Medical Emergency Flashcards
In patient with decreased cardiac function/atrial fibrillation/HF was is the risk of incorrect fluid management.
How would you manage GI bleed.
Resuscitation (fluid)
IV access
Correct losses
Restore BP
Routine bloods (FBC, U&E, LFTs, cross-match, INR)
Keep patient NBM
Patient R comes in with acute GI bleed characterised by Malena, raised serum urea in isolation of creatinine and low Hb (81 g/L). Her BP is BP 67/55, HR 97, RR is 18. She is currently on:
(a) What medicines would you withhold, restart or continue. What drugs do you think may have caused her GI bleed.
(b) Would you still continue using Rivaroxban in this patient? Recommendation
(a) Rivaroxaban, Ibuprofen, Fluoxetine: precipitated the bleed.
(b) Data shows Rivaroxaban has increased risk of bleed relative to edoxaban and apixaban. In practice, Apixaban is good in the elderly population. Dabigatran is likely to offset GI upset so not appropriate.
Signs and symptoms of anaphylaxis
GI problems: abdominal pain, hyperperistalsis, vomiting, diarrhoea
Oral: swelling of the lips, tongue
Respiratory: SOB, angioedema of the tongue/throat, wheeze
Cutaneous: rash, flushing
Cardiovascular: hypotension, tachycardia
CNS: confusion.
First treatments and rationale for anaphylaxis treatment
First - Remove the trigger – but do not delay treatment if removing trigger is not possible
Drug – stop infusion
Stings – removal, early
Food – do not induce vomiting
IM adrenaline
When you are in hospital what anaphylaxis treatment would you start in the case where Tx has an allergy of benzylpencillin administered
Stop infusion. IM adrenaline. Further treatment: stabilise airway, high flow oxygen, IV fluid challenge, chlorphenamine, hydrocortisone
Mechanism of adrenaline (epinephrine)
Produces its effects on end organs via, α1, β1 and β2 receptors – aim to increase blood pressure and pulse offsetting the circulatory collapse/shock caused by the allergen.
Effects of noradrenaline
Causes sympathetic stimulation – fight or flight reaction:
Pupillary dilation
Bronchodilation
Heart rate and force increase – blood pressure rises
Vasoconstriction in skin and viscera, vasodilation in skeletal muscles
Energy production – glycogenosis stimulated, blood sugar levels increase GI tract and bladder relax
Mechanism of Chlorphenamine
H1-antagonist, blocks histamine mast cell degranulation action in the lungs & capillaries inducing vasoconstriction.
Action of hydrocortisone
Can help prevent or shorten protracted reactions. Vascular effects – reduces vasodilation, decreases fluid exudates, decreases leucocyte influx and activation, decreases cytokine and eicosanoid production via repression or induction of genes.
Which one from this list modulates arachidonic acid metabolism offsetting an anaphylaxis reaction
a)Stings, food, antibiotics
b)Whole blood, immunoglobulins
c) Radio contrast media, low molecular weight heparin
d)Opioids
e)Aspirin, NSAIDs
f) Sodium and potassium sulphites
(e)
Which one from this list causes mast cell activation.
a)Stings, food, antibiotics
b)Whole blood, immunoglobulins
c) Radio contrast media, low molecular weight heparin
d)Opioids
e)Aspirin, NSAIDs
f) Sodium and potassium sulphites
(d)
Which one from this list cause non-immunological mast cell activation.
a)Stings, food, antibiotics
b)Whole blood, immunoglobulins
c) Radio contrast media, low molecular weight heparin
d)Opioids
e)Aspirin, NSAIDs
f) Sodium and potassium sulphites
(b)
Which one from this list cause IgE mediated reactions
a)Stings, food, antibiotics
b)Whole blood, immunoglobulins
c) Radio contrast media, low molecular weight heparin
d)Opioids
e)Aspirin, NSAIDs
f) Sodium and potassium sulphites
(a)
