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AFP Prep > Clinical Emergencies > Flashcards

Clinical Emergencies Flashcards

1
Q

what conditions come under acute coronary syndrome

A

STEMI
NSTEMI
Unstable angina

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2
Q

Initial investigations for someone with suspected STEMI/NSTEMI

A

ECG
Bloods: FBC, U+E, Troponin, (glucose + lipids)
CXR - but don’t delay management
BP on both arms

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3
Q

Initial management of STEMI

A

300mg of aspirin if not already given
180mg ticagrelor
5 - 10mg IV morphine + 10mg IV metoclopramide (can repeat morphine after 5 mins if necessary)

Can give oxygen if breathless or sats <95%
Can give bisoprolol if no heart failure, asthma/COPD or cardiogenic shock

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4
Q

Reperfusion therapy in STEMI

A
  1. Primary PCI - if less than 12h from symptom start + can be delivered within 2hrs of medical contact; can sometimes be given in 24h if evidence of ongoing ischaemia; also give injectable anticoagulant e.g. bivalirudin
  2. Thrombolysis with IV tenecteplase (tissue plasminogen activator) If PCI not available. Ideally within 30mins of admission; can be transferred for rescue PCI
  3. Fondaparinux if presenting >12h after symptom onset
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5
Q

Contraindications for thrombolysis

A 
previous intracranial haemorrhage 
known bleeding disorder 
cerebral malignancy 
recent major trauma/surgery/head injury (3w)
recent ischaemic stroke (6m)

relative CI: anticoagulant therapy, pregnancy, advanced liver disease

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6
Q

ECG STEMI findings

A

ST Elevation in 2 or more consecutive leads
new left bundle branch block
recipricol changes: deep ST depression

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7
Q

ECG NSTEMI findings

A

ST depression
Flat or inverted T waves
normal

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8
Q

Management of NSTEMI

A

Antiplatelets: aspirin - 300mg then 75mg OD + ticagrelor - 180mg then 90mg BD
Anticoagulation: Fondaparinux until discharge: 2.5mg OD
Analgesia: morphine 5-10mg IV + 10mg IV metoclopramide
Nitrates (PO or IV)
Beta-blockers (2.5mg bisoprolol), ACE-i, statins (80mg atorvastatin)

Address modifiable risk factors: smoking, hypertension, hyperlipidaemia, diabetes

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9
Q

How can you stratify patients with acute coronary syndrome and why is this important

A

GRACE score
- history of unstable angina, >70, general co-morbidities e.g. diabetes, previous MI

High risk patients may need coronary angiography –> coronary stenting or CABG

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10
Q

Causes of pulmonary oedema

A

Cardiovascular: LV failure post MI, valvular heart disease, arrythmias
Acute respiratory distress syndrome
Fluid overload

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11
Q

differential diagnoses for pulmonary oedema

A

asthma/COPD
pulmonary fibrosis: bi-basal crepitation
Pneumonia

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12
Q

signs/symptoms of pulmonary oedema

A

general observation: distressed, pale, sweaty, leaning forward
observations: increased pulse + resp rate (+ low O2 sats)
chest exam: increased JVP, wheeze, triple/gallop rhythm, crepitations

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13
Q

investigations for suspected pulmonary oedema

A

Bedside: ECG, glucose (SOB could be a sign of DKA)
Bloods: U+E, troponin, BNP, ABG
Imaging: CXR, consider echo

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14
Q

findings on CXR for pulmonary oedema

A 
A - alveolar oedema
B - kerley B lines
C - cardiomegaly 
D - dilated upper lobe vessels
E - pleural effusions (blunting of costophrenic angles)
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15
Q

findings on ECG for pulmonary oedema

A

MI, dysarrythmia

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16
Q

initial management of pulmonary oedema

A

oxygen if sats are low
IV diamorphine: 1.25mg - 5mg
IV Furosemide: 40-80mg
GTN/IV nitrate if BP>90/100

can repeat dose of furosemide
consider CPAP

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17
Q

management of pulmonary oedema once patient is stable

A

daily weights: -0,5kg/day
oral furosemide
consider addition of a thiazide e.g. bendroflumethiazide
consider ACE-i, beta-blockers and spironolactone

