Clinical Emergencies Flashcards
acute asthma
PEFR
prev ITU admission: admit regardless of severity
o2 salbutamol 5mg neb - monitor ecg, give back to back every 15min hydrocortisone 100mg iv or pred 40mg po ipratropium bromide 500mcg neb escalate, consider mgs04 IV
covid swab: DONT FORGET COVID IN DD
sputum culture
if features of acute severe or life-threatening: warn ICU, seniors
How do you treat a bleeding peptic ulcer?
ABCDE IV fluids blood products if needed: blood transfusion, platelets, FFP, consider vit K blatchford sore high dose PPI IV 40mg omeprazole iv morphine iv antiemetic e.g. 10mg metoclopramide
Upper GI endoscopy:
- clipping +/- adrenaline
- thermal regulation with adrenaline
- sclerotherapy (inject thrombin/fibrin) with adrenaline
- H pylori: amoxicillin (metro) + clarithromycin + PPI
How to treat hyperkalaemia?
10U actrapid/novorapid in 100ml of 20% dextrose of 30min IV = first drug to lower pt’s K+
IV 10% 10ml calcium gluconate
IV 10U insulin + 50% 50ml dextrose
5mg neb salbutamol
calcium resonium
what are some complications of acute pancreatitis?
peripancreatic collections
pseudocysts
pancreatic necrosis, abscess
ARDS
aortic dissection
c - large bore cannulae, abx, analgesia
USS/ct
immediate refer: vascular surgeons, anaesthetist
paracetamol OD
activated charcoal <1h
if <4h, wait till 4h to do levels
4-8hr: do para levels, start nac if over tx line
immediate nac if staggered od, uncertain time, >8hr since presentation
consider transfer to liver uni, call toxicology
psych r/v if suicide attempt
DKA
high bm, ketones >3, acidaemia
ketones
fluid bolus (protocol), senior, DM team
intravenous infusion at a rate that replaces deficit and provides maintenance; see guideline
continuously re-assess
insulin: 0.1U/kg/h
k+ replacement when urine output adequate, monitor u/e every hour
dextrose once bm <15: 10% dex infusion with nacl
heparin/lmwh: prothorombotic state
AECOPD
B - peak expiratory flow rate, sputum culture
C - theophylline levels of on it at home, blood culture, ABX if sputum purulent
O2 salbutamol 5mg neb hydrocortison 100mg iv ipratropium bromide 500mcg neb escalate: bipap (pH <7.35) or I&V (pH<7.25) or doxapram theophylline: seniors
unconscious patient
head injury
trauma call: EM, anaes, ortho, gen surg, radio…
CABCDE
a- 3 point immob, jaw thrust, anaes
15l, o2
c: bloods for alc, salicylate, para, lft, u/e, tft, cortisol, glucose, preg, trop, d-dimer
d;: pupiles for stroke, opiates, glucose, gcs, neuro exam to localise lesion
e: skull: battle’s, raccoon, csf leak, haemotypanum
neurosurg, ct head, tetanus status
septic shock
BUFALO Give 3 - oxygen - broad spectrum antibiotics (within 1hr) - IV fluids
Take 3
- blood cultures (urine, sputum, csf)
- urine output
- ABG (including lactate)
sepsis: qSOFA score
stroke / TIA
CT head aspirin 300mg PO after excluding haemorrhagic stroke thrombolysis: 4.5 hr, if no contraindic sec: clopidogrel / aspirim carotid endarterectomy
PE
also presents with haemoptysis, SOB, pleuritic cp
check leg swelling, ask details of it (DVT)
Well's O2 IV morphine treat: DOAC if delay ctpa: doac until scan
if massive PE (haemodynamic compromise): consider bolus alteplase
future Mx: look for underlying malig
tension pneumothorax
1 way valve: air sucked in, pressure on side, push mediastinum, kink great veins, prevent venous return –> fall stroke vol, fall cardiac output
immediate needle decompression 2nd ICS, MCL
seniors: CXR, chest drain-
pneumonia
- CURB-65 to assess severity 2 = hospital
confusion, urea>7, rr>30, bp <90/60, age>65 - Oxygen (15L 100% NRB) if still hypoxic:
CPAP , NIV, Intubation - Antibiotics (local protocol/contact microbiology)
amox, amox + other, HAP: co-amox or taz - Analgesia (paracetamol/ NSAID for pleuritic pain)
HHS
fluid bolus
insulin only if bm not falling adequately, 0.05u/kg/h
k+ replacement when urine output adequate, monitor u/e every hour
dextrose
heparin/lmwh: prothorombotic state
what are the complications of status epilepticus?
permanent cerebral damage cardiac arrhythmia aspiration pneumonia: vomiting hypoglycaemia hyperkalaemia: rhabdomyolysis death
encephalitis
like meningitis but with impaired consciousness, odd behaviour
bc, viral pcr of serum, malaria film
contrast ct
lp: hsv pcr
acyclovir (for hsv)
adjust mx: liaise with micro
upper GI bleed:
what causes to consider?
how to manage?
peptic ulcer disease duodenal erosions oesophagitis varices mallory-weiss
b - erect cxr if perf
c- 2x large bore cannulae, cross match, clotting, lft, calculate blatchford score
iv fluids
blood products: ffp, blood transfusion
e- abdo exam, peritonism, look for peri oedema, ascites in cirrhotic pt, PR for malaena
- Keep patient nil by mouth + notify surgeons
- Bleep endoscopist
varices: abx: cef, quinolone, terlipressin or octreotide if ihd
varices: banding, injection sclerotherapy, TIPS, sengstaken blakemore tube to arrest bleed
peptic ulcer: clipping w adrenaline, sclerotherapy, high dose ppi 40mg omeprazole post endoscopy
- check for/eradicate H pylori - triple therapy amox, clari, ppi
- If massive bleed activate major haemorrhage protocol
rockall score post endoscopy
anaphylaxis
B - neb adrenaline if wheeze
C - 500ml iv nacl stat
HELP: peri arrest team
0.5ml 1:1000 IM adrenaline
200mg iv hydrocortisone
10mg iv chlorphenamine
Additionally, consider nebuliser adrenaline if wheeze. Measure mast cell tryptase at 1-6h and test for igE mediated reaction with RAST test
