Acute Medical Algorithms Flashcards
A 34-year-old woman is admitted with rigors, chills and left flank pain. What is the most likely diagnosis?
Pyelonephritis
A 34-year-old woman is admitted with rigors, chills and left flank pain. A diagnosis of pyelonephritis is made and she is started on Ciprofloxacin.
* You are called to review her as she immediately started to complain of itchiness in her arms and developed laboured breathing. The nurse has discontinued the antibiotic.
* On review, she is now gasping for breath but is still able to talk in gasps. Her peripheral oxygen saturation is 85% on room air and her blood pressure has dropped to 86/50mmHg
What is the diagnosis?
What is your management algorithm?
Anaphylaxis
A 64-year-old man presents to the emergency department complaining of severe central chest tightness for the past 40 minutes. His medical history includes dyslipidaemia, hypertension and gout. He is diaphoretic and appears to be in some distress. His blood pressure is 150/85mmHg, heart rate is 98 beats per minute and peripheral O2 saturation is 96% on room air.
An electrocardiogram (ECG) is performed:
What findings are evident on this ECG?
What is the most likely diagnosis?
ST elevated Myocardial infarction (STEMI)
Anterolateral (bonus points)
What is your algorithm for acute tx of STEMI
A 24-year-old woman with a past medical history of eczema and asthma is brought in by ambulance to the emergency department with worsening shortness of breath for the past few hours and is in some respiratory distress.
* On arrival to the hospital, she is gasping for breath, wheezy and is finding it difficult to complete sentences.
* Her blood pressure is 120/75mmHg, heart rate 101 beats per minute, peripheral O2 saturation is 92% on room air and respiratory rate is 38 breaths per minute
What is the diagnosis?
What is your treatment algorithm?
A 34-year-old man with a known history of epilepsy is brought in by ambulance to the emergency department following witnessed seizures at home by his wife.
* She states that he ran out of his anti-epileptic medication 2 nights ago.
* He also has a significant alcohol history and normally drinks 40 units per day. He also suddenly quit alcohol 2 days ago.
* He has been having an ongoing generalized seizure for the past 10 minutes.
What is your diagnosis?
Define the diagnosis
What is your treatment algorithm?
What would you do if IV access cannot be secured due to ongoing seizure activity?
Status Epilepticus: 5 minutes or more of continuous clinical and/or electrographic seizure activity
Buccal Midazolam
Nasal Midazolam
PR Diazepam
A 23-year-old man presented to the emergency department with a 3 day history of increasing confusion, lethargy and vomiting. His friends
mentioned that had been unwell since consuming a kebab at the weekend.
* He has a background history of type 1 diabetes mellitus. His urine dipstick shows 3+ ketones with a serum venous bicarbonate is < 12 mmol/L and his
pH is 7.1. His plasma glucose is 26 mmol/L
What is the diagnosis?
What are the diagnosis guidelines for this?
What is your treatment algorithm?
Serum glucose >11mmol/L
pH <7.3 or Bicarb <15
Presence of ketonemia or ketonuria
A 19-year-old woman with a past medical history of palpitations presents to
the emergency department with severe palpitations for the past hour
associated with shortness of breath.
* On assessment, she is diaphoretic and distressed. Her blood pressure is
125/78mmHg, heart rate is 158 beats per minute. Her rhythm strip displays
the following:
What is the most likely diagnosis?
What are the findings of this rhythm strip?
SVT - Supraventricular tachycardia
Absent P waves, Narrow QRS, regular rhythm
What is your treatment algorithm for SVT?
A 66-year-old woman is referred by her general practitioner to the emergency department with a 5-day history of a cough productive of green sputum, shortness of breath and a fever.
* She has not been in hospital recently.
* On assessment, she is confused.
* Her vitals are as follows: respiratory rate 34 breaths per minute, blood pressure 110/75mmHg, heart rate 98 beats per minute, temperature 38.1°C.
Her chest x-ray demonstrates the following:
Discuss the image
What is the most likely diagnosis?
What scoring system is used to assess the severity of pneumonia? How would this influence your management?
What is the score of this patient?
What is your treatment algorithm for this patient?
Assuming this patient has a penicillin allergy. When taken
1) Feels very very sick:
2) Admitted to hospital for anaphylaxis in 2015 after taking medication for a chest infection:
How would this influence your management?
What is the most likely diagnosis?
Community Acquired pneumonia
What scoring system is used to assess the severity of pneumonia? How would this influence your management?
CURB-65
C - Confusion
U - Urea >7mmol/L
R - RR 30+
B - BP - SBP <90 or DBP <60
65 - Age >65
What is the score of this patient?
3 - confusion, RR, age
What is your treatment algorithm for this patient?
Assuming this patient has a penicillin allergy. When taken
1) Feels very very sick: Cefuroxime AND Clarithromycin
2) Admitted to hospital for anaphylaxis in 2015 after taking medication for a chest infection: Levofloxacin
An 81-year-old man is day 3 into his admission for urosepsis. The ward nurse has asked you to review him overnight as he is aggressive and confused, hitting out at other people.
* She is afraid that he is a danger to himself as well as others.
* His daughter tells you he is normally very pleasant and engaging at home
What is the diagnosis?
How would you manage this patient?
What medications should not be prescribed?
Hyperactive Delirium, secondary to his infection
1) Always try to de-escalate the situation and explain gently what is happening to re-orient themselves. Try to nurse in a quiet area and consider one-on-one care
2) If restraint w/meds are needed => give 0.5 mg Lorazepam PO as needed (max=2mg/day unless senior clinician) +/- Risperidone antipsychotics (same max).
3) IV/IM sedation (by senior consultant and old-age psychiatry). Administration should be in an area that can be monitored and with resp support if needed
Remember most sedation is renally excreted and hence may be toxic to older patients and those with CKD.
Avoid Haloperidol or other 1st generation Antipsychotics as it may cause parkinsonism and cardiac arrhythmias
67 years old patient presents to the emergency room with breathlessness.
On questioning the patient she tells you that she has COPD. She normally controls this with inhalers alone, and has no home nebulizers or long-term oxygen therapy. She says she is more breathless and wheezy but her
sputum has not changed in colour.
* On assessment RR is 30/min, O2 sats: 82% n 2 L, BP: 122/68; Temp: 36.7; HR: 84. You notice that she is alert but difficult to speak in sentence. BGL is 9.5 mmol/L.
* On auscultation there is good bilateral air entry with widespread inspiratory
wheeze. No crepitations.
What is the most likely diagnosis?
What investigations will you carry out?
What is the treatment algorithm for this?
Acute Exacerbation of COPD
FBC, U&E, CRP, ABG, CXR
WCC: 8.6
* Neuts: 6
* Hb: 15
* Plt: 220
* CRP: 12mg/L (0 - 5)
* ABG:
* pH: 7.48 (7.35 – 7.45)
* PaO2: 6kPa (>10kPa)
* PaCO2: 3.1kPa (4.7 – 6.0kPa)
* HCO3: 26mmol/L (22 - 26)
* H+: 33 nmol/L (35 - 45)
CXR: No consolidation
