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4th Year SB > Acute Care > Flashcards

Acute Care Flashcards

1
Q

acute pain management

A

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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2
Q

standard PCA prescription

A

1mg morphine bolus

5 min lock out

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3
Q

Oral morphine to SC morphine = conversion factor

A

Divide by 2

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4
Q

Weak Opioid to Oral Morphine = conversion factor

A

Divide by 10

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5
Q

Oral Morphine to IV morphine = conversion factor

A

Divide by 3??

Some places say divide by 2??

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6
Q

how to calculate breakthrough dose for morphine

A

1/6th of the total daily dose

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7
Q

Initial management of DKA

A

Fluids

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8
Q

DKA protocol for changing IV to S/C insulin

A

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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9
Q

HDU patient with some severe illness, how you monitor BP

A

Intra-arterial BP

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10
Q

infusion rate of insulin in DKA

A

0.1 units/kg/hour

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11
Q

first step in bradycardia algorithm

A

IV Atropine 500mcg

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12
Q

Next step if unsatisfied with response to one bolus of atropine

A 
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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13
Q

Tachycardia with pulse algorithm - step 1

A

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

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14
Q

Tachycardia with pulse algorithm - if adverse features, next step

A

Synchronised DC shock - up to 3 attempts

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15
Q

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

A

Amiodarone 300mg IV over 10-20 mins

Repeat Shock

Then give Amiodarone 900mg over 24 hours

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16
Q

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

A

assess QRS complex = broad or narrow

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17
Q

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

A

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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18
Q

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

A

Assess whether regular or irregular

If regular

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

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19
Q

what is half life of adenosine

A

8 to 10 seconds

20
Q

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

A

Seek expert help

21
Q

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

A

IF VT

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

22
Q

ALS algorithm - first step

A

CPR 30:2

[assess rhythm]

23
Q

ALS algorithm - what are the shockable rhythms

A

Pulseless VT

VF

24
Q

ALS algorithm - next step with shockable rhythms

A

1 shock

25
Q

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

A

after 3 shocks give adrenaline 1 mg IV and amiodarone 300 mg IV

give further Adrenaline with alternative shocks

26
Q

ALS Algorithm - what are non-shockable rhythms

A

asystole

pulseless electrical activity

27
Q

how often can adrenaline be given

A

every 3 to 5 minutes

28
Q

what are the reversible causes

A

4H’s and 4T’s

Hypothermia
Hypoxia
Hypovalaemia
Hyperkalaemia/Hypokalaemia

Thrombosis
Toxin
Tension pneumothorax
Tamponade

29
Q

ALS Algorithm - non-shockable rhythms, approach

A

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)

30
Q

Paeds ALS Algorithm - step 1

A

5 rescue breaths

CPR 15:2

31
Q

what is the dose of adrenaline for adults

A

500 micrograms IM [0.5 mL]

32
Q

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

A

500 micrograms IM [0.5 mL]

33
Q

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

A

300 micrograms IM [0.3 mL]

34
Q

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

A

150 micrograms IM [0.15mL]

35
Q

what does it mean if adrenaline is 1 in 1000

A

1g in 1000ml

[as 1mg in 1ml]

i.e. to get 500 MICROgrams only need 0.5ml

36
Q

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

A

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

37
Q

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

A

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

38
Q

monitoring needed in anaphylaxis

A

ECG
Pulse oximetry
Blood Pressure

39
Q

what do you need to do when you suspect anaphylaxis

A

phone peri-arrest team

40
Q

paracetamol overdose treatment

A

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

41
Q

TCA overdose treatment

A

IV Sodium Bicarbonate

42
Q

Beta-Blockers overdose treatment

A

Glucagon

43
Q

Opioids overdose tx

A

naloxone 400mcg IV/IM

44
Q

cocaine overdose tx

A

diazepam

45
Q

benzos overdose tx

A

flumazenil 200mcg IV

46
Q

CCBs overdose Tx

A

high dose insulin

47
Q

what causes toxicity in paracetamol overdose

A

too much for glutathione to deal with&raquo_space; unconjugated&raquo_space; toxic

4th Year SB (22 decks)

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