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WorksheetsParacetamol Quiz
Total questions: 13
Worksheet time: 7mins
What is the correct regime for standard strength NAC?
200mg/kg NAC over 4 hours followed by 100mg/kg over 16 hours
150mg/kg over 15 minutes, then 50mg/kg over 4 hours, then 100mg/kg over 16 hours
200mg/kg NAC over 4 hours followed by 200mg/kg over 16 hours
100mg/kg NAC over 4 hours followed by 200mg/kg over 16 hours
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: 1.5hrs
Clinical features: asymptomatic, normal vital signs and examination
Check LFTs and APAP at 4 hours—NAC as per nomogram
Start NAC, check LFTs and APAP at 4 hours
Offer activated charcoal, check APAP + LFTs at 4hrs—NAC as per nomogram
Offer activated charcoal, Check APAP at 4 hours—NAC as per nomogram
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: 3.5hrs
Clinical features: asymptomatic, normal vital signs and examination
Medically clear and refer to psych
Start NAC, check LFTs and APAP at 4 hours
Offer activated charcoal, check APAP + LFTs at 4hrs—NAC as per nomogram
Check APAP + LFTs at 4 hours—NAC as per nomogram
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: 10hrs
Clinical features: asymptomatic, normal vital signs and examination
Start NAC, check FBE, EUC, LFTs, coags, VBG, paracetamol level
Start NAC, check LFTs and paracetamol level
Offer activated charcoal, check paracetamol level + LFT—NAC as per nomogram
Check paracetamol level + LFT—NAC as per nomogram
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: 28hrs
Clinical features: epigastric pain and nausea, normal vital signs and examination
Start NAC, Check FBE, EUC, LFTs, coags, VBG, paracetamol level
Start NAC, check LFTs and paracetamol level
Offer activated charcoal, check paracetamol level + LFTs—NAC as per nomogram
Check paracetamol level + LFTs; It is too late for NAC or activated charcoal.
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: 28hrs
Clinical features: epigastric pain and nausea, normal vital signs and examination
Bloods show APAP 30mg/L and ALT 78
Medically clear patient
Continue NAC infusion and send to EMU, repeat LFTs and APAP level 2 hours before end of infusion
Commence double-strength NAC and refer to medics, repeat LFTs and APAP level 2 hours before end of infusion
Continue NAC infusion and refer to medics, repeat LFTs and APAP level 2 hours before end of infusion
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40
Time: between 6 and 12hrs ago
Clinical features: asymptomatic, normal vital signs and examination
Check paracetamol level + LFT, NAC as per 6hr level on nomogram
Check paracetamol level + LFT, NAC as per 12hr level on nomogram
Start NAC, check paracetamol level + LFT, stop NAC if under 9hr level and ALT <50
Start NAC, check paracetamol level + LFT, stop NAC if under 12hr level and ALT <50
24M, 80kg
Agent/dose: paracetamol IR 500mg x 40, alcohol
Time: unknown
Clinical features: intoxicated, normal vital signs and examination
Check FBE, EUC, LFTs, coags, VBG, paracetamol level—Start NAC if ALT >50 or paracetamol >20mg/L
Start NAC, check LFTs and paracetamol level, stop only if ALT <50 and paracetamol <10mg/L
Offer activated charcoal, start NAC and complete full course; Check LFT and paracetamol level at the end
Check paracetamol level on arrival and in four hours; Start NAC if either level >50mg/L
24M, 80kg
Agent/dose: paracetamol IR 500mg x 200
Time: 3 hours
Clinical features: GCS 8/15, normal vital signs
Start NAC, check FBE, EUC, LFTs, coags, VBG, paracetamol level
Start NAC, check LFTs and paracetamol level
Intubate, give activated charcoal through NGT, start NAC, check FBE, EUC, LFTs, coags, VBG, check paracetamol level at 4hrs to guide strength of NAC
Intubate, give activated charcoal through NGT, check FBE, EUC, LFTs, coags, VBG, check paracetamol level at 4hrs and give NAC as per nomogram
24M, 80kg
Agent/dose: paracetamol IR 2g q2h for 48hrs for dental pain
Clinical features: nausea, dental and epigastric pain, normal vital signs and examination
Check FBE, EUC, LFTs, coags, VBG, paracetamol level and plot on nomogram
Check paracetamol level + LFTs and plot on nomogram (48 hours)
Check FBE, EUC, LFTs, paracetamol level, start NAC and stop only if ALT <50 and paracetamol <20mg/L (<132micromol/L)
Check LFTs, paracetamol level, start NAC only if ALT >50U/L or paracetamol >20mg/L (>132micromol/L)
2M, 12kg
Agent/dose: liquid paracetamol IR 250mg/kg
Time: 45min
Clinical features: asymptomatic, normal vital signs and examination, running around ED
Check paracetamol level at 4 hours and treat as per nomogram
Charcoal and check paracetamol level at 4 hours and treat as per nomogram
Check paracetamol level at 2hrs, if levels under nomogram (<150mg/L)
Medically clear
Check paracetamol level at 2hrs, if levels >150mg/L
Repeat paracetamol level at 4 hours—Medically clear if <150mg/L at 4 hours
24M, 80kg
Agent/dose: paracetamol SR 665mg x 10
Time: 3hrs
Clinical features: asymptomatic, normal vital signs and examination
Check FBE, EUC, LFTs, coags, VBG, paracetamol level and plot on nomogram
Start NAC, check LFTs and paracetamol level, stop only if ALT normal and paracetamol <10
Offer activated charcoal, start NAC, check paracetamol level at 4hrs and 8hrs, stop only if both levels below line and down-trending
Check paracetamol level at 4hrs and 8hrs, start NAC if either level above line or up-trending
24M, 80kg
Agent/dose: paracetamol SR 665mg x 40 (26.6g)
Time: 3hrs
Clinical features: asymptomatic, normal vital signs and examination
Check paracetamol level at 4hrs and 8hrs, start NAC if either level above nomogram
Offer activated charcoal, Start NAC, check LFTs, paracetamol level at 4hrs and 8hrs, use levels to guide strength of NAC infusion or repeat activated charcoal—Needs to complete NAC even if both levels under the line
Offer activated charcoal, start NAC, stop only if ALT down-trending and Paracetamol level <10 after complete course
Start NAC, Check paracetamol level at 4hrs and 8hrs, stop NAC if both levels below line and down-trending
