acute care Flashcards
in adult anaphylaxis how much adrenaline is given?
0.5ml/mg 1:1000 IM
how often do you repeat IM adrenaline in adult anaphylaxis?
repeat every 5 minutes
how much hydrocortisone is given in adult anaphylaxis?
200mg slow IV
how much chlorphenamine is given in adult anaphylaxis?
10mg slow IV
how much hydrocortisone and chlorphenamine is given in a child aged 6-12 during anaphylaxis?
hydrocortisone - 100mg
chlorphenamine 5mg
how much hydrocortisone and chlorphenamine is given in a child aged less than 6 during anaphylaxis?
hydrocortisone - 50mg
chlorphenamine - 2.5mg
what is the treatment for bradycardia?
atropine 500mcg IV
how many times can atropine be used for bradycardia?
repeat atropine up to 6 times (3mg)
what other drugs can be used to treat bradycardia?
isoprenaline 5mcg IV
adrenaline 2-10mcg IV
transcutaneous wiring
what drug is used to treat adult broad complex tachycardia?
amiodarone
300mg IV over 10 to 20 mins
how much amiodarone can be given in 24 hours?
900mg IV over 24 hours
when is it indicated to give amiodarone in tachycardia with a pulse?
after three failed DC shocks in unstable patient
regular BROAD complex tachycardia
what is used to adult narrow complex tachycardia?
adenosine 6mg IV bolus
how much adenosine can be given in taychardia?
up to two further 12mg blouses if no effect
what are the indications for using adenosine in tachycardia?
failed vagal manoeuvres in regular narrow complex tachycardia
how much adrenaline is given during cardiac arrest?
10mg 1:10,000 adrenaline IV
how often can adrenaline be given during cardiac arrest?
every 3-5 minutes
how much amiodarine is given during cardiac arrest?
300mg amiodarone
when is amiodarone given during cardiac arrest?
after 3 shocks
what is the unsafe metabolite produced by paracetamol? what does it cause?
NAPQI
liver damage
what is used to treatment paracetamol overdose?
acetylcysteine - Parvolex
how does Pravolex treat paracetamol overdose?
broken down to produce acetylcysteine which mops up the excess
how do you treat paracetamol overdose if they present in <8 hours since taking overdose?
if >150mg/kg within last hour - activated charcoal
wait till 4 hours to send off paracetamol levels
how do you treat paracetamol overdose if they present in 8-24 hours since taking overdose?
send away paracetamol levels urgently
how do you treat paracetamol overdose if they present in<24 hours since taking overdose?
depends on serum paracetamol level - treat if >5mg
what is the antidote for opioid overdose?
naloxone
what is the antidote for benzo overdose?
flumazenil
what is the antidote for beta blocker overdose?
glucagon
prior to surgery, when should you stop ACE inhibitor? why?
day before
risk of AKI
prior to surgery, when should you stop warfarin?
5 days before
prior to surgery, when should you stop LMWH?
24 hours before
prior to surgery, when should you stop anti-platlets?
7 days before
what is used to bridge high risk patients who have come off warfarin for an operation?
heparin
who is considered high risk warfarin patient?
AF
VTE in last 3 months
metal heart valves
what are the INR cut offs for surgery going ahead?
<1.5
if INR prior to surgery is 1.6-1.7 what should done?
1mg of vit K
if INR is >1.8 prior to surgery what should be done?
2mg of vit K
what should be done post operatively about restarting warfarin?
if no major bleeding risk
restart on day of operation and cover with heparin
recheck INR in 48 hours
what is a short acting local anaesthetic?
lidocaine
what is a long acting local anaesthetic?
bupivacaine
what can sometimes be given with local anaesthetic? which areas of the body can this not be used on?
adrenaline
fingers, ears, nose
what are induction agents used in GA? how do they work?
propofol
thiopental
- GABAa agonists
what are muscle relaxers used in GA? how do they work?
rocuronium
vecuronium
suxamethonium
- nACH antagonists
what can be used to reserve the affects of a muscle relaxer?
neostigmine
what opiate is used in GA?
fentanyl
prevent response to trauma of intubation and incision
what benzo is used in GA?
midazolam
makes patient drowsy prior to procedure
what are some complications of GA?
bradycardia hypotension laryngospasm malignant hyperthermia mendelson syndrome
how do you treat bradycardia in GA?
IV atropine (500mcg)
how do you treat hypotension in GA?
vasopressors
ephedrine (a + b agonist)
metaraminol (alpha 1 agonist)
metaraminol more selective, ephedrine will act on receptors on myocardium and cause increased HR
how do you treat laryngospasm in GA?
extension of neck to aid oxygenation
minor - resolve spontaneously
severe - suxamethonium and reintubate
how do you treat malignant hyperthermia in GA?
IV dantrolene + active cooling
what is mendelson syndrome?
inflammation of lungs when under GA due to aspiration of stomach acid
how can mendelson syndrome be prevented?
antacid pre-operative –> ranitidine
