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Management Year 3 > Acute care and Trauma > Flashcards

Acute care and Trauma Flashcards

1
Q

Describe the management plan for AKI?

A
  • ABCDE approach
    • Assess volume status - aim for euvolaemia
    • Treat Hyperkalaemia - 10 ml Calcium Gluconate
    • Review and stop nephrotoxic drugs
    • Monitor fluid intake and output + U+Es
  • Pre-renal - correct volume depletion and treat cause ​
  • Intrinsic - refer to neurology
  • Post-renal - catheterise, consider CT-KUB if obstruction

If hyperkalaemia despite management w/ pulmonary oedema, severe metabolic acidosis or uraemic Sx –> Renal Replacement Therapy

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2
Q

Describe the management plan for Addisionian Crisis?

A
  • Rapid IV rehydration + 50ml 50% dextrose
  • IV 200mg bolus hydrocortisone followed by 100mg/6hr until normalised BP
  • Treat cause of crisis e.g. ABx for infection
  • Monitor regularly
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3
Q

What is the management plan for Alcohol Withdrawal?

A

All patients

  • 1st Line - Benzodiazepines (chlordiazepoxide) - reduces symptoms.
    • consider Barbiturates if servere/ delirium tremens
  • Plus pabrinex - prevents progression to Wernicke-Korsakoff
  • Consider propofol if admitted to ATU and very severe
  • If pyschotic symptoms e.g. delirium tremens add antipyschotic - haloperidol
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4
Q

What is the management plan for Anaphylaxis

A
  • ABCDE approach + stop suspected cause
    • Position patient comfortably depending on Sx
    • IM adrenaline (0.5mg) - anterolateral aspect of thigh
      • ​Repeat dose if no change after 5 mins
    • Secure airway and give 100% O2 (>10ml/min)
    • Monitor vital signs regularly
    • Nebulised salutomol if bronchoconstriction
    • If no change consult cardiologist - consider IV atropine/glucagon
  • After attack = admit to ward and carry further tests for cause
    • ​1st Line - IM/IV Antihistamine (chlorphenamine) + IM/IV hydrocortisone
    • Monitor and review for biphasic reaction
  • Precaution - 2X adrenaline auto-injectors always on hand
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5
Q

What is the management plan for Acute Asthma attack? (In line with british thoracic society)

A
  • ABCDE approach
    • ​Supplementory O2 (Venturi mask) + monitor resp vitals
      • ​Aim for 94-98% O2 sats
    • 1st Line - SABA (salbutamol) - consider nebulisation
      • ​0.5mg every 15 minutes + oral prednisolone
    • 2nd Line - add (SAMA) iprotropium bromide if severe
    • 3rd Line - IV magnesium sulphate or aminophylline
      • ​only if PEFR <50%
  • Treat underlying cause e.g. infection w/ ABx
  • Monitor K+ as bronchodilators can cause hypokalaemia
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6
Q

What is the management plan for Cardiac Arrest?

A
  • If not in hospital setting start BLS immediately and consider precordial thump
  • Start ALS as soon as possible, assess rhythm
  • If VT or VF (Shockable rhythm)
    • Defibrillate once and continue CPR for 2 mins and reassess rhythm and shock again if no change
    • If no change after second shock administer 1mg IV adrenaline and repeat every 3-5 minutes
    • If shockable rhythm persists after 3rd shock, consider 300mg IV bolus amiodarone (once only)
  • If PEA or asystole (<60bpm) (non-shockable)
    • CPR for 2 mins and reassess rhythm
    • If no change administer 1mg IV adrenaline every 3-5 min and continue CPR
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7
Q

What is the management plan for Acute Cardiac Failure?

A
  • IPOD MAN for acute HF (look up)
    • If patient is in cardiogenic shock (SBP <90) administer inotropes e.g. dobutamine
    • Treat pulmonary oedema
    • Sit the patient up with 60-100% oxygen therapy
    • Diamorphine - venodilate + anxiolytic
    • GTN infusion
    • IV furosemide
  • Monitor essential sats

Treat cause of LV failure e.g. MI, arrhythmias

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8
Q

What is the managament plan for Chronic LV failure?

A
  • Treat the cause e.g. HTN or Valvular disease
  • Treat excacerbating factors e.g. anaemia
  • 1st line - ACEi (ARB if contraindicated) +BB +lifestyle changes
    • Consider: diuretic, aldosterone antagonists, hydrazaline and isosorbide dinatrate, digoxin
  • 2nd line - hydrazaline and isosorbide dinatrate + BB mandatory next step if ACEi contraindicated
  • If ejection fraction <35% or severe symptoms consider Cardiac Resynchronisation Therapy
  • NOTE: Avoid NSAIDs and non-dihydropiridine CCB if HF
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9
Q

What is the management plan for COPD acute exacerbation?

A

note - Usually occurs in the winter due to viral or bacterial infection

  • 1st Line = Controlled O2 (venturi mask) - aim for 88%-92% 02
    • ​+ SABA nebulised, consider SAMA if innefective
      • Oral/IV hydrocortisone - 100mg/day for 5 days
        • ​Reduce down to oral prednisolone when possible
    • Consider oral amoxicillin if infectious cause
  • 2nd Line = IV aminophylline
  • 3rd Line = intubation and ventilation in ITU
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10
Q

What is the management plan for Diabetic Ketoacidosis?

