Chapter 4 - Planning Management Flashcards
Analgesia + antiemetic choice for STEMI/NSTEMI/acute LVF?
Morphine 5-10mg IV + cyclizine 50mg IV
Anti-clot drugs for NSTEMI?
Clopidogrel 300mg PO + LMWH or Fondaparinux 2.5mg OD s/c
Drug to give for STEMI/NSTEMI to decrease heart workload?
Beta-blocker e.g. bisoprolol 2.5mg PO
Short-term reliever drug to consider in heart patients?
GTN spray/tablet
Main drugs to use in tachycardia situations?
Unstable - amiodarone after 3 sync DC shocks
Irregular + broad QRS = mag sulph (amiodarone if pre-excited AF)
Regular + broad QRS = amiodarone (adenosine if SVT with bundle branch block)
Regular + narrow QRS = adenosine after vagal maneouvres
Irregular + narrow QRS = rate/rhythm control with beta-blocker or diltiazem
Anaphylaxis emergency treatment algorithm?
ABC + 15L O2 by non-rebreather
Remove cause
Adrenaline 0.5mg 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Acute exacerbation of asthma treatment algorithm?
ABC + 100% O2 by non-rebreather
Salbutamol 5mg nebuliser
Moderate = prednisolone 40-50mg PO
Severe/LTing = hydrocortisone 100mg IV
Ipratropium 500mcg nebuliser
If LTing - add aminophylline
Pulmonary embolism treatment algorithm?
ABC + high-flow oxygen
Morphine 5-10mg IV + cyclizine 50mg IV
LMWH e.g. tinzaparin 175 units/kg SC OD
If unstable then thrombolysis with alteplase
Acute GI bleed treatment algorithm?
ABC + O2 15L by non-rebreather
2 large bore cannulae + catheter
Crystalloid bolus + cross-match 6 units blood
Endoscopy
Stop culprit drugs
Bacterial meningitis treatment algorithm?
1.2g IM benzylpenicillin if primary care (600mg if child)
4-10mg dexamethasone IV (unless immunocompromise/septicaemia)
LP (+/- CT head)
2g cefotaxime IV, add 2g ampicillin IV if immunocompromised/>55
Seizures/status epilepticus treatment algorithm?
ABC + put patient in recovery position
IV lorazepam/diazepam or buccal midazolam
If still fitting after 5 min then repeat benzo
If still fitting after 5 min then phenytoin IV
If still fitting after 5 min then propofol + intubation
Stroke treatment algorithm?
ABC + CT head
<4.5 hours = thrombolysis +/- thrombectomy if available
Aspirin 300mg once haemorrhage excluded
Fluids in DKA?
IV fluids
- 1L saline stat
- 1L over 1 hour
- 1L over 2 hours
- 1L over 4 hours
- 1L over 8 hours
Example of insulin regimen in DKA?
50 units Actrapid in 50ml 0.9% saline infused at 0.1 units/kg/hour
Glucose + potassium rules in DKA treatment?
Potassium - if 4-5.5mmol/L = add 20mmol KCl to IV fluids, if <4 = add 40 mmol KCl to IV fluids (take this with a pinch of salt (haha) because passmed says 40 mmol if in normal range and more than this if below 3.5)
Glucose - once <14 mmol/L then add 10% dextrose at 125ml/hr
Monitoring requirements in DKA?
Cap glucose + ketones hourly, VBG 2-hourly
Ketone and venous bicarb target reduction rates in DKA treatment?
Ketones = >0.5mmol/L/hr
HCO3- = >3mmol/L/hr
Osmolarity threshold for HHS?
> 340 mmol/L
Calculation for serum osmolarity?
2x(Na + K) + urea + glucose