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Obs & Gyny - Risk Factors > A&E Emergencies > Flashcards

A&E Emergencies Flashcards

1
Q

Pulmonary Oedema (Specific investigations & management)

A

INVESTIGATIONS

  • ABG
  • CXR
  • ECG
  • Bloods (renal function)

MANAGEMENT (LMNOP - loop, morphine, nitrates, oxygen, posture)

  • Sit up bed
  • O2 high flow
  • Diamorphine slow IV
  • Furosemide 40-60mg slow IV
  • GTN 2 sprays
  • FURTHER: CPAP if no response, GTN infusion
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2
Q

MI emergency management (specific investigations & management)

A

INVESTIGATIONS

  • CXR
  • ECG
  • BM
  • BLOODS: CARDIAC TROPONINS
  • Caution ABG: May damage arteries for PCI

MANAGEMENT (ROMANCE)

  • Reassurance
  • Oxygen (if <94%)
  • Morphine (5mg) IV + metoclopramide 10mg IV
  • Aspirin 300mg oral
  • GTN - 2 sprays sub-lingual
  • Clopidogrel 300mg
  • Enoxaparin
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3
Q

MI: Thrombolysis contraindications

A

Absolute

  • Lumbar puncture <7 days previously
  • Intracranial neoplasm
  • Stroke <6 months
  • GI bleeding <1 month

Relative

  • INR >1.7
  • Surgery in last 2 weeks
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4
Q

COPD I&M

A

INVESTIGATIONS

  • ABG
  • CXR
  • ECG
  • BLOODS: FBC, U&E, CRP, cultures

MANAGEMENT

  • High flow O2
  • 5mg salbutamol + 500mcg ipratropium bromide nebulised
  • 200mg IV hydrocortisone IV or 40mg prednisone oral
  • 500mg amoxicillin TDS or clarithromycin 500mg BD if penicillin allergic
  • further management: Physiotherapy, CPAP/BIPAP
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5
Q

Hyperkalaemia I&M

A

INVESTIGATIONS

  • VBG/ABG
  • Bloods (U&E)
  • ECG

MANAGEMENT

  • 1-10ml 10% calcium gluconate
  • 10 units act rapid in 250ml 10% dextrose
  • 5mg salbutamol nebulised
  • IV fluids
  • Further: Catheter, withhold nephrotoxic drugs, haemodialysis
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6
Q

Asthma I&M

A

INVESTIGATIONS

  • BLOODS
  • ABG
  • Peak flow
  • CXR
  • ECG

MANAGEMENT

  • 5mg nebuliser salbutamol back to back
  • 100mg IV hydrocortisone and/or 40-50mg predinisolone
  • 500mcgs ipratropium bromide in nebuliser
  • 1.2-2.0g magnesium sulphate IV over 20mins
  • Further: ICU, Aminophylline, IV salbutamol, CPAP/BIPAP
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7
Q

Small bowel obstruction MANAGEMENT

A
  • 500ml IV saline
  • 5mg IV morphine
  • 50mg IV cyclizine
  • 1g IV paracetamol
  • 6mg dexamethasone IV
  • 40-120 mg IV hyoscine butyl bromide
  • NBM
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8
Q

Abdominal sepsis

A 
SEPSIS 6 
Morphine 5mg IV 
Cyclizine - 50mg IV 
TAZOCIN - 4.5g IV
Paracetamol 1g IV
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9
Q

Pneumonia

A
  • Co-amoxiclave 1.2g AND clarithromycin 500mg
  • 500ml 0.9% NaCl
  • High flow O2
  • Urine output
  • Lactate
  • Blood cultures
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10
Q

Acute GI bleed

A
  • X match & G&S
  • two large bore canulla
  • IV 0.9% NaCL
  • Catheterisation
  • Vit K & FFP if clotting factors low
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11
Q

DKA

A
  • 500ml bolus NaCl (overall fluid deficit 7L in 70kg man)
  • 50units act rapid to 50ml 0.9% saline - infuse continuously at 0.1/kg/hr, aiming for fall in blood ketones of 0.5mmol/l/hour
  • Assess need for K+ replacement
  • Glucose <14mmol/l start 10% glucose at 125ml/hr alongside saline
  • LMWH

K+
>5.5 give nothing
3.5 - 5.5 give 40mmol in bag

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12
Q

Hypoglycaemia

A

CONCIOUS (BM <3.0mmol/l

  • 200ml orange juice
  • 3 teaspoons of sugar
  • 5-7 dextrose tablets (one of)
  • long acting carbohydrate

Conscious but confused
- 2 tubes glucogel into gums

UNCONCIOUS

  • 1mg glucagon IM (does not work if drunk)
  • 250ml 10% dextrose
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13
Q

HONK

A
  • LMWH

- rehydration - 8-15L fluid deficit

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14
Q

addisonian crisis

A

100mg IV hydrocortisone
IV fluid bolus
Glucose IV (250ml 10% dextrose)

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15
Q

Thyrotoxic storm

A
  • If in need of sedation: 50mg chlorpromazine IM
  • Propanolol 40mg/8hr
  • Carbimazole 15-25mg/6hours
  • after 4 hours give lug’s solution 0.3ml/8h
  • 100mg hydrocortisone IV to prevent T4 to T3 confession
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16
Q

Myxoedema coma

A

Fluids
T3 5-20mcgs
100mg hydrocortisone

17
Q

Raised ICP

A
  • Treat seizures
  • Elevate hed of bed
  • Mannitol 20% 0.5/kg IV over 10-20 mins
  • Dexamethasone 10mg IV
  • Encourage hyperventilation to reduce PCO2
18
Q

Status epilepticus

A
  • Airway open, recovery position
  • IV lorazepam 4mg if >5 mins, 2nd dose in 10mins/10mg buccal midazolam (5mg 1-5 years, 7.5 5-10 years)
  • IF ALCOHOL thiamine 250mg IV, if BM low 10% dextrose in 250ml
  • ESCALATE TO ANAESTHETIST
  • IV phenytoin 15-20mg/kg IV - monitor ECG and BP
19
Q

Meningitis

A

> 55yrs 2g cefotaxime IV + ampicillin 2g IV (listeria) - If <55 years then
aciclovir if viral cause suspected

20
Q

PE!

A
  • O2
  • Morphine 5-10mg
  • LMWH tinzaparin 175u/kg/24h SC
    OR
    UFH 10,000 units bolus
  • IF NO RESPONSE OR MASSIVE PE THEN ALTEPLASE 50mg IV over 1-2mins

Follow up: Warfarin for 3-6 months

21
Q

Anaphylaxis

A

0.5ml 1/1000
10mg chlorphenamine
200mg hydrocortisone

salbutamol 5mg nebs

Obs & Gyny - Risk Factors (18 decks)

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