acute care

Question 1

in adult anaphylaxis how much adrenaline is given?

Answer 1

0.5ml/mg 1:1000 IM

Question 2

how often do you repeat IM adrenaline in adult anaphylaxis?

Answer 2

repeat every 5 minutes

Question 3

how much hydrocortisone is given in adult anaphylaxis?

Answer 3

200mg slow IV

Question 4

how much chlorphenamine is given in adult anaphylaxis?

Answer 4

10mg slow IV

Question 5

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

Answer 5

hydrocortisone - 100mg

chlorphenamine 5mg

Question 6

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

Answer 6

hydrocortisone - 50mg

chlorphenamine - 2.5mg

Question 7

what is the treatment for bradycardia?

Answer 7

atropine 500mcg IV

Question 8

how many times can atropine be used for bradycardia?

Answer 8

repeat atropine up to 6 times (3mg)

Question 9

what other drugs can be used to treat bradycardia?

Answer 9

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

Question 10

what drug is used to treat adult broad complex tachycardia?

Answer 10

amiodarone

300mg IV over 10 to 20 mins

Question 11

how much amiodarone can be given in 24 hours?

Answer 11

900mg IV over 24 hours

Question 12

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

Answer 12

after three failed DC shocks in unstable patient

regular BROAD complex tachycardia

Question 13

what is used to adult narrow complex tachycardia?

Answer 13

adenosine 6mg IV bolus

Question 14

how much adenosine can be given in taychardia?

Answer 14

up to two further 12mg blouses if no effect

Question 15

what are the indications for using adenosine in tachycardia?

Answer 15

failed vagal manoeuvres in regular narrow complex tachycardia

Question 16

how much adrenaline is given during cardiac arrest?

Answer 16

10mg 1:10,000 adrenaline IV

Question 17

how often can adrenaline be given during cardiac arrest?

Answer 17

every 3-5 minutes

Question 18

how much amiodarine is given during cardiac arrest?

Answer 18

300mg amiodarone

Question 19

when is amiodarone given during cardiac arrest?

Answer 19

after 3 shocks

Question 20

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

Answer 20

NAPQI

liver damage

Question 21

what is used to treatment paracetamol overdose?

Answer 21

acetylcysteine - Parvolex

Question 22

how does Pravolex treat paracetamol overdose?

Answer 22

broken down to produce acetylcysteine which mops up the excess

Question 23

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

Answer 23

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

wait till 4 hours to send off paracetamol levels

Question 24

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

Answer 24

send away paracetamol levels urgently

Question 25

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

Answer 25

depends on serum paracetamol level - treat if >5mg

Question 26

what is the antidote for opioid overdose?

Answer 26

naloxone

Question 27

what is the antidote for benzo overdose?

Answer 27

flumazenil

Question 28

what is the antidote for beta blocker overdose?

Answer 28

glucagon

Question 29

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

Answer 29

day before | risk of AKI

Question 30

prior to surgery, when should you stop warfarin?

Answer 30

5 days before

Question 31

prior to surgery, when should you stop LMWH?

Answer 31

24 hours before

Question 32

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

Answer 32

7 days before

Question 33

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

Answer 33

heparin

Question 34

who is considered high risk warfarin patient?

Answer 34

AF VTE in last 3 months metal heart valves

Question 35

what are the INR cut offs for surgery going ahead?

Answer 35

<1.5

Question 36

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

Answer 36

1mg of vit K

Question 37

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

Answer 37

2mg of vit K

Question 38

what should be done post operatively about restarting warfarin?

Answer 38

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

Question 39

what is a short acting local anaesthetic?

Answer 39

lidocaine

Question 40

what is a long acting local anaesthetic?

Answer 40

bupivacaine

Question 41

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

Answer 41

adrenaline | fingers, ears, nose

Question 42

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

Answer 42

propofol thiopental - GABAa agonists

Question 43

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

Answer 43

rocuronium vecuronium suxamethonium - nACH antagonists

Question 44

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

Answer 44

neostigmine

Question 45

what opiate is used in GA?

Answer 45

fentanyl | prevent response to trauma of intubation and incision

Question 46

what benzo is used in GA?

Answer 46

midazolam | makes patient drowsy prior to procedure

Question 47

what are some complications of GA?

Answer 47

``` bradycardia hypotension laryngospasm malignant hyperthermia mendelson syndrome ```

Question 48

how do you treat bradycardia in GA?

Answer 48

IV atropine (500mcg)

Question 49

how do you treat hypotension in GA?

Answer 49

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

Question 50

how do you treat laryngospasm in GA?

Answer 50

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

Question 51

how do you treat malignant hyperthermia in GA?

Answer 51

IV dantrolene + active cooling

Question 52

what is mendelson syndrome?

Answer 52

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

Question 53

how can mendelson syndrome be prevented?

Answer 53

antacid pre-operative --> ranitidine