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18
Q

causes of cardiogenic shock

A

Cardiac: MI, arrythmias, myocarditis, aortic dissection

respiratory: PE, tension pneumothorax

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19
Q

management of cardiogenic shock

A

oxygen
diamorphine: IV 1.25 - 5MG
close monitoring
treat underlying cause

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20
Q

what is cardiac tamponade

A

increase in pericardial fluid increases intrapericardial pressure making it hard for the heart to fill –> heart stops pumping

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21
Q

causes of cardiac tamponade

signs of cardiac tamponade

management of cardiac tamponade

A

trauma, lung/breast cancer, pericarditis, MI

Beck’s triad: low BP, high JVP and muffled heart sounds
Also: pulsus paradoxus - pulse fades on inspiration

Get a senior at the bedside

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22
Q

investigations for suspected asthma

A

Bedside: PEF (if not too ill), BM (if suspecting DKA)

Bloods: ABG, FBC, U+E

Imaging: rule out pneumothorax, infection

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23
Q

Features of a severe asthma attack

A

Unable to complete sentences in one breath
RR>25, HR>110
PEF 33-50%

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24
Q

Features of life threatening asthma attack

A

general observation: exhaustion, confusion, coma

examination: silent chest, feeble respiratory effort, cyanosis

Bedside tests/observations: hypotension, arrythmia, PEF >33%, Sats <92%

ABG: normal/high PCO2 (>4.6); PO2 <8

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25
Q

Immediate management of asthma attack

A

oxygen
5mg nebulised salbutamol
30mg PO prednisolone (40mg if severe)

Reassess every 15 mins

  • Add 0.5mg/6h ipratropium bromide if not responding or severe asthma
  • Repeat salbutamol every 15-30m
  • monitor ECG
  • consider single dose IV magnesium sulfate 1.2 -2g
  • ESCALATE
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26
Q

Continued management of asthma attack

A

If not improving after initial management
- refer to ICU for ventilatory support + aminophylline/ IV salbutamol

If improving

  • continue nebulised salbutamol +/- ipratropium bromide every 4-6h
  • 40-50mg prednisolone for 5-7 days
  • monitor PEF and oxygen sats
  • consider discharge if PEF > 75% 1h after initial treatment

otherwise discharge if

  • stable on discharge medication for 24hrs
  • check inhaler technique + that they’re on right medication (e.g. inhaled and oral steroids)
  • written management plan
  • GP appt within 2 days; resp clinic appt within 4weeks
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27
Q

investigations for COPD

A

Bedside: sputum culture, ECG

Bloods: FBC, U+E, CRP, blood cultures

Imaging: CXR

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28
Q

ethics surrounding advanced COPD

A

autonomy: what does the patient actually want? Speak to patient early

NM: doing harm by invasive ventilation? - difficult to wean off, ventilation associated pneumonia and pneumothoraces

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29
Q

management of acute COPD

A

nebulised salbutamol/ipratropium bromide (5mg/4h 0.5mg/6h)

Oxygen: venturi mask 24-28% oxygen; 88-92%

Steroids: 200mg IV hydrocortisone + oral 3omg prednisolone (continue for 7 - 14d)

Antibiotics: (evidence of infection) 500mg amoxicillin TD (or clarythromycin)

If no response
- consider IV aminophilline, NIPPV, intubation and ventilation

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30
Q

causes of pneumothorax

A

can be spontaneous, esp. in young thin men
trauma: inc. iatrogenic e.g. ventilation
chronic lung disease
infection
carcinoma
connective tissue disorders e.g. marfan

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31
Q

signs and symptoms of pneumothorax

A

pleuritic chest pain + dyspnoea

reduced chest expansion, hyperresonant, diminished breath sounds on affected side,

tension pneumothorax: trachea deviated away from affected side; respiratory distress, tachycardia, hypotension, distended neck veins

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32
Q

management of pneumothorax

A

Can discharge if its a primary pneumothorax, less than 2cm on CXR and no dyspnoea

Otherwise: Aspiration/insert chest drain

Tension pneumothorax: insert large bore needle + syringe with 0.9% saline into 2nd IC space, mid clavicular line; then request CXR, insert a chest drain

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33
Q

Most common organisms that cause pneumonia

A

Strep. pneumonia

Also: haemophilus influenzae, mycoplasma influenzae, influenza virus

ICU: staph. aureus

COPD/HAP: gram negative bacilli e.g. psuedomomas

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34
Q

Investigations for pneumonia

A

The usual plus:

sputum cultures
viral throat swabs (e.g. COVID)

