Acute Flashcards
STEMI management
- IV morphine + metoclopramide
- 15L oxygen if low
- Dual antiplatelet (high dose): aspirin 300mg, ticagrelor 180mg
- Percutaneous coronary intervention if possible within 120 mins (or IV alteplase within 30 mins if PCI not ready by then)
NSTEMI management
- IV morphine + metoclopramide
- 15L oxygen if low
- Dual antiplatelet (high dose): aspirin 300mg, ticagrelor 180mg
- Immediate coronary angiography (or fondaparinux if not immediate)
Acute heart failure management
A-E
Sit upright
15L oxygen
IV furosemide
IV diamorphine
GTN spray SL
No response:
Repeat furosemide
Escalate to ITU
Non-invasive PPV
Nitrate
PEFR in moderate, severe and life-threatening asthma
Moderate: 50-75%
Severe: 33-50%
Life-threatening: PEFR <33%
Acute asthma management
A-E
Warn ICU
15L oxygen
Nebulised salbutamol
IV hydrocortisone (or PO prednisolone)
If responding: continue 4-6 hourly nebulised salbutamol + prednisolone for 1 week
Escalation:
Nebulised ipratropium bromide
IV magnesium sulphate
IV aminophylline
Intubation
Acute exacerbation of COPD management and what to discharge with
A-E
15L oxygen (24% first venturi mask if CO2 retention)
Nebulised salbutamol
Nebulised ipratropium
IV hydrocortisone
IV antibiotics
Escalation to ICU:
Non-invasive PPV
(IV aminophylline - not used really anymore)
Intubation and ventilation
Discharge with prednisolone 7-14 days
Primary pneumothorax management
> 2cm/breathless - aspirate (16-18G)
<2cm - review in 2-4 weeks
Secondary pneumothorax management
> 2cm/breathless - chest drain
1-2cm - aspirate
<1cm - high flow O2, observe 24 hours
Haemodynamically unstable pneumothorax management
Chest drain
Bilateral pneumothorax management
Chest drain
Tension pneumothorax management
Large-bore needle (14-16G) with syring with saline
Remove trapped air bubbling into syringe
Request CXR
Insert chest drain
Pulmonary embolism management (Well’s score > 4) and haemodynamically stable
PE likely
A-E
CTPA (anticoagulate with DOAC e.g. apixiban if delayed)
If positive:
DOAC
Heparin if low eGFR
If negative:
Proximal leg vein USS
Pulmonary embolism management (Well’s score > 4) and haemodynamically unstable
A-E
Heparin and alteplase
Pulmonary embolism management (Well’s score 4 or less)
A-E
D dimer
Positive: CTPA
Negative: Consider alternative diagnosis
Upper GI bleed management
A-E
Initiate major haemorrhage protocol if >5L
NBM
Stop anticoag/platelet
2 large-bore cannulae
IV crystalloid up to 1L
O-negative blood until crossmatch complete
Monitor urine output with catheter
Endscopy or mesenteric angiography
Sengstaken-Blakemore tube
SC ceftriaxone and terlipressin if variceal bleed
PPI if ulcer bleed
Meningitis management
A-E
IV access:
Blood culture, blood glucose, HIV
LP unless rapidly deteriorating or raised ICP
IV cefoxatime (+ ampicillin > 50 years)
Consider IV dexamethasone
Status epilepticus management
Start a clock
A-E
Open and secure airway
Call for help
15L oxygen and suction
IV access - bloods
IV lorazepam - repeat once after 10 mins if no response
(Thiamine if malnourishment
100ml 20% glucose if hypoglycaemia
Fluids if hypotension
Dexamethasone if tumour)
IV phenytoin (monitor BP and ECG)
ICU review
When to CT head < 1 hour
Focal neurological deficit
Skull fracture
Seizure
Vomit 2+
Raised ICP management
A-E
Urgent neurosurgery referral
Sit up 40 degrees
Hyperventilate if intubated (reduced CO2, cerebral vasoconstriction)
Mannitol
Dexamethasone (if tumour)
Fluid restriction
DKA management
A-E
Call for help
Fluid bolus (500ml over 15 mins) then continue
Insulin - fixed-rate infusion until ketones <0.6
Potassium
10% dextrose when glucose <14
LMWH for VTE prophylaxis due to dehydration
Myxoedema coma management
A-E
IV T3
IV hydrocortisone
Warming blanket
Thyroid storm management
A-E
IV propranolol
PO carbimazole
IV hydrocortisone
IV fluids
Cooling
Treat precipitant
Lugol’s iodine for 10 days
Carbon monoxide poisoning management
A-E
100% high-flow oxygen via tight-fitting non-rebreathe mask with inflated seal for 6 hours
SpO2 target 100%
Mannitol of cerebral oedema
Hyperbaric oxygen if severe (specialist)
Hypothermia management
A-E
Warm-humified O2
Remove wet clothes
Rewarm +0.5C an hour - blankets, warm IV infusion
Abx cover for pneumonia
Sepsis management
A-E
Administer O2 – aim >94%, or 88-92% if at risk of CO2 retention
Take blood cultures
Give broad-spectrum abx
IV fluid challenge – 500ml over 15 mins
Measure lactate
Measure hourly urine output
Anaphylaxis management
A-E but straight to management if suspected
Call for help
Remove trigger
Lie flat and secure airway
IM adrenaline 1:1000 500ug
Repeat after 5 mins if no response
Still no response = refractory
Adrenaline infusion and continue IM doses
IV access and fluid challenge for hypotension
Alert ITU/CCOT/anaesthetics
Anaphylaxis discharge plan
Allergy clinic visit
2x epipens - teach
MedicAlert bracelet with allergen name
Stroke management
A-E
CT head: excluded haemorrhagic
- aspirin 300mg
- alteplase within 4.5 hours
- consider thrombectomy within 6 hours
If haemorrhagic, generally supportive care / surgical resection of haematomas.
Secondary prevention anticoag/platelet for PE, MI, AF, stroke, TIA
PE
1) DOAC
2) heparin
MI
- aspirin
- clopidogrel
AF
1) DOAC
2) warfarin
Stroke
- aspirin
- clopidogrel
- dipyridamole
TIA
- clopidogrel
