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PSA Prep > 3 > Flashcards

3 Flashcards

1
Q

Can we use b-blocker in LVF?

A

No

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2
Q

Management of STEMI

A
  • ABC
  • if hypoxic and no COPD: 15L O2 via non-rebreather

Meds:

  • Aspirin 300 mg PO
  • Morphine 5-10 mg IV + Cyclizine 50mg IV
  • GTN spray/tablet
  • PCI or thrombolysis
  • B-blocker (unless LVH/asthmatic) e.g. Bisoprolol 2.5 mg PO
  • Transfer CCU
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3
Q

Management of NSTEMI

A
  • ABC
  • if hypoxic and no COPD: 15L O2 via non-rebreather

Meds:

  • Aspirin 300 mg PO
  • Morphine 5-10 mg IV + Cyclizine 50mg IV
  • GTN spray/tablet
  • Clopidogrel 300mg PO and either LMWH 0r Foundapatinux 2.5mg OD SC
  • B-blocker (unless LVH/asthmatic) e.g. Bisoprolol 2.5 mg PO
  • Transfer CCU
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4
Q

The difference in the management of STEMI vs NSTEMI

A
  • STEMI: Primary PCI or thrombolysis
  • NSTEMI: Clopidogrel 300mg PO + LMWH/Foundaparinux 2.5mg OD SC

(all other steps are the same)

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5
Q

Management of Acute LVF

A
  • ABC
  • if hypoxic and no COPD: 15L O2 via non-rebreather

Meds:

  • Sit patient up
  • Morphine 5-10 mg IV + Cyclizine 50mg IV
  • GTN spray/tablet
  • Furosemide 40 - 80mg IV (repeat again as required/tolerated)
  • If inadequate response Isosorbide dinitrate infusion +/- CPAP
  • Transfer CCU
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6
Q

Adverse features of tachycardia

A
  • syncope
  • shock
  • MI
  • HF
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7
Q

Treatment of an unstable patient with tachycardia

A

(unstable/adverse features: syncope, MI, HF, shock)

  • Synchronised DC shock (up to 3 attempts)
  • Amiodarone 300 mg IV over 10-20 min + repeat shock
  • then Amiodarone 900mg over 24 hours
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8
Q

Treatment of tachycardia (with no adverse/unstable features) if QRS is narrow + rhythm is regular

A
  • Vagal manoeuvers
  • Adenosine 6 mg rapid IV bolus
  • if unsuccessful give 12 mg Adenosine
  • if unsuccessful, again 12 mg Adenosine

If sinus rhythm:

  • restored -> probable re-entry paroxysmal SVT: record ECG, if recurs give adenosine again + consider anti-arrhythmic prophylaxis
  • not restored: seek senior help + consider atrial flutter (control rate B-blocker)
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9
Q

Management of tachycardia (with no adverse features) that is of narrow QRS complex and irregular

A
  • probable AF
  • control rate with B-blocker or diltiazem
  • consider Digoxin or amiodarone if evidence of HF
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10
Q

A stable patient with tachycardia and irregular rhythm + broad QRS

(3) possible diagnosis and management

A

Seek senior help!

Possibilities:

  • AF with BBB: treat as narrow complex (control rate)
  • Pre-excited AF: amiodarone
  • Polymorphic VT (torsades de pointes): Magnessium 2g over 10 min
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11
Q

Management of a stable patient with tachycardia + broad complex QRS + regular rhythm

(2 possibilities)

A

If ventricular tachycardia (or uncertain rhythm):

  • Amiodarone 300 mg IV over 20-60 min + 900 mg Amiodarone over 24 hours

If previously confirmed SVT + BBB:

  • give adenosine (6mg -> 12mg ->12mg)
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12
Q

Is Domperidone safe to use in Parkinson’s?

A

Yes. Although Domperidone is a dopamine antagonist it doesn’t cross BBB, hence it’s safe in Parkinson’s

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13
Q

Management of acute exacerbation of asthma

A
  • ABC
  • 100% O2 by non-rebreather mask
  • Salbutamol 5mg NEB
  • Hydrocortisone 100 mg IV (if severe life-threatening)
  • Prednisolone 40-50 mg PO (if moderate)
  • Ipratropium 500 micrograms NEB
  • Aminophylline (only if life-threatening)
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14
Q

What type of pneumothorax always require treatment?

A

secondary i.e. patient has lung disease = always need treatment of pneumothorax

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15
Q

Management of anapylaxis

A
  • ABC + 15L non-rebreather mask oxygen if needed (and if no COPD)
  • remove the cause
  • Adrenaline 500 micrograms of 1:1000 IM
  • Chlorphenamine 10 mg IV
  • Hydrocortisone 200 mg IV
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16
Q

When do we insert chest drain in secondary pneumothorax?

A

Chest drain if any of the following:

  • SOB
  • >50 y/o
  • >2cm

(otherwise aspirate)

17
Q

Management of primary pneumothorax

A

Primary pneumothorax

  • if <2cm rim on CXR and not SOB -> discharge with outpatient follow up in 4 weeks
  • if >2 cm or SOB -> aspirate, if unsuccessful, aspirate again and if still unsuccessful, then chest drain
18
Q

Management of tension pneumothorax

A

emergency aspiration but will need chest drain quickly

19
Q

Management of pneumonia

A
  • High flow oxygen
  • antibiotics (depends on CURB-65 and CAP or HAP) e.g. Amoxicillin or Co-amoxiclav
  • Paracetamol
  • if low BP then IV fluids
20
Q

Management of PE

A
  • High-flow oxygen
  • Morphine 5-10 mg IV + Cyclizine 50mg IV
  • LMWH treatment dose
  • If low BP: fluid bolus + contact ITU + consider thrombolysis
21
Q

Management of GI bleed

A
  • as usual: ABC and if needed oxygen
  • cannulate x2 large bore
  • catheter + strict fluid monitoring
  • crystalloid bolus
  • cross-match 6 units of blood
  • correct clotting abnormalities
  • Endoscopy
  • STOP NSAIDs, aspirin, warfarin, heparin
  • call surgeons - if severe
22
Q

How to correct clotting abnormalities in GI bleed?

A
  • if PT/aPTT more than 1/5 times normal range -> give fresh frozen plasma (unless due to warfarin - then give prothrombin complex)
  • if platlets <50 x 109 / L + actively bleeding -> platlet transfusion
23
Q

Management of bacterial meningitis in a hospital

A
  • ABC + oxygen if needed
  • IV fluids
  • 4-10 mg Dexamethasone IV (unless severly immunocompromised)
  • LP +/- CT head
  • 2g Cefotaxime IV

*if immunocompromised or >55 y/o add 2g ampicillin IV

24
Q

When to start drug management in a seizure?

A

If lasts more than 5 min

25
Q

Drug management in seizure

A
  • Lorazepam 2-4 mg IV

OR: diazepam 10 mg IV or midazolam 10mg buccal

  • If still fitting after 5 min -> repeat benzodiazepine
  • Inform anaesthetist
  • If still fitting after further 5 min: Phenytoin 15-20 mg/kg IV
  • If still fitting after further 5 min: Propofol (intubate + ventilate)
26
Q

Management of ischaemic stroke

A
  • ABC
  • CT to exclude haemorrhage
  • if onset < 4.5 hours ago -> thrombolysis

In some centres thrombectomy may be available for certain patients if onset <24 hours ago

  • Aspirin 300 mg oral or rectal (if unsafe to swallow)
  • Transfer to stroke unit

PSA Prep (11 decks)

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