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35
Q

How to calculate severity of pneumonia

A

CURB-65

  • confusion (<8 on AMT)
  • urea > 7mmol
  • RR > 30
  • BP <90/60
  • Age >65

0-1: home
2: hospital
3+: severe pneumonia, consider ICU

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36
Q

management of pneumonia

A

oxygen
treat hypotension with IV fluids if requires
antibiotics: amoxicillin (5 days); co-amoxiclav if severe
analgesia for chest pain

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37
Q

Risk factors for PE

A 
malignancy 
surgery (esp, pelvic + lower limb)
immobility; active inflammation (infection, IBD)
pregnancy, COCP, HRT
Previous VTE
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38
Q

signs and symptoms of PE

A

acute dyspnoea, pleuritic chest pain, haemoptysis and syncope

hypotension, tachycardia, gallop rhythm, increased JVP, right ventricular heave, pleural rub, tachypnoea, cyanosis, AF

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39
Q

investigations for PE

A

Bedside: ECG - might show sinus tachycardia, RBBB, AF, right ventricular strain

Bloods: U+E, ABG, FBC, clotting

Imaging:

  • CXR: rule out pneumonia, COVID etc.; may show wedged shaped infarction and small pleural effusions
  • CTPA (ventilation perfusion scan if possible)
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40
Q

Management of PE

A

15L oxygen if hypoxic
IV morphine 5-10mg + antiemetic if distressed/in pain
IV LMWH/fondaparinux
500ml IV fluid bolus if hypotensive
consider thrombolysis with IV alteplase bolus if still haemodynamically unstable
initiate long term anticoagulation: DOAC or warfarin 3 - 6+ months

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41
Q

causes of upper GI bleeds

A 
peptic ulcer disease
gastroduodenal erosions 
oesophagitis 
MW tear 
varices
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42
Q

What are PRISMA guidelines

A

preferred reporting terms for systematic reviews and meta analyses

guidelines systematic reviews should follow such as clearly defining inclusion and exclusion criteria

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43
Q

what is a forest plot

A

a plot used in meta-analyses that show the effect/outcome of each study and the overall outcome

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44
Q

what do the lines on a forest plot represent

what happens if the mean diamond crosses the line of null effect

A

confidence interval

no significant difference between the treatment of interest and the control

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45
Q

what is a systematic review

A

a review of the literature regarding a research question of interest

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46
Q

what are the pros and cons of an RCT

A

pros: randomisation could reduce systemic bias by distributing confounding factors, prospective design can demonstrate temporality + causality
cons: expensive (may be funded by bodies with vested interest), time consuming, ethical concerns, requires large numbers of people

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47
Q

pros and cons of cohort study

A

pros: time sequence –> help identify causality, good for rare exposures, can identify multiple outcomes for given exposure
cons: expensive, time, loss of people to follow up can introduce bias

48
Q

pros and cons of case control studies

A

pros: quick and inexpensive, good for rare diseases
cons: subject to recall bias, requires good reporting, can be difficult to select suitable control group, not good for rare exposures

49
Q

pros and cons of cross-sectional studies

A

pros: quick and inexpensive, good for assessing health needs of a population
cons: not causal, only a snapshot of the time, use health surveys - subject to recall bias, study population must be representative of total population

50
Q

pros and cons of case reports

A

pros: quick, can inform about rare/new presentations
cons: plenty of bias, weak evidence

51
Q

immediate management for suspected upper GI bleed + shock

A

(contact endoscopist and notify surgeons)

Protect airway and keep NBM

(VBG)

Insert 2 large bore cannulas and request urgent bloods (FBC, U+E, LFTs, clotting, crossmatch 4-6 units)

Rapid IVI up to 1L (Hartmann’s, avoid saline if cirrhotic)

If signs of stage 3/4 shock (e.g. RR>30, HR>120, Low BP) or Hb<70g/L; start major haemorrhage protocol with O- until crossmatch done

Correct clotting abnormalities

If risk of varices: terlipressin (IV 1-2mg/6h) + broad spectrum IV antibiotics

catheterise and monitor urine output

monitor vital signs every 15mins until stable, then hourly

Consider referral to ICU

Urgent endoscopy for diagnosis and control of bleeding once stable

52
Q

what is the glasgow-blatchford score

A

stratifies upper GI patients to determine who is low risk and could be potentially managed as an outpatient

53
Q

What is the rockall score

A

determines severity of GI bleed and risk of mortality ( + re-bleed risk)
age, shock, co-morbidities (+ diagnosis, stigmata of recent major haemorrhage)

