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Some kfp stuff

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elliptic's version from 2018-05-01 10:50

Some drug doses

Question Answer
Pharmacotherapy for paracetamol overdoseAcetylcysteine 150 mg/kg IV infusion, over 15 to 60 minutes. Then 50 over 4 hrs, then 100 over 16 hours.
Toxic dose of paracetamolAcute dose: 10g or 200mg/kg. Supratherapeutic: >10g or 200mg/kg per 24 hrs, or 6g / 150mg/kg per 24h over 48h; or >4g/day or 100mg/kg/d; or >4g or 100mg/kg in someone with risk factors.
Drugs for acute goutColchicine 1 mg orally initially, then 500 micrograms 1 hour later. Ibuprofen 400mg tds. Prednisone 30mg / day for 5 days.
Dosages for smoking cessationNicotine 21mg/24hr transdermally, once daily for 24h. Varenicline 0.5mg/d for 3 days, then bd for 4 days, then 1mg bd for remainder of 12 weeks.
Antidepressant with lowest risk of serotonin syndromeMirtazapine 15 to 30 mg orally, at night
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Mixed bag 1

Question Answer
Margins for BCC3-4mm. Other options include radiotherapy (for frail), photodynamic therapy (nodular, superficial), cryotherapy (confirmed histo, well defined tumour, not head/neck), imiquamod (superficial).
Fertility testsFSH (day 3). Progesterone (7 weeks prior to menses).
Interstitial lung disease, examples1. Idiopathic, eg idiopathic pulmonary fibrosis. 2. Multisystem dz, eg connective tissue dz, sarcoid, IBD. 3. Environmental, eg. hypersensitivity pneumonitis, pneumoconiosis, drug/radiation induced. 4. Other, eg. histiocytosis.
Non-ACS causes of elevated troponins1. iatrogenic (cardiac contusion/surgery, ablation, pacemaker implantation) . 2. other heart disease (aortic dissection, aortic valve disease, hypertrophic cardiomyopathy, tachyarrhythmias, Takostubo, myocarditis) . 3. pulmonary (embolism, hypertension) . 4. neurological (stroke or SAH) . 5. other such as renal failure, rhabdo, severe illness (resp failure, sepsis), infiltrative disease (eg amyloidosis, haemochromatosis, sarcoidosis, and scleroderma)
Components of planning for future medical events for elderly patients1. appoint medical EPOA, 2. create AHD, 3. create health summary, 4. establish MyHealth Record, 5. ACAT assessment.
Surgical sieveMetabolic, Autoimmune, Genetic, Infective, Cancer, Acquired (eg. COPD, asbestosis), Degenerative, Drugs, Insanity, Trauma, Idiopathic, Vascular, Endocrine
Risk factors for BCC1. previous BCC/skin cancers; 2. skin damage (sun damage, repeated sunburn, prev cutaneous injury, prev thernal burn), 3. ionising radiation, 4. immunosuppression, 5. arsenic
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Emergencies!

Question Answer
Meningitis benzylpenicillin [60 mg/kg up to] 2.4 g IV or IM - max infusion rate 300mg/min.
Epiglottitismaintain airway, don't examine throat; urgent escorted transfer to hospital. close monitoring. empirical abx is ceftriaxone 50mg/kg up to 1g, daily for 5 days.
Acute MIAspirin 300mg chewed or dissolved. GTN 400mcg spray subling every 5 minutes to max 1200mcg. Morphine 5-10mg every 5 minutes as required. O2 if required to maintain SpO2 94-96%. If reperfusion therapy for STEMI: reteplase 10u IV bolus, repeat once after 30 minutes
AnaphylaxisRemove allergen, call for help, and lie the patient flat. 0.01mL/kg of 1:1000 adrenaline (1mg per mL), up to maximum 0.5mL. Repeat every 5 minutes as needed. Monitor abc's; give high flow O2 and/or 20mL/kg normal saline bolus if required.
Modified Parkland Formula for burnsEstimate burn extent using rule of 9's (9% = whole head or upper limb, front or back of lower limb, half of trunk) or hand = 1%. Resuscitation needed if >10% TBSA (kids) or >15% (adults). 3-4mL/kg/TBSA%. first half in 8 hours, second half in 16.
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Lumbar nerve roots

Question Answer
Tests for L3 compromiseFemoral stretch test. Extension of knee. Sensation: anterior thigh. Knee jerk (L3/L4).
Tests for L4 compromiseResisted inversion of foot [resisted eversion is S1]. Sensation: inner border of foot to great toe. Knee jerk (L3/L4).
Tests for L5 compromiseGreat toe/foot dorsiflexion (heel walking) [toe walking is S1]. Sensation: middle 3 toes.
Test for S1 compromiseWalking on toes [heel walking is L5], resisted eversion [resisted inversion is L4]. Sensation: little toe, most of sole. Reflex: ankle jerk.
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