Acute scenarios

Question 1

Glasgow coma scale

Answer 1

Eyes 4 (4=spontaneous, 3=to voice, 2=pain, 1=none)
Vocal 5 (5=Oriented, 4=Confused conversation, 3=inappropriate speech, 2=incomprehensible sounds, 1=None)
Motor 6 (6=obeying commands, 5=localise to pain, 4=withdrawing to pain, 3=flexor response to pain, 2=extensor response to pain, 1=no response to pain)

Question 2

Anaphylaxis management (adult)

Answer 2

Secure airway - call anaesthetist if necessary or likely to be
100% oxygen
Remove cause
0.5mg IM adrenaline (0.5ml of 1:1000) - repeat every 5 mins as needed
10mg chlorphenamine IV and 200mg hydrocortisone IV
If wheeze present treat for asthma
If further treatment required (e.g IV adrenaline), admit to ICU
Measure mast cell tryptase 1-6 hours later
If itching 4mg chloramphenamine every 6 hours oral
Admit and monitor with ECG

Question 3

STEMI management

Answer 3

Initial: 12 lead ECG, Bloods (FBC, lipids, U&E’s, glucose, and cardiac enzymes), 300mg aspirin, 10mg IV morphine and anti-emetic. PCI if possible
Oxygen may be necessary
After: ACEinh, beta blocker and clopidogrel (300mg load followed by 75mg after). Statins too, Keep in for around 5 days. Off work for 2 months,

Question 4

NSTEMI management

Answer 4

Admit CCU, aspirin 300mg and clopidogrel/ticagrelor/prasugrel (300mg then 75mg,180mg then 90mg, 50mg then 10mg). 5-10mg IV morphine and anti-emetic.
Oral beta blocker and fondeparinux
Angiography within 72 hours to identify need for PCI/angioplasty