A

Diagnosis = pH < 7.3, hyperglycaemia and ketonaemia

  • 1st Line = IV Fluids
    • ​If SBP >90 = 0.9% saline transfusion
    • If SBP <90 = 500ml bolus
  • ​Supportive care and ICU admission
  • Consider K+ therapy if <5.3mmol/L
  • IV insulin neutral (only once K+ reaches 3.3mmol/L)
  • If severe volume depletion use vasopressors
  • if pH <7 - Sodium Bicarbonate therapy

Treat precipitating cause if possible e.g. infection

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11
Q

What is the management plan for Status Epilepticus?

A
  • Note - a seizure lasting >30 mins but treatment commenced after 5 mins
  • CHECK GLUCOSE - If hypo give glucose immediately
  • 1st Line = IV Lorazepam or IV/PR diazepam after 10 mins
    • ​Repeat if unsuccessful
  • 2nd Line = IV phenytoin (need ECG first)
  • 3rd Line = General anaesthetic and Intubate

Treat the cause if possible

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12
Q

What is the management plan for Stable Angina?

A
  • Primarily manage modifiable risk factors
  • Acute attacks - manage with sublingual GTN spray
  • Long term prevention
    • 1st Line - BBs e.g. atenolol
      • If contraindicated e.g Prinzmetal’s use verapamil
    • 2nd Line - combination of BB and CCB
      • If contraindicated consider addition of long-acting nitrates
  • Syndrome X - CCBs
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13
Q

What is the management plan for Unstable Angina and NSTEMI?

A

MONA BASH

  • Oxygen adminstered, IV access, vital signs + serial ECG
  • IV GTN/Isosorbide dinitrate for ischaemic relief
  • IV Morphine for pain > metoclopramide for nausea
  • Antiplatelets - Aspirin (300mg immediately, 75mg a day after)
    • Plus - Clopidogrel (300mg immediately, 75mg a day after)
  • LMWH e.g. enoxaparin
  • BBs (unless contraindicated in LV dysfunction - verapamil)
  • GPIIb/IIIa - given to those at risk of MI or Death
  • Abciximab/ eptifibatide to those undergoing PCI
  • Long term management is similar to that of stable angina
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14
Q

What is the management plan for STEMI?

A
  • Same management as NSTEMI/UA except:
    • Clopidogrel 600mg if undergoing PCI
      • plus abciximab and IV heparin
    • Clopidogrel 75 mg if >75 years undergoing thrombolysis
      • Plus Heparin/ LMWH
  • If available in <90 mins Primary PCI
  • Otherwise perform thrombolysis with alteplase
    • Only considered if <12 hours post event
    • If pain persists rescue PCI can be performed after
  • Long-term management
    • Anti-platelet - Aspirin + clopidogrel (75mg daily)
    • BBs unless contraindicated
    • ACEi for all patients unless contraindicated
    • Statins
    • Advice and Lifestyle management
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15
Q

What is the management plan for Meningitis?

A
  • Immediate - IV Abx (before LP)
    • ​1st Line = cefatoxime/ceftriaxone
      • If >55yrs add ampicillin too for listeria cause
    • ​If blind treatment in GP - IM benzylpenicillin
  • ​Dexamethasone IV - reduce risk of complications
  • If no signs of raised ICP perform LP
  • Manage in ITU and notify public health
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16
Q

What is the management plan for Ischaemic stroke?

A
  • Hyperacute (<4.5hrs) - rule out haemorrhage w/ CT
    • ​IV alteplase
    • Aspirin 24 hours after event
  • Acute - rule out haemorrage w/ CT
    • ​300mg aspirin to prevent further thrombosis
      • ​If high risk of progression or emboli consider heparin
    • Thromboprophylaxis after initial treatment
    • Formal swallow assessment + GCS monitoring
  • Preventative = 75mg clopidogrel (aspirin if contraindicated)
    • ​If paroxysmal or permanent AF - use warfarin
    • Modify risk factors e.g. HTN, DM, hyperlipidaemia
  • Surgical = carotid endarterectomy
17
Q

What is the management plan for subdural haemorrhage?

A
  • Acute - ALS protocol + watch for cervical spine injury
    • ​If raised ICP consider osmotic diuresis (mannitol)
    • If <10mm - conservative management ​
      • ​Correction of coagulopathies
      • Prophylactic anti-epileptics
    • If >10mm - Surgical + conservative management
      • ​1st line = Borr twist + hole craniostomy
      • 2nd Line = craniotomy
  • Chronic - Always antiepileptics
    • ​If symptomatic - consider elective surgery

note - young children can be treated with percutaneous aspiration via open fontanelle

18
Q

What is the management for Aspirin, opiate and paracetomol overdose?

A
  • ASPIRIN = SODIUM BICARBONATE
  • OPIATE = NALOXONE
  • PARACETOMOL = N-ACETYLCYSTEINE

Management Year 3 (13 decks)

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