Acute Care Flashcards
Do an A-E
Airway - speak to patient
Breathing - pulse oximetry, RR, tracheal deviation, percuss, auscultate
Circulation - CRT, HR, BP, JVP, heart sounds, access (bloods, fluids, drugs), ECG, abdominal examination
Disability - glucose (BM), AVPU/GCS, temperature, eyes
Exposure - top/bottom/front/back for rashes, bleeding
Describe the management of an acute STEMI
Morpine 5-10mg IV + antiemetic (metoclopramide 10mg IV) Oxygen (high flow) if sats <95% GTN spray - two puffs sublingual Aspirin 300mg PO Clopidogrel 300mg PO Primary PCI (within 120 mins) or fibrinolysis (e.g. alteplase) + fondaparinux 2.5mg or LMWH Metoprolol 50mg if HTN ACEi
Describe the longterm management of acute STEMI
Aspirin Statin ACEi Anticoag (clopidogrel) B-blocker Lifestyle advice - smoking, diet, exercise, weight, alcohol Cardiac rehabilitation
Describe the management of acute NSTEMI
Morphine 5-10mg IV + antiemetic (metoclopramide 10mg IV)
Oxygen if sats <90%
GTN spray - two puffs sublingual
Aspirin 300mg
Clopidogrel 300mg/ticagrelor 180mg/prasugrel 60mg
Metoprolol 50mg if HTN
Anticoag (fondaparinux 2.5mg or LMWH)
List differentials for a broad complex tachycardia
VT (torsades de pointes)
SVT
AF
AVNRT (WPW)
Describe the management of broad complex tachycardias
If no pulse –> arrest protocol
If pulse –> O2, IV access, 12 lead ECG
If no adverse signs –> correct electrolytes
If adverse signs –> sedate and shock
Amiodarone 300mg IV over 20-60 mins, 900mg over 24h
List differentials for a narrow complex tachycardia
AF
Atrial flutter
AVNRT (WPW)
Describe the management of narrow complex tachycardia
If rhythm irregular –> treat as AF (rate control, rhythm control, anticoagulation)
If rhythm regular –> vagal manoeuvres, adenosine 6mg, 12mg, 12mg
If no adverse signs –> b blocker, digoxin, amiodarone 300mg
If adverse signs –> sedate and shock, amiodarone 300mg IV over 20-60 mins, 900mg over 24h
List differentials for a bradycardia
Heart block
Sinus bradycardia
Sick sinus syndrome
Describe the management of bradyarrhythmias
Atropine 0.6-1.2g IV
Transcutaneous pacing
IV glucagon (in B-blocker overdose)
Describe the management of an acute asthma attack
Oxygen (high flow) *check ABG Salbutamol 5mg nebulised (back to back - every 15mins) Hydrocortisone 100mg IV or prednisolone 40mg PO Ipratropium bromide 0.5mg *Call for senior, alert ITU Theophylline Magnesium sulphate 1.2-2g IV Salbutamol IV
Describe the management of a COPD exacerbation
(Controlled) O2 - titrate to ABG *consider NIV/intubation if high pCO2
Salbutamol 5mg nebulised
Ipratropium bromide 0.5mg
Hydrocortisone 200mg +prednisolone 30mg (continue for 7-14 days)
Amoxicillin 500mg PO
Describe the management of a tension pneumothorax
Insert large bore (14-16G) cannula into second intercostal space, mid clavicular line –> chest drain
Describe the management of a pulmonary embolism
Oxygen (high flow)
Morphine 5-10mg IV + antiemetic
IV access –> treatment dose LMWH + warfarin 5-10mg PO until INR >2
Continue warfarin for 3/6 months
If massive –> immediate thrombolysis (e.g. alteplase 50mg)
If recurrent PEs, consider vena cava filter
Describe the management of an acute upper GI bleed
Protect airway
NBM
IV access (2 large bore cannula) –> fluids (consider transfusion, *massive haemorrhage protocol if necessary)
Notify gastro/surgeons –> endoscopy
If varices –> banding/sclerotherapy/terlipressin 2mg SC QDS
If ulcer –> omeprazole 80mg IV 5 mins, 8mg/hr for 72h
Describe the management of status epilepticus
Maintain airway, recovery position Oxygen (high flow) + suction if necessary IV access After 5 mins - IV lorazepam 4mg (or buccal midazolam/rectal diazepam) *Call for senior help Phenytoin infusion Diazepam infusion General anaesthetic
Define GCS
Level of consciousness /15 (minimum = 3) Eyes /4 4 - spontaneous 3 - open to pain 2 - open to voice 1 - none
Verbal 5 - orientated 4 - confused conversation 3 - inappropriate speech 2 - incomprehensible sounds 1 - none
Motor 6 - obey commands 5 - localise to pain 4 - withdraw from pain 3 - flexion to pain 2 - extension to pain 1 - no response
List indications of when to perform a CT head investigation within 1hr
GCS <13 on initial assessment GCS <15 two hours after injury Focal neurological deficit ?Skull fracture/basal skull fracture Unexplained seizure Vomit >once
List indications of when to perform a CT head investigation within 8hrs
Current warfarin treatment LOC + - age >65 - coagulopathy - dangerous mechanism of injury - retrograde amnesia >30 mins before injury
Define DKA
Hyperglycaemia (>11mmol/L)
Ketonuria (>2+) or ketonaemia (>3mmol/L)
Acidosis (pH <7.3) or bicarbonate <15mmol/L
List features of severe DKA
Ketonaemia >6mmol/L Bicarbonate <5mmol/L pH <7.1 Hypokalaemia <3.5mmol/L GCS <12 pO2 <92% Systolic BP <90 Pulse >100 or <60 Anion gap >16
Describe the management of DKA
DKA protocol: Fluid VBG Insulin 50 units actrapid to 50ml 0.9% saline infused at a rate of 0.1 units/kg/hr Check VBG at 1h, 2h, 2hrly Assess need for K+ replacement (~40mmol) Consider catheterisation Avoid hypos
List complications of DKA
Cerebral oedema (particularly children)
Hypo/hyperkalaemia
Hypoglycaemia
Pulmonary oedema
Describe the management of hypoglycaemia
20-30g glucose IV (200ml 10% dextrose)
Glucagon 1mg IV/IM
