Term
| What is the IM dose of adrenaline? Where is the best place to administer it? |
|
Definition
0.5mg IM = 500 mcg = 0.5ml of 1:1000
It should be repeated after 5 mins if there is no clinical improvement.
the best place to give it is the anterolateral aspect of the middle third of the thigh |
|
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Term
| What signs suggest airway involvement in anaphylaxis? |
|
Definition
itching of the palate or external auditory meatus
laryngeal oedema (stridor)
wheezing
bronchospasm |
|
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Term
| what are anaphylactoid reactions? |
|
Definition
| These are not IgE mediated but they cause similar mast cell activation. |
|
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Term
| Which Ig is involved in anaphylaxis? |
|
Definition
IgE.
The allergen reacts with IgE on mast cells and basophilic triggering the release of histamine and formation of new mediators. |
|
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Term
|
Definition
A severe life threatening generalised or systemic hypersensitivity reaction.
It is a type 1 hypersensitivity reaction. |
|
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Term
| What dose and route should we give chlorphenamine in anaphylaxis? |
|
Definition
10mg IM or IV slowly
This is an antihistamine |
|
|
Term
| what dose and route of hydrocortisone should we give in anaphylaxis? |
|
Definition
|
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Term
| How can anaphylaxis be diagnosed in cases where there is ambiguity? |
|
Definition
Measure serum mast-cell tryptase. Tryptase demonstrates mast cell degranulation.
they peak one hour after anaphylactic reaction and stay elevated for 6 hours |
|
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Term
| What dose of adrenaline is contained in an adult self-use Epipen? Is this the same as in children's? |
|
Definition
300mcg = 0.3ml in 1:1000
the children's pen has 0.3ml 1:2000 = 150mcg |
|
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Term
| formulate a management plan for pt with life threatening allergy. |
|
Definition
ID allergen so it can be avoided
Organise self use eli pen and demonstrate how to use it
Give a written self management plan and information about anaphylaxis, biphasic reactions and signs and symptoms of a possible severe reaction
Encourage the pt to wear a medical ID bracelet or something similar. |
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Term
| DDx for respiratory depression in drug OD |
|
Definition
|
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Term
| if someone presents with OD and are tachypnoeic what would you be thinking is the cause? |
|
Definition
metabolic acidosis
e.g Salicylate poisoning or methanol |
|
|
Term
| if pt is tachycardic with irregular pulse in drug OD which drugs would you suspect are involved? |
|
Definition
Salbutamol
antimuscarinics
TCA
quinine
phenothiazine
cardiac glycosides
amphetamines
theophylline poisoning. |
|
|
Term
| If pupils are dilated in OD which drugs would you be thinking? |
|
Definition
amphetamines
TCA
anticholinergics |
|
|
Term
| Pin point pupils in drug OD |
|
Definition
|
|
Term
|
Definition
400mcg IV, no response after 1m?
800mcg IV, no response 1m?
Repeat 800mcg, no response?
2mg IV
review |
|
|
Term
Causes of unreactive pupils in drug OD?
Which drug can cause strabismus in OD? |
|
Definition
Barbiturates
CO
hydrogen sulphide
carbamazepine can cause strabismus if taken in excess |
|
|
Term
| Which drugs can cause hypoglycaemia? What rx would you give for this? |
|
Definition
Insulin
PO hypoglycemic
alcohol
salicylates
rx: 50ml 50% dextrose IV |
|
|
Term
| Which drugs can cause hyperglycaemia in OD? |
|
Definition
organophosphates
theophyllines
MAOI
salicylates. |
|
|
Term
| what medication can you give to calm seizures in OD? |
|
Definition
Diazepam 5-10mg IV or
Midazolam 0.15mg/kg body weight |
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|
Term
| in Paracetamol OD which enzyme rise is suggestive of severe liver damage? |
|
Definition
|
|
Term
| Ingesting how many grams of paracetamol is potentially fatal? |
|
Definition
12g.
<150mg/kg body weight is unlikely to be toxic but
> 250 mg/kg body weight is likely to be toxic |
|
|
Term
| Paracetamol is inactivated by the liver by conjugation. What are the 2 main metabolites? |
|
Definition
Glucuronide
Sulfate
it is then renal extorted via urine |
|
|
Term
| name the toxic metabolite produced in paracetamol OD |
|
Definition
N-acetyl-p-benzoquinone imine (NAPQI)
this is usually inactivated by glutathione but in OD glutathione reserves are depleted to less than ~30% allowing NAPQI to react with nucleophilic aspects of the cell. this causes necrosis in the liver and kidney tubules. |
|
|
Term
| if someone has HIV, (alcoholic) liver disease, CF or is malnutrition what happens to their glutathione reserve levels? |
|
Definition
|
|
Term
| clinical features of paracetamol OD |
|
Definition
RUQ pain
Jaundice
encephalopathy
oliguria
hypoglycemia
renal failure - develops on day 3
lactic acidosis |
|
|
Term
| what is the significance of asking the pt whether they took alcohol with their paracetamol OD? |
|
Definition
Acute alcohol ingestion will inhibit liver enzymes. This may reduce the production of the toxin NAPQI.