54
Q

further management of upper GI bleed

A

PUD: endoclips
Varices: oesophageal banding or injection sclerotherapy

Check for + treat H.pylori using triple therapy (PPI + 2 antibiotics)

IV PPI

55
Q

main causes of meningitis

A

meningococcus, pneumococcus

56
Q

Management of meningitis

A

C: take blood + blood cultures, then start broad spectrum antibiotics according to local guidelines (ceftriaxone + amoxicillin >65/immunocompromised), IV fluids if shocked,
D: check + correct glucose, consider IV dexamethasone

Escalate early: seniors, ITU, microbiology, public health (urgent if suspected bacterial or septicaemia)

Discuss antibiotic therapy with microbiology
Isolate for 1st 24hrs

57
Q

prophylactic management of meningitis

A

ciprofloxacin to household contacts in droplet range

58
Q

encephalitis management

A

C: IV access, blood cultures, viral PCR of serum
D: Acyclovir within 30mins (14 days or 21 if immunocompromised); LP with viral HSV PCR of CSF + contrast CT to confirm diagnosis

Liaise with microbiology to adjust management

59
Q

status epilepticus management

A

open + secure airway

IV access: 4mg lorazepam (or rectal diazepam if IV cannot be obtained); repeat if no response after 15 minutes
- URGENT SENIOR REVIEW

IV phenytoin; monitor ECG and BP
- URGENT ITU/ANAESTHETIST SUPPORT BY THIS POINT

Rapid sequence induction with general anaesthesia

Note: consider whether patient could be pregnant; dexamethasone if tumour a possibility

Once stable, continue oral drugs and try to establish cause

60
Q

causes of raised ICP

A

trauma
space occupying lesion (e.g. tumour)
bleeding
infection

61
Q

signs and symptoms of raised ICP

A

headache worse on coughing/straining/in the morning
coma/drowsiness
Cushing’s triad: low RR + HR, high BP
Papilloedema/pupillary dilatation

62
Q

management of raised ICP

A

early referral to neurosurgeons (craniotomy) and anaesthetists (intubation)

A: protect airway, consider intubating
B: CXR to check possible source of infection; ABG etc.
C: IV access, bloods (FBC, U+E, blood cultures), maintain MAP>90, elevate head to 30-40 dgrees
D: discuss with senior about IV mannitol (can cause rebound ICP increase); dexamethasone if tumour suspected
E: check for rash - meningitis?

63
Q

management of head injury

A

seek support: trauma call, neurosurgeons etc.

exclude catastrophic haemorrhage

Airway: protect c-spine: 3 point immobilisation + jaw thrust, seek anaesthetist support

E: inspect + palpate skull for deformity, bleeding, CSF leak, Battle’s sign, raccoon eyes (basal skull fracture), tetanus status review

64
Q

CT head criteria

A

CT head within 1hr if

  • GCS<13 on admission or <15 after 2h
  • focal neurology
  • vomiting > 1ce
  • seizures
  • suspected basal skull fracture
CT head within 8h if 
- anti-coagulated patients 
- amnesia/LOC + 
> coagulopathy 
> dangerous mechanism of injury 
> over 65
65
Q

CT spine criteria

A 
GCS < 13 on admission 
intubation required 
pre-operatively 
undergoing a head scan 
suspected c-spine injury +
> over 65
> parasthaesia 
> dangerous mechanism of injury 
> focal CNS deficit
66
Q

things to consider for someone with SAH

A

CT/MRI Brain
LP: xanthochromia

liaise with seniors, neurosurgeons, ICU if GCS is falling

lie flat, appropriate analgesia, consider nimodipine, dexamethasone if increased ICP

67
Q

things to consider for someone presenting with stroke

A

CT brain to rule out haemorrhagic stroke

If not haemorrhagic: 300mg aspirin + thrombolysis within 4.5h

Consider AF: start warfarin after 14d; cholesterol: statin

secondary prevention: lifelong clopidogrel; >70% carotid stenosis –> carotid endarterectomy

68
Q

things to consider for someone with aortic dissection

A

imaging: USS/CT

immediate referral to vascular surgeons, anaesthetists, CEPOD (emergency theatre)

69
Q

what is pheochromocytoma and what are the symptoms

A

catecholamine neuroendocrine producing tumour, usually from adrenal glands

pain (headaches), pallor, palpitations, panic, perspiration, pressure (high BP)

