Makindo Medical Notes

🚨 Initial Assessment and Emergency Management

• Primary Survey (ABCDE):
  • 🫁 A – Airway: Clear airway; protect cervical spine if trauma suspected.
  • 🌬️ B – Breathing: Assess rate, SpO₂; give oxygen if hypoxic.
  • ❤️ C – Circulation: BP, HR, IV access; give IV fluids if shocked.
  • 🧠 D – Disability: GCS/AVPU; check blood glucose.
  • 👕 E – Exposure: Look for needle marks, rashes, burns, tablets.
• 📊 Vital signs: Continuous ECG, BP, RR, SpO₂.
• 🧠 Neurology: GCS or AVPU assessment.
• 🧪 Bloods: CBC, U&E, LFT, glucose, ABG, toxicology screen.
• 📈 ECG: Check QRS/QT (esp. TCAs, digoxin, hyperkalaemia).
• 🧴 Decontamination:
  • Activated charcoal if <1 hr post-ingestion & airway safe.
  • Gastric lavage – rare, only life-threatening ingestion within 1 hr.

📏 Drugs that Need Serum Levels

💊 Specific Medical Management

• Paracetamol: N-acetylcysteine (NAC) within 8 hrs; monitor INR, LFTs.
• Opioids: Naloxone (IV/IM); repeat if needed; monitor airway/respiratory rate.
• Benzodiazepines: Flumazenil (caution – can trigger seizures in mixed OD).
• TCA overdose: Sodium bicarbonate if QRS >100 ms; benzodiazepines for seizures.

🧯 Poisons & Antidotes (Key Examples)

🧠 Psychiatric Care

• ⚡ Risk assessment: intent, method, support system.
• 👩‍⚕️ Crisis team/psychiatry referral for suicide/self-harm risk.
• 💬 Counselling & safety plan (remove access to meds/means).
• 🏥 Admit if: high risk of repetition, unsafe home environment, severe psychiatric illness.

📅 Follow-Up & Discharge

• ✅ Criteria: Medically stable + psychiatric plan in place.
• 📞 Follow-up: Crisis team, GP, outpatient psychiatry.
• 🧑‍🤝‍🧑 Family support: Involve relatives, educate on relapse signs.
• 🚭 Substance use: Refer to addiction services if alcohol/drug-related.

💡 Exam Pearl: Always think ABCDE first, then drug-specific antidotes. A negative paracetamol level does not rule out staggered ingestion → always treat if uncertain.