Acute Management Flashcards
TIA/stroke
ABC, vitals
Glucose, ECG, telemetry
IV x2, O2 >90%
Determine symptom onset
FAST, DDx
Labs (rememeber INR, trop)
CT head and angio
Hemorrhagic stroke
See stroke card
Reverse AC
Monitor ICP
Consult neurosx
Non-hemorrhagic stroke
TPA if <3-4.5he from onset, >18yo, and clinical Dx ischemic stroke with deficit
With alteplase (thrombolytic)
Target BP<185/110
Check if eligible for endovascular neurointerventional care
Anaphylaxis
ABC vital IVx2 O2 airway as needed
Epinephrine 0.5mg IM thigh q5min x3 or 0.01mg/kg up to 0.3mg in kids or epinephrine infusion 0.1mcg/kg/min IV
Fluid bolus
Salbutamol 5-10 MDI puff with spacer for bronchospasm
Antihistamine and steroid
Observe for biphasic reaction up to 6 days
Croup
Dexamethasone 0.6mg/kg PO or IM, onset 2 hr
Nebulozed epi 0.5ml over 15min
Missed OCP
If <24h just take two
If >24h and first week take missing pill and back up 7 days
If >24h and in weeks 2-3 take missing pill and continue pack then start new pack without hormone free interval, back up if >3 doses missed
If unprotected intercourse in last 5 days and no active hormone x7 days, emergency contraceptive
Heart failure
Lasix 20 to 80 mg IV bolus
Oxygen titration greater than 90-92%
BiPAP if oxygen saturation <90%
Position upright
Nitroglycerine SL 0.4 mg x3 Q5 minutes (avoid in PDE5i use or inferior STEMI)
Vasopressor to maintain MAP 65 to 80
ACS
ABC and vitals
Cardiac and oxygen monitor, IV x2
Oxygen saturation above 90%
AMPLE history, PE
ECG, CXR
ASA 325mg PO or PR
CBC, trop, chem 10, INR
consult cardiology
Nitroglycerin 0.4mg SL q5min x3 if AVSS and no PDE5i
Metoprolol 25mg PO if no HF/brady/severe asthma/cocaine
Fentanyl 25mcg/morphine 2.5mg IV q5min
Atorvastatin afterwards
STEMI
Assess CRUSADE risk of post MI bleed, consider less invasive treatment if high risk
Primary PCI <90min of medical contact plus ticagrelor 180mg plus UFJ 50-70u/kg IV
If no PCI or <120min from first medical contact or <12h from symptom onset and no CI:
Fibronolysis plus clopidogrel 300mg (75mg if >75yo) plus AC
If doesn’t meet above criteria start ticagrelor 180mg and enoxaparin
NSTEMI
DAP (Ticagrelor 180mg plus AC heparin)
PCI if persistent ischemia
PEA narrow QRS (RV problem)
Fluid and consider causes:
-cardiac tamponade
-tension PTX
-PE
-severe hypovolemia/hemorrhagic shock
-acute MI
-mechanical hyperinflation
PEA wide QRS (LV problem)
IV calcium and bisphosphonate bolus and consider causes:
-severe hyperK
-sodium channel blocker toxicity (TCA)
-Acute MI (pump failure)
Asthma exacerbation
ABC (if drowsy/confusion/silent chest then consult ICU and prep for intubation)
PRAM scoring (Dyspnea, RR, HR. O2, lung function)
- severe is agitated, breathless, RR>30, accessory muscle use, pulse>120, O2<90
O2 target 93-95%
SABA MDI spacer 4-8 puffs or 5mg neb q20min x3 and repeat q1-4hr
Early PO steroids
-dex 12-16mg for 1-2 dose
Atrovent
MgSO4 25-75mg/kg/dose IV
Hyperthermia/heat stroke (>40C)
Look for aLOC, heat exposure
ABC, intubate as needed
rapid cooling with sponges/towels/fan, avoid cooling blankets that cause vasoconstriction
Rehydration
Continuous rectal probe temp monitor
CBC, lytes, UA, CK, LFT, coags
Charcoal if due to atropine or LSD
Benzos for agitation/seizure
BB and PTU for thyroid storm
Status epilepticus
Protect airway, oxygen, intubate as needed, if unable to terminate seizure
IV access
Terminate seizure with benzodiazepine (at 5 and 10min if needed)
– Lorazepam, 0.1 mg/kg IV up to max 8mg IV
Rule out hypoglycaemia
– Glucose 1 to 2 amp D50W
Rule out hyponatremia
– 150ml of 3% NaCl
Antiepileptic, if seizure greater than five minutes (at 15 min use these if benzos not working)
-keppra 60mg/kg IV
-valproic acid
-fosphenytoin
-phenobarbital
Intubate if seizure continues
-propofol with ketamine and rocuronium at 30 min if no change
Call neurology and ICU