70
Q

management of pheochromocytoma

A

ABCDE
get ICU support

C: short acting alpha blocker e.g. phentolamine, then long acting alpha blocker + beta blocker (labetalol)
urinary/plasma metanephrine levels to confirm diagnosis

surgery 4-6w later (adrenalectomy)

71
Q

what is the modified glasgow score

A

tool for assessing severity of pancreatitis; if above 3 then consider ITU

P: PaO2
Age, neutrophils, calcium, renal, enzymes (LDH/AST), albumin, sugar

72
Q

management + complications of pancreatitis

A

IV fluids
analgesia

necrotising pancreatitis, collections, ARDS, MI

73
Q

classification of aki

A

pre renal: hypotension (sepsis, cardiac, hypovolaemia)
renal: drugs, glomerulonephritis, vasculitis
post renal: obstruction

74
Q

ABCDE consideration for AKI

A

B: VBG
C: ECG (K+ arrythmia), U+E, urine output (+ urinalysis)

75
Q

management of AKI

A

urgent FLUIDS

urgent escalation to seniors and nephrologists if: high potassium, pulmonary oedema, severe metabolic acidosis

Fluid bolus if dehydrated
low BP –> fluid bolus
urinalysis
imaging: urgent renal USS if obstructed or unsure of cause
D: stop nephrotoxic drugs - diuretics, metformin, nsaids, ACEi + nephrotoxic antibiotics
sepsis: sepsis 6 if signs of sepsis

76
Q

general management of clinical station

A

patient safety + SBAR (admission, complete obs, trend in obs)

See sickest patient

Delegate responsibilities for other patient to nurses/colleagues

Ask to meet nurse at bedside with notes + start jobs if possible (oxygen, IV access, ECG)

Run through A-E
assessment, observation/investigation, management

ask for help if patient is deteriorating

once stable

  • full clinical history + focused examination
  • order necessary investigations
  • document encounter in notes
  • discuss plan with senior + handover to the necessary team if required
77
Q

management of DKA

A

follow hospital protocol (esp. regarding fluid)

A
B: VBG, oxygen, CXR
C: IV access, BP, HR, fluids (1L/1hr unless shocked then 500ml/15mins), ECG
D: AVPU, pupils, glucose + ketones; insulin 0.1units/kg/hr; continue regular long acting insulin
E: sources of infection

Further management

  • monitor glucose + ketones hourly; check VBG at 2h, 4h, 8h etc.
  • assess need for potassium
  • add 10% dextrose once BM <15
  • prescribe LMWH
78
Q

What is the p-value

A

the probability that the null hypothesis is true (needs to be less than 0.05 to be significant)

the probability between 0 and 1 with one being the highest that the outcome of the experiment was due to chance rather than an actual difference

79
Q

what is the 95% confidence interval

A

the range in which you are 95% sure the real population lies somewhere between

80
Q

what is power

A

the likelihood of a study detecting a true difference. i.e. the probability of not making a type 2 error

81
Q

absolute risk

A

the probability of an event occurring within a certain group. can only be between 0 and 1.

82
Q

absolute risk difference

A

the difference in absolute risk between the intervention group and control

83
Q

relative risk

A

the absolute risk of an event occurring in the in the intervention group compared to the control group (AR group 1/ AR group 2)

If the relative risk is 0.8 then there is a 20% reduction in the relative risk
i.e. 20% less likely to have that outcome

84
Q

number needed to treat

A

how many people needed to treat to save 1 person

1 divided by absolute risk difference

85
Q

odds ratio

A

the odds of an outcome occurring if exposed to something vs the odds of that outcome occurring if unexposed to that same thing

OR: 1.6
In those who had the case (e.g. not understanding treatment), the odds of them having the exposure (e.g being black) was 1.6 times higher than if they were in the control group (e.g. understanding their treatment)

86
Q

relative risk reduction

A

absolute risk reduction divided by incidence in control group

87
Q

hazard ratio

A

relative risk at a specific time point

88
Q

kaplan-meier curve

A

a graph comparing probability of the event (usually death) as time goes on

89
Q

Blinding

A

an attempt at controlling bias by making participants (single blind) and observers (double blind) unaware of their treatment status

can also be double dummy if it is difficult to make the intervention and the placebo look similar (e.g. a patch vs. a pill)

