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What us a lymphangiosarcoma?

a reddish lump on the skin which is aggressive and spreads rapidly which can increase lymph-edema risk


Treatment of lymphangiosarcoma?

amputation the affected limb, poor prognosis


Complications of lymph-edema?

cellulitis, lymphangitis, DVT, cosmetic issues, impaired functioning in affected area


How to reduce risk of lymph-edema?

keep affected limb raised above heart, avoid tight jewelry and clothes, do not heat it, avoid heavy lifting stay hydrated, skin hygiene, avoid insect bites and sunburns


Treatment of lymph-edema?

preventative measures, compression treatments, support groups, elastic sleeves and stockings, bandages, pneumatic compression devices, manual compression, exercises that light contract and stimulate the affected limb, surgical treatments to remove excess fluid, antibiotics for infection


What causes carbon monoxide and how does this cause poisonin?

incomplete combustion of carbon or carbon containing compounds e.g. tobacco smoke in an inadequate supply of oxygen which then competes with oxygen to form carboxyhaemoglobin instead of oxyhaemoglobin due to carbon monoxides high affinity for Hb and myoglobin


How does methylene chloride cause poisoning?

it is readily absorbed and metabolized to CO by the liver, leading to poisoning


How common is CO poisoning?

kills 50 people and injuries 200 people per year in UK


Symptoms of CO poisoning?

headache at COHb 10%, mental impairment, convulsions, cardiac arrest, tachypnoea, pink skin and coma at >50%


Investigations of CO poisoning?

direct spectrophotometric measurement of HbCO and ABG in blood gas analyser, HbCO oximeter, low O2 sat, ECG shows myocaridal ischemia or infarction, creatinine and troponin levels indicate myocardial damage, MRI, CXR, neuropsychological testing


Management of CO poisoning?

remove source, ABC, give O2, mannitol 1g/kg IV for cerebral ischemia, monitor ECG, neuropsychiatric testing, contact local health protection unit for enviromental testing and management


Prognosis of CO poisoning?

can recover spontaneously , no long term treatment


Symptoms of TCA overdose?

tachycardia, hypotension, fixed dilated pupils, convulsions, urinary retention, arrhythmia, decreased conscious level


Management of TCA overdose?

diazepam for convulsions, IV sodium bicarbonate for tachycardia


Symptoms of benzodiazepine overdose?

drowsiness, ataxia, dysarthria, respiratory depression, coma


Treatment of benzodiazepine overdose?

IV flumazenil (CI for TCA for epilepsy)


Symptoms of phenothiazine overdose?

hypotension, hypothermia, arrhythmia, respiratory depression, coma, convulsions, dystonic reactions


Treatment of phenothiazine overdose?

symptomatic treatment e.g. diazepam for convulsions, benzatropine for dystonic reactions


Symptoms of NSAID overdose?

coma, convulsions, metabolic acidosis, renal failure


Treatment of NSAID overdose?

symptomatic and supportive


Symptoms of BB overdose?

bradycarida, hypotension, come, convulsion, hypoglycaemia


Treatment of BB overdose?

IV glucagon, inotropic action on heart, atropine IV


What is the toxicity risk for severe liver damage based on paracetamol (acetaminophen) dose?

250mg/kg likely
>12g fatal

serious adverse affects occur at around 150mg/kg in adults


paracetamol metabolism?

absorbed in stomach and small intestine, reaching peak plasma concentration in one house, then inactivated in the liver by glucuronide or sulphate and then excreted


What happens in paracetamol overdose?

liver conjugations becomes inundated so paracetamol must be metabolised by an alternative pathway which forms NAPQI which must be inactivated by gluthatione to prevent harm


What happens in paracetamol overdose if gluthatione stores are depleted to

NAPQI binds with sulfhydryl groups on liver cell membranes causing necrosis and to liver and kidney tubules


What can cause depleted gluthatione stores?

induction of the P450 system through drugs (rifampicin, phenobarbital, phenytoin, carbamazepine), alcohol, genetic variation, HIV, malnutrition, under 5 years


What is the most common form of poisoning in the UK?



Symptoms of paracetamol poisoning?

asymptomatic, nausea, vomiting, hepatic necrosis with associated symptoms, encephalopathy, oliguria, hypoglucaemia, lactic acidosis


Investigations of paracetamol poisoning?

find out dosages, formulation, concomitant tablets, time of overdose, suicide risk, any alcohol taken

paracetamol levels 4 hours post igestion, U+Es, creatinine to look for renal failure, normal LFTs but increased ALTs, capillary blood glucose for hypoglycaemia, PT, ABG for acidosis