Acute emergencies

Question 1

how to treat pneumothorax?

Answer 1

If secondary(i.e. patient has lung disease), then always needs treatment: chest drain if >2 cm or patient has shortness of breath (SOB) or if >50 years old; otherwise aspirate.

• Otherwise (i.e. if primary) determine whether the patient needs treatment:
• if <2 cm rim and not SOB, then discharge with outpatient follow-up in 4 weeks. * if >2 cm rim on CXR or feels SOB, then aspirate and if unsuccessful aspirate
  again, and if still unsuccessful, then chest drain.
• If tension pneumothorax(i.e. clinical distinction but often tracheal deviation +/− shock), then emergency aspiration required, but will need chest drain quickly.

Question 2

what are the elements of CURB-65?

Answer 2

Confusion (abbreviated mental test score (AMTS) ≤8/10)
Urea >7.5 mmol/L, Respiratory rate >30/min, Blood pressure (systolic) <90 mmHg
Age ≥65years.

Question 3

how do you treat pneumothorax according to the CURB-65?

Answer 3

No CURB-65 then home treatment

score of 1-2: hospital tx with oral or IV Abx

score of 3+ : consider ITU admission

Question 4

Treatment of GI bleeding

Answer 4

8 C”s
ABC and oxygen
1. Cannulae - x2 large bore
2. Catheter - and strict fluid monitoring
3. Crystalloid bolus
4. Cross-match - 6 units blood
5. Correct clotting abnormalities
6. Camera (endoscopy)
7. Stop culprit drugs (NSAIDs, aspirin, warfarin, heparin)
8. Call the surgeons if severe

Question 5

treatement for suspected Suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia) prior to urgent transfer to hospital

Answer 5

benzylpenicillin IM

300mg for 1 dose : 1-11 months

1-9 years
600mg for 1 dose