Acute Care Flashcards
How do you assess airway?
Talk to the patient
Look for FB, secretions, angioedema,
Listen for air entry, stridor
Feel expired air
How would you intervene if airway is not patent?
Remove FB with one finger
Suction of secretions
Airway manoeuvres
Oropharyngeal/Nasopharyngeal tubes
Intubate if GCS <8, call anaesthetics
How would you assess breathing?
Look for chest expansion, cyanosis, deformities
Listen for air entry, added sounds, wheezes
Feel for tracheal deviation, chest expansion, percussion
Obs: RR, Sats
How would you intervene if breathing is felt to be inadequate?
Sit pt upright
15 L non-rebreather
28% Venturi if CO2 retainer
?Nebulisers
Bedside CXR
ABG
How would you assess circulation?
Look: Warm, well, perfused or sweaty and cool. Any blood loss?
Listen: HS I + II + 0
Feel: Pulses and CRT x2, JVP
Obs: BP, HR, Temperature, UO
How would you intervene if circulation is inadequate?
2x wide bore cannulae
Take bloods before flush: offer relevant bloods
Fluid challenge (500ml 0.9% NaCl, 250ml if elderly/HF) Repeat twice
G&S/ O-ve blood products if indicated
12 lead ECG ?Cardiac Monitoring
Catheterise
How would you assess disability?
GCS
Pupils - equal, round, reactive to light accommodation
BM
Brief Neuro Exam
How would you intervene if disability is felt to be an issue?
Bleep Anaesthetics
Normalise BM
Antidotes if toxins suspected
CT Head? (Seek senior advice)
Exposure assessment?
Expose pt fully, looking for:
Rash
Surgical sites
Calf swelling
Indwelling catheters
Also:
Brief abdo exam
Analgesia
Urine dip +/- pregnancy test
How should you conclude all A-E approaches?
Contact a senior to make them aware of unwell pt
Full history
Document
Debrief team + Pt
Ensure long-term management is in place once stabilised
If ever concerned. 2222 peri-arrest
Reassess A-E if intervening at any stage
Delegate practical skills
‘Check guidelines’
What would you do if a pt had a cardiac arrest?
Press call bell, 2222 cardiac arrest x ward
Call for help, start CPR
Delegate other roles
high flow O2
Scribe
IV/IO access
Crash Trolley
Defibs on (r under clavicle) (l V6 MAL)
Give adrenaline (1/10,000 or 1mg/10ml) after 3rd shock and every shock thereafter
4 Hs, 4 Ts
How would you manage shock due to inadequate CO?
Hypovolaemia
Raise legs, 2x fluid bolus, assess response
If bleeding, consider cross matched blood +/- tranexamic acid
Consider Vit K/prothrombin complex if warfarinised
Cardiogenic: ITU, Cardiac monitor, diamorphine, UO, Echo, CT. No fluids
How would you manage shock due to inadequate CO?
Hypovolaemia
Raise legs, 2x fluid bolus, assess response
If bleeding, consider cross matched blood +/- tranexamic acid
Consider Vit K/prothrombin complex if warfarinised
Cardiogenic: ITU, Cardiac monitor, diamorphine, UO, Echo, CT. No fluids
Sepsis A-E
A - Airway
B - O2 (1 in), sputum for infection, CXR
C - Cultures (1 out), VBG for lactate (1 out), Catheter (UO = 1 out), Fluid Bolus (1 in), Abx (1 in)
D - BM, check for meningism
E - Check for source of infection
Burns management
Transfer to Major burns centre
Calculate based on Parkland formula for fluids
Warm pt if cool burn, saloine gauze, cling film, tetanus booster, morphine + metoclopramide, watch for compartment syndrome
Check for CO poisoning
Use warmed fluids
Rule of 9s
Check for trauma
Hypothermia management
Warmed O2, Warmed Fluids
J waves on ECG, Cardiac Monitor
Recheck obs every 30mins
Remove wet clothes
Hot air duvets
0.5 degrees/hr increase
Rectal temperature
Acute Asthma Management
Side rails up on bed
5mg salbutamol nebuliser back to back + 500mcg Ipratropium if severe.
100mg Hydrocortisone IV
Senior review with view to using Mg, Theophylline, IV salbutamol
Improving? Hourly nebs, Pred 40g 5-7 days, monitor peak flow, GP review that week, check inhaler technique
Acute COPD management?
Basically same as asthma.
More focus on preventing loss of respiratory urge in CO2 retainers
Check for infection
Anaphylaxis Management
Remove cause
2222, crash trolley
Raise Feet
0.5mg 1/1000 Adrenaline
200mg IV Hydrocortisone
10mg IV chlorphenamine
+/- Salbutamol meds
Hourly Obs Mast cell tryptase at 6h
COnsider ITU
After, allergy testing, epipen
Acute pneumonia management
CURB-65
Urea >7
RR >30
BP <90/60
Check for allergies, give Co-amoxiclav if severe enough for admission
Acute pulmonary oedema management
Sit up
1.25mg Diamorphine
40mg Furosemide IV
GTN (monitor BP)
Measure weight and U&Es
Fluid restriction
Escalate
Echo, optimise RFs, cardio review on discharge
PE management
<90sbp, thrombolysis with alteplase and peri-arrest call
Well’s Score >4 CTPA, <4 D-Dimer
Morphine 5mg + metoclopramide 10mg
Tinzaparin (LMWH)
IV Fluids
DOAC for 3/6m
TED stockings, mobilise, hydrate
DKA Management
Fluids (Bolus then 1L 1 hour)
500U Actrapid in 50ml Saline
0.1u/kg/hr, decrease ketones by 0.5/hr
Add potassium to fluids if normal potassium and normal Urine output
Start 10% dextrose when glucose <14
LMWH
STEMI Management
O2
Aspirin 300mg + Ticagrelor 180mg
Morphine 5mg + Metoclopramide 10mg
?GTN
Call Cardio, PCI in 120 mins, Thrombolyse with fondaparinux if no
ON discharge
-Bisoprolol
Ramipril
Atorvastatin
Dual AP therapy (aspirin for life, ticagrelor for 1y)
NSTEMI management
CCU
Aspirin 300mg + Ticagrelor 180mg
Morphine 5mg + Metoclopramide 10mg
GTN
GRACE SCORE
High risk? Metoprolol and Fondaparinux
Low risk? Discharge for outpatient review
Symptomatic bradycardia?
500mcg IV Artropine
Consider repeat/transcutaneous pacing or alternative drugs if non-adequate response or risk of asystole (heart block)
Broad regular tachycardia?
Probably VT
Amiodarone
Narrow regular tachycardia?
SVT
Vagal Manoeuvres
Adenosine 6mg -> 12mg -> 18mg
Narrow irregular tachycardia?
AF
Beta-Blocker or rate limiting CCB
Head Injury management
CT Head within 1 hour?
If GCS <13
GCS <15 after an hour
Focal Deficit
Open skull fracture
Seizure
>1 Vomiting
Refer to neurosurgery
Raised ICP management
Meningitis management
Status Epilepticus Management
Stroke management
Coma Management
AKI Management
Upper GI Bleed management?
Hyperkalaemia management?
Acute Abdomen management?
Hypoglycaemia management?
Tension Pneumothorax Management?
Pleural Effusion Management?
Aortic Dissection Management?
Hypertensive Crisis Management?
Infective Endocarditis Management?
Septic Arthritis Management
Cord Compression management