in contrast chronic alcoholism may increase it |
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|
Term
| What should you ix in paracetamol OD? |
|
Definition
ALT - if it is > 1000 iu/l suggest hepatotoxicity
glucose - hypoglycemia due to liver necrosis
clotting - prothrombin. INR 12 hourly
U and E - look for renal failure
ABG - acidosis |
|
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Term
| what is the criteria for receiving acetylcysteine in pts who's OD are being timed? |
|
Definition
| if the plotted plasma level is on or above the line between 100mg/L at 4hrs and 15mg/L at 15 hours post ingestion |
|
|
Term
| how is acetylcysteine administered? |
|
Definition
initial dose given as infusion over 60 mins.
full rx course consists of 3 doses given consecutively without any breaks. This usually takes 24 hours |
|
|
Term
| what is the King's college Hospital criteria for liver transplant in paracetamol induced ALF? |
|
Definition
you should list pt for transplant if:
Arterial PH <7.3 or lactate >3 after adequate fluid resus OR
if all the following 3 occur in a 24 hour period
1. creatinine > 300
2. PT >100seconds (INR >6.5)
3. Grade III/IV encephalopathy
strongly consider transplant is lactate >3.5 after early fluid resus |
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|
Term
| in salicylate OD what amount can children/adults ingest and not be admitted if they do not have symptoms? |
|
Definition
< 125mg/kg
ingestion of >250mg/kg likely to cause moderate toxicity
ingestion of >500mg/kg causes severe and possibly fatal consequences. |
|
|
Term
| S and S of mild salicylate poisoning |
|
Definition
Nausea
vomiting
tinnitus
lethargy
dizziness |
|
|
Term
| s and s of severe salicylate poisoning |
|
Definition
dehydration
restlessness
sweating
warm extremities, bounding pulse
increase RR, hyperventilation
deafness
there is disturbance in acid base balance.
hyper/hypo or normoglycemia may be evident. |
|
|
Term
|
Definition
renal fx
FBC
coagulation
urinary pH
blood glucose
plasma potassium check every 3 hours
ABG - mixed respiratory alkalosis and metabolic acidosis with normal or high arterial pH. |
|
|
Term
| describe the ingestion amounts and likely toxicity that can result in salicylate OD |
|
Definition
> 125 mg/kg - mild toxicity
>250 mg/kg - moderate
>500mg/kg - severe possibly fatal |
|
|
Term
| describe the clinical grading of salicylate toxicity e.g. mild moderate and severe |
|
Definition
Mild - tinnitus, nausea, vomiting
moderate - hyperventilation, confusion
severe - hallucinations, seizures, coma cerebral/pulmonary oedema |
|
|
Term
|
Definition
activated charcoal i if presentation <1 hour
gastric lavage if >500mg/kg within 1 hour
agressive rehydration and glucose
urinary alkalisation
sodium bicarbonate if levels are still >500mg/L. correct hypokalemia before giving bicarb.
Hemodyalisis. |
|
|
Term
| when should we consider hemodyalisis in salicylate poisoning? |
|
Definition
levels >700mg/L
AKI
CCF
coma
convulsions
severe metabolic acidosis < 7.2 |
|
|
Term
| list some acute opioid withdrawal symptoms |
|
Definition
sweating
watery eyes
runny nose
yawning
hot and cold
anorexia and stomach cramps
nausea, vomiting, diarrhoea, tremor
dilated pupils
goosebumps
increased bowel sounds
coughing
tachycardia
htn |
|
|
Term
| if someone presents with OD and smelling garlic like, what would you assume they had ingested? |
|
Definition
organophosphates.
organophosphates causes small pin point pupils like opiates. |
|
|
Term
| mx for organophosphate poisoning |
|
Definition
activate charcoal if within 2 hours
atropine to reduce secretions and give until hr is at 80-90 bpm
Pralidoxime may be given with atropine
diazepam 5-10 mg IV |
|
|
Term
|
Definition
| Belongs to family of oxides. it binds to organosphosphate inactivated acetylcholinesterase and is used to combat poisoning by organophosphates. it is given in conjunction with atropine and diazepam. |
|
|
Term
| what would you see in the blood film of lead and arsenic poisoning? |
|
Definition
Basophilic stippling.
in lead poisoning you may also get normochromic or microcytic anaemia. |
|
|
Term
| How would you manage mercury poisoning? |
|
Definition
inhaled mercury should be rx with IV hydrocortisone to minimise pulmonary complications
acute intake of inorganic mercury should be treated with chelating agents such as d-penicillamine. |
|
|
Term
|
Definition
| IV desferrioxamine is the antidote |
|
|
Term
| what to give in methanol OD? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| amitryptiline OD? what is the rx? |
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
| rx for cyanide poisoning? |
|
Definition
| hydroxycobalamin/Nitrites (inhales) |
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Term
|
Definition
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Term
|
Definition
|
|
Term
| Metheamoglobin poisoning rx? |
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Definition
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Term
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Definition
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Term
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Definition
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