and seizures
- Use isotonic saline to manage volume depletion
- Use external cooling and sedation to reduce hyperthermia if the temperature is 39-41.2 degrees
- Manage arrhythmias as indicated
- If there is muscle rigidity and hyperthermia or >41.2 degrees use external cooling and consider sedation, paralysis and mechanical ventilation
96
what are the clinical features of amphetamine overdose?
- Agitation, irrationality, restlessness and aggressive behaviour
- Hyperthermia
- Seizures
- Diaphoresis and flushed facial skin
- Tachycardia and palpitations
- Traumatic injury
- Headache
- Hypertension
- Hyper-reflexia and clonus
- Tremor
- Racing speech, pacing and trismus
- Hallucinations or delusions
- Hypertonicity and muscle rigidity
- Mydriasis
97
how is amphetamine overdose managed?
- Monitor vital signs and cardiac monitoring
- Give activated charcoal if presentation is within 1 hour
- If the patient is agitated, give reassurance and oral or parenteral sedation with benzodiazepines
- If there is volume depletion or rhabdomyolysis, rehydrate with IV fluids
- Give sodium bicarbonate for severe metabolic acidosis
- Commence active cooling if the body temperature exceeds 38 degrees
- If temperature exceeds 39.5 degrees, actively cool, then intubate and paralyse
- Give a beta-blocker for sinus tachycardia and SVT
- If there is hypertension use IV labetalol or IV GTN to reduce
98
how is epistaxis managed?
- If there is major haemorrhage, follow local major haemorrhage protocol and resuscitate as appropriate
- If there is no major haemorrhage, administer nasal first aid by asking the patient to lean forward squeeze the soft part of their nose for 10-15 minutes
- If this fails, offer nasal cautery if the bleeding point is visible, or nasal packing if not
- Once the bleeding has stopped, offer topical naseptin (Not if there is allergy to neomycin, peanut or soya) or mupirocin ointment if contraindicated, and advise against nose picking or blowing, heavy lifting, strenuous exercise, lying flat and hot drinks
- Consider referral to ENT if a person has recurrent epistaxis
99
what are the clinical features of foreign body ingestion?
- Dysphagia
- Non-specific abdominal pain
- Stridor and wheeze
- Drooling
- Gagging, nausea and vomiting
- Neck and throat pain
- Atypical chest pain
- Choking
- Signs of upper GI obstruction or lower GI bleeding
100
how is foreign body ingestion managed?
- Resuscitate unstable patients as needed and offer surgery for viscus perforation
- If there is drooling or spitting, insert a nasogastric or orogastric tube with low intermittent suction
- Use a watchful waiting approach
- Glucagon can be administered IV to decrease lower sphincter tone in those with oesophageal and rectal FBs
- Use a Foley catheter extraction technique for FBs in the rectum or oesophagus
- If there are multiple magnets or batteries, perform emergency endoscopic or surgical removal
101
what are the clinical features of paracetamol overdose?
- Nausea and vomiting
- RUQ pain
- Jaundice
- Hepatomegaly
- Altered conscious level
- Asterixis
- Loin pain
102
how is paracetamol overdose managed?
- If <1 hour, give activated charcoal to reduce absorption
- If 2-24+ hours since ingestion, give acetylcysteine immediately if the patient has ingested more than 150mg/kg or paracetamol level is raised according to treatment graph
- Give acetylcysteine intravenously in three sequential infusions over 1 hour, 4 hours, and 16 hours (totalling 21 hours) based on the patient’s body weight.
103
what is type 1 necrotising fasciitis?
- Type I necrotising fasciitis is a polymicrobial infection with an anaerobe such as Bacteroides or Peptostreptococcus and a facultative anaerobe such as certain Enterobacterales or non-group A streptococcus.
104
what is type 2 necrotising fasciitis?
- Type II necrotising fasciitis is most commonly a monomicrobial infection with Streptococcus pyogenes (group A streptococci).
105
what are the clinical features of necrotising fasciitis?
- Anaesthesia or severe pain
- Fever
- Palpitations
- Tachycardia
- Tachypnoea
- Hypotension
- Nausea and vomiting
106
how is type 1 necrotising fasciitis managed?
- Offer surgical debridement and haemodynamic support with IV fluids
- Give IV antibiotics (vancomycin, tazocin)
107
how is type 2 necrotising fasciitis managed?
- Offer surgical debridement and haemodynamic support with IV fluids
- Give IV antibiotics
- Group A strep: benzylpenicillin and clindamycin or vancomycin, with IVIG if there is toxic shock
- Staph aureus: Vancomycin
- Aeromonas hydrophila: doxycycline and ciprofloxacin
- Mucorales fungus: Amphotericin B
108
what are the clinical features of opioid overdose?
- Pinpoint pupils
- Bradypnoea
- Altered mental status
- Dramatic response to naloxone
- Decreased GI motility
- Presence of track marks
109
how is opioid overdose managed?
- Perform airway manoeuvres and ventilation support with a bag-valve mask and supplementary oxygen
- Administer 0.4mg to 2mg of Naloxone
110
what are the clinical features of TCA overdose?
- Change in mental status
- Tachycardia
- Hypotension
- Mydriasis
- Warm, dry, flushed skin
- Decreased or absent bowel sounds
- Urinary retention
- Divergent squint, internuclear ophthalmoplegia, gaze paralysis and nystagmus
- Ataxia, myoclonus, choreoathetoid movements, increased muscle tone, hyperreflexia and extensor plantar response
111
what is seen on ECG in TCA overdose?
- Tachycardia
| - QRS prolongation with rightward axis deviation
112
how is TCA overdose managed?
- If ingestion has occurred within the last 2 hours, give activated charcoal
- Give a sodium bicarbonate bolus, followed by an infusion, if the QRS is prolonged or there is acidosis
- Consider using magnesium sulfate for tachyarrythmias that persist despite correction of acidosis
