Acute Flashcards
Acute pancreatitis treatment
• Initial treatment conservative: IV fluids and pain control; nasogastric tube if vomiting May requireL • Enteral nutrition • Intravenous antibiotics • ITU support
Management of DVT
Calculate Well’s score, if DVT likely
- do proximal leg vein ultrasound scan within 4 hours and, if the result is negative, a D-dimer test
- LMWH or fondaparinux for 5 days
- Warfarin within 24 hours for 3 months
Mx of anaphylaxis
ABCDE
Arenaline 0.5mg IM (0.5ml of 1: 1000)
Salbutamol 5mg nebulised if wheezy
Hydrocortisone 200mg IV
Chlorphrenamine 10mg IV
Give appropriate fluids e.g. bolus
- Mast cell tryptase
- Teach self injection with adrenaline
- Arrange allergy testing in OP follow up
Mx of narrow complex tachycardia/SVT
Definition: >100bpm, QRS <120ms
Could be: ST, AF, AF, AVNRT, AVRT
If unstable: sedate + DC cardiovert
If irregular rhythm - treat as AF with B-blocker + digoxin
If stable: Vagal manouvres
If fails: Adenosine
If fails: Digoxin/atenolol/verapamil/amiodarone
If fails: DC cardiovert
Mx of STEMI
ABCDE
O2 2-4L - aim for sats above 94%
12 lead ECG
“MONAC BE” PCI
Morphine/metoclopramide 10/10mg IV Oxygen if desaturating (see above) Nitrates Aspirin Clopidogrel 300mg
B blocker - atenolol 5mg
Enoxaparin - DVT prophylaxis
Primary PCI/thrombolysis with alteplase
Contraindications to thrombolysis
AGAINST
Aortic dissection GI bleeding Allergy Iatrogenic (major surgery <14days) Neuro: CVA hx or cerebral neoplasm Severe HTN Trauma
Continued therapy after MI
“ABCDS”
ACEis within 24 hours and Aspirin 75mg indefinitely B blocker Clopidogrel 75mg for 1 month DVT prophylaxis until mobile Statin
NSTEMI Mx
Same as STEMI, but no PCI. Instead:
Anticoagulate with LMWH or fondaparinux
Consider CCB (diltiazem/verapamil)
ABCS for future Aspirin and ACEi Beta blocker Clopidogrel Statin
Mx of severe pulmonary oedema
ABCDE
Sit up
15L O2 via reservoir mask
IV access + monitor ECG
Diamorphine/metaclopramide 5/10mg
Furosemide IV
GTN
If worsening, consider CPAP, nitrate infusion
Meningitis Mx
ABCDE
O2 15L
Fluid resus
If mainly septic:
Ceftriaxone 2g IV, consider ITU if shocked
If mainly meningitis:
Do LP if no CIs
Dexamethasone IV
Ceftriaxone IV
Contraindications to LP
Thrombocytopenia ICP raised Unstable Coagulation disorder Infection at LP site Focal neurological signs
Organisms causing meningitis
Meningococcus Pneumococcus Listeria Haemophilus TB Cryptococcus
Viruses (HSV2, coxsackie)
Mx of status epilepticus
Open an maintain the airway, lie in the recovery position
Oxygen, 100% + suction
Thiamine 250mg IV over 10 mins if alcoholism or malnourishment expected.
Glucose 50mL 50% IV, unless you know the glucose is normal
Correct hypotension with fluids
Slow IV bolus - LORAZEPAM. 2nd dose if no response within 2min (rectal diaz or buccal midaz can be used)
if seizures continue start PHENYTOIN
Monitor ECG and BP.
If fits continue, diazepam in 5% dextrose
Dexamethasone IV if vasculitis/cerebral oedema possible
Continuing seizures require expert help with paralysis and ventilation with continous EEG monitoring in ITU
After the seizures are controlled switch to oral therapy
Acute severe asthma Mx
ABCDE
Sit up, 100% O2 non rebreathe
Salbutamol and ipratropium news (5/0.5mg)
IV hydrocortisone (200mg)/PO pred
MgSO4
Consider aminophylline
ITU for intubation
Exacerbation of COPD
ABCDE
PEFR, ABG, CXR
24% Venturi: keep sats 88-92%
Salbutamol and ipratropium news (5/0.5mg)
IV hydrocortisone (200mg)/PO pred
If evidence of infection
Amox/Clari
Physio for sputum
If not responding, consider aminophylline, NIV, intubation
CURB-65 score
CURB 65
Confusion Urea >7 RR >30 BP <80 systolic <60 diastolic Age >65
2: intermediate
3-5: severe
CAP Mx
Suspect pneumonia - CXR
Admit if CURB65 2 or above. 3 = severe
Blood cultures, pleural fluid aspirate, brochonscopy and bronchiolar lavage if immunocompromise
Abx: co-amoxiclav IV AND clarithromycin IV. If HAP consider IV gentamicin + antipseudomonal penicillin
Senior involvement and HDU if severe
IV fluids
Analgesia
Intubation/ventilation
Pulmonary embolism management
100% O2
IV Access: clotting
ECG, CXR, ABG, serum D-dimer, CTPA/VQ scan
Morphine/metoclopramide
Suspect massive PE if systolic BP<90 or fall of 40mmHg for 15min
If critically ill with massive PE consider immediate thrombolysis (e.g. 50mg bolus of alteplase) or surgery
LMWH
Get senior help
If BP>90 start warfarin 10mg/24h
Upper GI Bleed Mx
ABCDE
Correct clotting abnormalities- vitamin K, FFP, platelet concentrate
Rockall score
Set up CVP line to guide fluid replacement
Catheterise and monitor urine output
Monitor vital signs
Endoscopy- within 4h if you suspect variceal bleeding and within 12-24h if shocked on admission with significant comorbidity
(During endoscopy you can give an injection of 1:10,000 adrenaline, thermocoagulation or endoscopic clipping)
If variceal bleeding: urgent endoscopy for diagnosis and control of bleeding- banding/sclerotherapy.
Give TERLIPRESSIN 2mg before and after endoscopy.
Post-endoscopy give high dose IV PPI e.g. omeprazole
Discontinue NSAIDs if possible and start concomitant PPI therapy
Test patients with peptic ulcer bleeding for H. Pylori and give eradication therapy if appropriate
Dx criteria for DKA
pH < 7.3
ketosis
HCO3 <15 mmol/L
hyperglycemia
Mx of DKA
insulin infusion 0.1u/kg/hr
aim to lower glucose by 1-2mmol/L/hr
balanced 0.9% saline fluid resuscitation, K+ in second bag
once glucose < 15mmol/L -> give dextrose (5%) 100mL/hr
monitor urinary ketones or BE clearance
correct osmolality by 3mosmol/kg/hr
Hourly Monitoring:
VBG
Catheter, monitor urine output
NICE CT Head guidelines
Within 1 hr if:
GCS <13 or <15 at 2 hours
Sign of basal or open skull fracture
Vomiting >1
Focal neurology
