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Phase 2 > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Do an A-E

A

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

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2
Q

Describe the management of an acute STEMI

A 
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
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3
Q

Describe the longterm management of acute STEMI

A 
Aspirin
Statin
ACEi
Anticoag (clopidogrel)
B-blocker
Lifestyle advice - smoking, diet, exercise, weight, alcohol 
Cardiac rehabilitation
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4
Q

Describe the management of acute NSTEMI

A

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)

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5
Q

List differentials for a broad complex tachycardia

A

VT (torsades de pointes)
SVT
AF
AVNRT (WPW)

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6
Q

Describe the management of broad complex tachycardias

A

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

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7
Q

List differentials for a narrow complex tachycardia

A

AF
Atrial flutter
AVNRT (WPW)

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8
Q

Describe the management of narrow complex tachycardia

A

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

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9
Q

List differentials for a bradycardia

A

Heart block
Sinus bradycardia
Sick sinus syndrome

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10
Q

Describe the management of bradyarrhythmias

A

Atropine 0.6-1.2g IV
Transcutaneous pacing
IV glucagon (in B-blocker overdose)

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11
Q

Describe the management of an acute asthma attack

A 
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
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12
Q

Describe the management of a COPD exacerbation

A

(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

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13
Q

Describe the management of a tension pneumothorax

A

Insert large bore (14-16G) cannula into second intercostal space, mid clavicular line –> chest drain

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14
Q

Describe the management of a pulmonary embolism

A

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

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15
Q

Describe the management of an acute upper GI bleed

A

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

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16
Q

Describe the management of status epilepticus

A 
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
17
Q

Define GCS

A 
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
18
Q

List indications of when to perform a CT head investigation within 1hr

A 
GCS <13 on initial assessment
GCS <15 two hours after injury
Focal neurological deficit
?Skull fracture/basal skull fracture
Unexplained seizure
Vomit >once
19
Q

List indications of when to perform a CT head investigation within 8hrs

A 
Current warfarin treatment
LOC + 
- age >65
- coagulopathy
- dangerous mechanism of injury
- retrograde amnesia >30 mins before injury
20
Q

Define DKA

A

Hyperglycaemia (>11mmol/L)
Ketonuria (>2+) or ketonaemia (>3mmol/L)
Acidosis (pH <7.3) or bicarbonate <15mmol/L

21
Q

List features of severe DKA

A 
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
22
Q

Describe the management of DKA

A 
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
23
Q

List complications of DKA

A

Cerebral oedema (particularly children)
Hypo/hyperkalaemia
Hypoglycaemia
Pulmonary oedema

24
Q

Describe the management of hypoglycaemia

A

20-30g glucose IV (200ml 10% dextrose)

Glucagon 1mg IV/IM

25
Q

Describe the management of HHS

A

Rehydrate (0.9% saline
Replace K+
Consider insulin 0.05 units/kg/hr

26
Q

Describe the management of hyperkalaemia

A

Stabilise cardiac membrane - 10mls 10% calcium gluconate
Insulin and dextrose - 10 units actrapid (50mls 20% glucose)
Salbutamol 5mg nebulised
Fluids
Consider dialysis

27
Q

What is the antidote for paracetamol overdose?

A

NAC

28
Q

What is the antidote for aspirin overdose?

A

Sodium bicarbonate

29
Q

What is the antidote for opiate overdose?

A

Naloxone 0.4-2mg IV

30
Q

What is the antidote for warfarin overdose?

A

Vitamin K 5mg

FFP 15ml/kg

31
Q

What is the antidote for heparin overdose?

A

Protamine sulphate

32
Q

What is the antidote for benzodiazepine overdose?

A

Flumazenil 200ug (over 15s)

33
Q

What is the antidote for lithium overdose?

A 
Fluid resuscitation (0.9% saline)
Dialysis
34
Q

What is the antidote for B-blocker overdose?

A

Atropine 3mg IV

Glucagon IV

35
Q

What is the antidote for methanol overdose?

A

Fomepizole
Ethanol
Dialysis

36
Q

Describe the management of anaphylaxis

A

Adrenaline 0.5mg IM (0.5ml of 1 in 1000) - can be repeated every 5 mins
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Fluid resuscitation
If wheezing - salbutamol 5mg nebulised
Measure mast cell tryptase 1-6h post event

37
Q

Describe the management of sepsis

A

Sepsis Six within 1hr
Administer oxygen - keep sats >94% (88-92% if COPD)
Take blood cultures
Give IV ABx according to trust protocol (meropenem 1g IV)
Give IV fluids (500mls in 15 mins bolus)
Check serial lactate with VBG
Measure urine output - catheter or fluid balance chart

Phase 2 (11 decks)

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