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FINALS > acute care > Flashcards

acute care Flashcards

1
Q

in adult anaphylaxis how much adrenaline is given?

A

0.5ml/mg 1:1000 IM

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2
Q

how often do you repeat IM adrenaline in adult anaphylaxis?

A

repeat every 5 minutes

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3
Q

how much hydrocortisone is given in adult anaphylaxis?

A

200mg slow IV

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4
Q

how much chlorphenamine is given in adult anaphylaxis?

A

10mg slow IV

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5
Q

how much hydrocortisone and chlorphenamine is given in a child aged 6-12 during anaphylaxis?

A

hydrocortisone - 100mg

chlorphenamine 5mg

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6
Q

how much hydrocortisone and chlorphenamine is given in a child aged less than 6 during anaphylaxis?

A

hydrocortisone - 50mg

chlorphenamine - 2.5mg

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7
Q

what is the treatment for bradycardia?

A

atropine 500mcg IV

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8
Q

how many times can atropine be used for bradycardia?

A

repeat atropine up to 6 times (3mg)

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9
Q

what other drugs can be used to treat bradycardia?

A

isoprenaline 5mcg IV
adrenaline 2-10mcg IV
transcutaneous wiring

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10
Q

what drug is used to treat adult broad complex tachycardia?

A

amiodarone

300mg IV over 10 to 20 mins

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11
Q

how much amiodarone can be given in 24 hours?

A

900mg IV over 24 hours

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12
Q

when is it indicated to give amiodarone in tachycardia with a pulse?

A

after three failed DC shocks in unstable patient

regular BROAD complex tachycardia

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13
Q

what is used to adult narrow complex tachycardia?

A

adenosine 6mg IV bolus

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14
Q

how much adenosine can be given in taychardia?

A

up to two further 12mg blouses if no effect

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15
Q

what are the indications for using adenosine in tachycardia?

A

failed vagal manoeuvres in regular narrow complex tachycardia

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16
Q

how much adrenaline is given during cardiac arrest?

A

10mg 1:10,000 adrenaline IV

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17
Q

how often can adrenaline be given during cardiac arrest?

A

every 3-5 minutes

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18
Q

how much amiodarine is given during cardiac arrest?

A

300mg amiodarone

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19
Q

when is amiodarone given during cardiac arrest?

A

after 3 shocks

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20
Q

what is the unsafe metabolite produced by paracetamol? what does it cause?

A

NAPQI

liver damage

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21
Q

what is used to treatment paracetamol overdose?

A

acetylcysteine - Parvolex

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22
Q

how does Pravolex treat paracetamol overdose?

A

broken down to produce acetylcysteine which mops up the excess

23
Q

how do you treat paracetamol overdose if they present in <8 hours since taking overdose?

A

if >150mg/kg within last hour - activated charcoal

wait till 4 hours to send off paracetamol levels

24
Q

how do you treat paracetamol overdose if they present in 8-24 hours since taking overdose?

A

send away paracetamol levels urgently

25
Q

how do you treat paracetamol overdose if they present in<24 hours since taking overdose?

A

depends on serum paracetamol level - treat if >5mg

26
Q

what is the antidote for opioid overdose?

A

naloxone

27
Q

what is the antidote for benzo overdose?

A

flumazenil

28
Q

what is the antidote for beta blocker overdose?

A

glucagon

29
Q

prior to surgery, when should you stop ACE inhibitor? why?

A

day before

risk of AKI

30
Q

prior to surgery, when should you stop warfarin?

A

5 days before

31
Q

prior to surgery, when should you stop LMWH?

A

24 hours before

32
Q

prior to surgery, when should you stop anti-platlets?

A

7 days before

33
Q

what is used to bridge high risk patients who have come off warfarin for an operation?

A

heparin

34
Q

who is considered high risk warfarin patient?

A

AF
VTE in last 3 months
metal heart valves

35
Q

what are the INR cut offs for surgery going ahead?

A

<1.5

36
Q

if INR prior to surgery is 1.6-1.7 what should done?

A

1mg of vit K

37
Q

if INR is >1.8 prior to surgery what should be done?

A

2mg of vit K

38
Q

what should be done post operatively about restarting warfarin?

A

if no major bleeding risk
restart on day of operation and cover with heparin
recheck INR in 48 hours

39
Q

what is a short acting local anaesthetic?

A

lidocaine

40
Q

what is a long acting local anaesthetic?

A

bupivacaine

41
Q

what can sometimes be given with local anaesthetic? which areas of the body can this not be used on?

A

adrenaline

fingers, ears, nose

42
Q

what are induction agents used in GA? how do they work?

A

propofol
thiopental
- GABAa agonists

43
Q

what are muscle relaxers used in GA? how do they work?

A

rocuronium
vecuronium
suxamethonium
- nACH antagonists

44
Q

what can be used to reserve the affects of a muscle relaxer?

A

neostigmine

45
Q

what opiate is used in GA?

A

fentanyl

prevent response to trauma of intubation and incision

46
Q

what benzo is used in GA?

A

midazolam

makes patient drowsy prior to procedure

47
Q

what are some complications of GA?

A 
bradycardia
hypotension 
laryngospasm 
malignant hyperthermia 
mendelson syndrome
48
Q

how do you treat bradycardia in GA?

A

IV atropine (500mcg)

49
Q

how do you treat hypotension in GA?

A

vasopressors
ephedrine (a + b agonist)
metaraminol (alpha 1 agonist)
metaraminol more selective, ephedrine will act on receptors on myocardium and cause increased HR

50
Q

how do you treat laryngospasm in GA?

A

extension of neck to aid oxygenation
minor - resolve spontaneously
severe - suxamethonium and reintubate

51
Q

how do you treat malignant hyperthermia in GA?

A

IV dantrolene + active cooling

52
Q

what is mendelson syndrome?

A

inflammation of lungs when under GA due to aspiration of stomach acid

53
Q

how can mendelson syndrome be prevented?

A

antacid pre-operative –> ranitidine

FINALS (25 decks)

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