Clinical Emergencies Flashcards
Define moderate asthma
SPO2 >92%, PEF >50-70% best or predicted, no features of acute asthma
Define acute severe asthma
PEF >50% of best/predicted
REsp rate >25
SPO2>92%
Tachycardia
Cannot complete sentences in one breath
Define life threatening asthma
spo2<92%
Silent chest
Arrhythmia, Hypotension, Exhaustion, Confusion, Coma
PEF <33%
What is the management of moderate asthma?
Give salbutamol inhaler, preferably via spacer
What is the management of acute severe asthma?
Give salbutamol 5mg via nebuliser, repeat if PEF does not improve/if patient does not stabilise and give 40g oral prednisolone
Repeat observations
If persistent, admit to hospital, contact respiratory team
What is the treatment of life threatening asthma?
Call for help
Give salbutamol 5mg plus ipratropium via nebuliser
If able to swallow, 40mg oral prednisolone, if unable, IV hydrocortisone 100mg
ABG
Continous salbutamol nebs if required
IV Magnesium sulphate
Correct electrolytes, CXR, repeat ABG
Management of low potassium
ECG
U&Es, VBG (check for magnesium)
Oral K+ replacement if mild
IV K+ if patient is unable to swallow/ if K+ is severely low
How to manage high potassium
ECG
VBG
10% Calcium gluconate 10ml over 10 mins then switch to infusion
IV soluble insulin (5-10 units) and 50ml glucose 50% (over 5-15 mins)
Salbutamol nebulisers
How to manage low calcium?
Mild - calcichew
Severe - IV calcium gluconate 10% then IV continuous infusion
How to manage high calcium?
IV sodium chloride 0.9% infusion over 4-6hours
Bisphosphonates
Anaphylaxis management
ABCDE
IM Adrenaline (1:1000)
Establish airway, high flow o2, ECG
If no response, repeat IM adrenaline after 5 mins, IV fluid bolus
What are the clinical parameters of DKA?
Hyperglycaemia >14mmol/L
Ketoneaemia >3mmol/L
Metabolic acidosis pH<7.3
What is the initial management of DKA?
0.9% sodium chloride infusion
Fixed rate insulin infusion
ABCDE
VBG, capillary and lab glucose
FBC, U&Es, cultures, ECG
Establish one hourly glucose and ketones
Potassium replacement if K+<3.5 mmol/l
How to manage a paracetamol overdose
- take paracetamol level if time of overdose >4 hours, or if staggered
- U&Es, LFTs, Glucose, Coag, ABG
NAC Chart - if on or above line, give NAC. If staggered, give NAC straight away
What are the three doses of NAC given in a paracetamol overdose?
Initial dose - 150mg/kg over one hour
Second dose - 50mg/kg over next four hours
Third dose - 100mg/kg over next 16 hours
What are the signs of an opioid overdose?
Reduced resp rate, drowsy, confused, pinpoint pupils
Hx of opioid prescription
How are opioid overdoses managed?
Naloxone bolus
then naloxone infusion
Management of status epilepticus
Call for help
IV lorazepam/buccal midazolam/rectal diazepam
Second dose of benzos if no response
If nil response, levitiracetam/sodium valproate/phenytoin
Management of a pneumothorax
ABCDE
Aspirate to 16/18G cannula or chest drain
oxygen
What is the management of hypoglycaemia?
Initial hypo
- quick-acting carbohydrate or glucotabs
- recheck capillary blood glucose after 15 mins
If patient unconscious
- ABCDE
- IV 10%/20% glucose
- IM glucagon
Symptoms of hypoglycaemia
Confusion, weakness, malaise, tremor, dizziness, reduced GCS
How to manage an upper GI bleed?
ABCDE
Blatchford Score
FBC, U&Es, Urea, CRP, Coag, group and save
Endoscopy once stable
Terlipressin if suspected variceal bleed
PPI if non-variceal GI bleed
STEMI presentation
Sudden onset pain, tightness radiating to left arm and jaw, nausea, breathlessness, shortness of breath, sweating
Dyspnoea, arrythmia, pale, clammy and non-tender chest wall
ECG - STEMI/ New LBBB, increased troponin
NSTEMI presentation
Sudden onset pain, tightness, radiating to jaw, breathlessness, sweating, nausea
Dyspnoea, arrhythmia, pale, clammy, non-tender chest wall
ST Depression, t-wave inversion, q waves, ECG can be normal, increased troponin
Unstable angina presentation
Anginal pain at rest, increasing in frequency, severity, duration
Dyspnoea, arrhythmia, pale, clammy, tender chest wall
ST Depression, twave inversion, ECG can be normal, Troponin not elevated
STEMI management
PCI within 12 hours of onset
O2, 300mg aspirin, ticagrelor or clopidogrel, anti-emetic, GTN, morphine, bisoprolol
Thrombolysis if no PCI available
NSTEMI management
O2, aspirin, clopidogrel, morphine, anti-emetic, GTN, fondaparinux, bisoprolol
Unstable angina management
Analgesia, aspirin, clopidogrel, bispoprolol, fondaparinux
How does septic shock present ?
Dizziness, sob, chest pain, rigors, fever, confusion +/- abdo pain +/- oliguria +/- productive cough
Tachycardia, bounding pulse, low BP, Decreased GCS, skin mottling
How do you manage septic shock?
FBC, Cultures, CRP, U&Es, LFTs, glucose, coag
VBG (lactate), monitor urine output
IV access then IV fluids - hartmanns, plasmalyte, normal saline
O2, broad spectrum antibiotics,
Common ABG finding in COPD
Type 2 resp failure
How to manage a stroke?
Call for senior help
ABCDE
Monitor saturations
Venous access
Bloods - FBC, UsEs, CRP, Coag, Glucose, lipids, trop
Nil by mouth and IV fluids
ECG
Examination
- neuro, cranial nerves, cardio, resp, swallow
CT Head
?carotid doppler
aspirin/ thrombolysis if ischaemic
What are the indications for thrombolysis?
Symptom onset < 4.5 hours if under 80 years old
Symptom onset <3 hours if over 80
CT shows no haemorrhage
Significant symptoms with no improvement
What are the indications for thrombectomy?
CT shows no haemorrhage or signs of early ischeamic changes
CT angio shows proximal occlusion of anterior circulation
Can be initated within 6 hours of symptom onset
How to manage SAH?
Call for senior help
Urgent referral to neurosurg for coiling or clipping
Lie patient flat
A-E
Aim for BP control <130mmHg with IV bisoprolol
Urgent CT head
Lumbar puncture 12 hours post onset
Nifedipine
