Acute Care Flashcards by S B

acute pain management

dilute 10mg of morphine in 0.9% saline to 10 mls (i.e. 1mg/1ml), and give in 1-2mg increments

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standard PCA prescription

1mg morphine bolus

5 min lock out

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Oral morphine to SC morphine = conversion factor

Divide by 2

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Weak Opioid to Oral Morphine = conversion factor

Divide by 10

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Oral Morphine to IV morphine = conversion factor

Divide by 3??

Some places say divide by 2??

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how to calculate breakthrough dose for morphine

1/6th of the total daily dose

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Initial management of DKA

Fluids

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DKA protocol for changing IV to S/C insulin

Established subcutaneous therapy with long-acting insulin analogues (insulin detemir or insulin glargine) should be continued during Tx of DKA

Continue insulin infusion until blood-ketone concentration is below 0.3 mmol/litre, blood pH is above 7.3 and the patient is able to eat and drink; ideally give subcutaneous fast-acting insulin and a meal, and stop the insulin infusion 1 hour later.

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HDU patient with some severe illness, how you monitor BP

Intra-arterial BP

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infusion rate of insulin in DKA

0.1 units/kg/hour

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first step in bradycardia algorithm

IV Atropine 500mcg

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Next step if unsatisfied with response to one bolus of atropine

Repeat IV Atropine 500mcg up to 3mg. 
OR
Transcutaneous pacing 
OR
Adrenaline 5-10mcg min IV
Isoprenaline 5mcg min IV

Seek expert help

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Tachycardia with pulse algorithm - step 1

Assess whether adverse features i.e. shock, myocardial ischaemia, HF, syncope

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Tachycardia with pulse algorithm - if adverse features, next step

Synchronised DC shock - up to 3 attempts

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Tachycardia with pulse algorithm - if adverse features, after DC shocks (x3), what next

Amiodarone 300mg IV over 10-20 mins

Repeat Shock

Then give Amiodarone 900mg over 24 hours

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Tachycardia with pulse algorithm - if no adverse features, next step

assess QRS complex = broad or narrow

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Tachycardia with pulse algorithm - if no adverse features, narrow tachycardia, next step (irregular)

Assess whether regular or irregular

If irregular = probable AF
Tx = 1) Control Rate with BB or Diltiazem
2) consider digoxin if HF

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Tachycardia with pulse algorithm - if no adverse features, narrow tachycardia, next step (regular)

Assess whether regular or irregular

If regular

1) Vagal manoeuvres
2) Adenosine 6mg&raquo_space; 12mg&raquo_space; 12mg IV

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what is half life of adenosine

8 to 10 seconds

Tachycardia with pulse algorithm - if no adverse features, broad complex tachycardia, next step (irregular)

Seek expert help

Tachycardia with pulse algorithm - if no adverse features, broad complex tachycardia, next step (regular)

IF VT

- Amiodarone 300mg IV over 20-60 mins then 900mg over 24 hours

ALS algorithm - first step

CPR 30:2

[assess rhythm]

ALS algorithm - what are the shockable rhythms

Pulseless VT

ALS algorithm - next step with shockable rhythms

1 shock

ALS algortihm - how many shocks till [name drug] is given

after 3 shocks give adrenaline 1 mg IV and amiodarone 300 mg IV give further Adrenaline with alternative shocks

ALS Algorithm - what are non-shockable rhythms

asystole | pulseless electrical activity

how often can adrenaline be given

every 3 to 5 minutes

what are the reversible causes

4H's and 4T's Hypothermia Hypoxia Hypovalaemia Hyperkalaemia/Hypokalaemia Thrombosis Toxin Tension pneumothorax Tamponade

ALS Algorithm - non-shockable rhythms, approach

1 - Start CPR 30:2 2 - Give Adrenaline as soon as access gained 3 - recheck rhythm after 2 mins 4 - Give further adrenaline 1 mg IV every 3–5 min (during alternate 2-min loops of CPR)

Paeds ALS Algorithm - step 1

5 rescue breaths CPR 15:2

what is the dose of adrenaline for adults

500 micrograms IM [0.5 mL]

what is the dose of adrenaline for Child > 12 y/o

500 micrograms IM [0.5 mL]

what is the dose of adrenaline for Child 6 - 12 y/o

300 micrograms IM [0.3 mL]

what is the dose of adrenaline for Child < 6 y/o

150 micrograms IM [0.15mL]

what does it mean if adrenaline is 1 in 1000

1g in 1000ml [as 1mg in 1ml] i.e. to get 500 MICROgrams only need 0.5ml

doses of hydrocortisone for anaphylaxis = adult, child older than 12, child aged 6-12, child 6 months to 6 years, child < 6 months

adult and child older than 12 = 200mg child aged 6-12 = 100mg child aged 6 months to 6 years = 50mg child < 6 months = 25mg

doses of chlorphenamine for anaphylaxis = adult, child older than 12, child aged 6-12, child 6 months to 6 years, child < 6 months

adult and child older than 12 = 10mg child aged 6-12 = 5mg child aged 6 months to 6 years = 2.5mg child < 6 months = 250mcg

monitoring needed in anaphylaxis

ECG Pulse oximetry Blood Pressure

what do you need to do when you suspect anaphylaxis

phone peri-arrest team

paracetamol overdose treatment

N-acetylcysteine [parvolex] - 150mg/kg over 1 hour

TCA overdose treatment

IV Sodium Bicarbonate

Beta-Blockers overdose treatment

Glucagon

Opioids overdose tx

naloxone 400mcg IV/IM

cocaine overdose tx

diazepam

benzos overdose tx

flumazenil 200mcg IV

CCBs overdose Tx

high dose insulin

what causes toxicity in paracetamol overdose

too much for glutathione to deal with >> unconjugated >> toxic