Flashcards in Misc Deck (180)
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?
serious adverse affects occur at around 150mg/kg in adults
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