90
Q

confounding factor

A

a variable that affects the dependent variable/outcome but it is unaccounted for

91
Q

intention to treat analysis

A

analysis of trial participants per the group they were allocated to irrespective of whether they completed treatment

92
Q

per protocol analysis

A

analysis of trial participants excluding those who didn’t follow protocol

93
Q

sensitivity

A

how good is a test at picking out people who have the disease

94
Q

specificity

A

how good is a test at ruling out people who don’t have the disease

95
Q

positive predictive value

A

following a positive test, what is the probability that the subject has the disease

96
Q

type 1 error

A

rejecting the null hypothesis when it is actually true (false positive result)

97
Q

type 2 error

A

accepting the null hypothesis when it’s actually false (false negative)

98
Q

bias

A

systematic error that leads to deviation from the true value

99
Q

types of bias

A

selection
publication
attrition bias
measurement (recall, response/non response, observer, Hawthorne)

100
Q

what is evidence based medicine

A

the use of current best evidence in making decisions about the care of individual patients

101
Q

what is shock

A

circulatory failure resulting in inadequate organ perfusion

  • systolic BP < 90
  • MAP < 65
  • evidence of tissue hypotension (mottled skin, decreased urine output, serum lactate >2)
102
Q

how to calculate MAP

A

cardiac output (stroke volume x HR) x systemic vascular resistance

103
Q

causes of shock

A

Cardiac output

  • hypovolaemia: bleeding, fluid loss e.g. vomiting + burns
  • pump failure: cardiogenic shock e.g. ACS, arrythmias

Peripheral circulatory failure

  • sepsis
  • anaphylaxis
  • neurogenic e.g. spinal cord injury
  • endocrine: addison’s, hypothyroidsm
  • drugs: anaesthetics, anti-hypertensives
104
Q

BLS for the unconscious patient

A 
Danger 
Response to voice and pain 
Shout for help 
Airway 
Breathing: 10s look for chest movement, listen for breath, feel for breath (feel carotid pulse)
Call 2222 
Start chest compressions: 30-2
105
Q

unconscious patient management

A

A: stabilise c-spine if traumatic, maintain airway - manouvres, adjuncts
B: 15LO2, RR, ABG
C: bloods (toxins - alcohol, salicylate, paracetamol), cortisol, glucose, troponin etc.
D: glucose, pupils (overdose), GCS, neuro exam - localising lesion
E: temperature for seizure

106
Q

what is septic shock

A

sepsis with hypotension despite adequate fluid resuscitation

107
Q

when to consider ITU referral for septic patients?

A

BP<90, lactate > 4

108
Q

when might anaphylactic reactions occur during hospital

A

blood transfusions
contrast imaging
medication administration
food exposure

109
Q

how to manage hypovolaemic shock

A

raise legs
fluid bolus x 2 –> ICU referral
treat underlying cause

110
Q

how to manage haemorrhagic shock

A 
stop bleeding 
2L crystallois 
crossmatch or request O-ve blood 
major haemorrhage protocol if >30% blood loss estimated
liaise with seniors/haematologists 
FFP + red cells 
consider 2g IV tranexamic acid
111
Q

what is sepsis

A

life threathening organ dysfunction due to dysregulated host response to infection

112
Q

management of sepsis

A

A
B: oxygen, sputum sample, CXR, ABG (lactate)
C: BP, urine output + catheterise, urinalysis (source of infection), IV access, blood cultures, U+E, FBC, clotting, broad spectrum antibiotics, 2x fluid bolus
D: consciousness level, temperature
E: look for source of infection, rash, infected wounds; swab wounds, consider LP, ascitic tap, joint aspirate

113
Q

what is anaphylaxis

A

Type 1 IGE mediated hypersensitivity reaction

114
Q

management of anaphylaxis

A

Airway: most important, stop offending agent; manouvres, suction, adjuncts, consider intubation + senior help; IM adrenaline 0.5ml 1:1000 in anterolateral 1/3 of thigh; repeat every 5 mins
B: 15LO2
C: IV access 200mg hydrocortisone, fluid bolus over 15, chlorphenamine 10mg

second line: ICU admission –> IV adrenaline

consider nebulised adrenaline if wheezy

serum tryptase 1-6h; monitor ECG on wards, medic alert bracelet, self administered adrenaline (i.e. epipen)

115
Q

overdose/poisoning

A

discuss with toxicology/toxbase
A: consider anaesthetist support to maintain airway (esp. if RR<8, PO2<8, GCS<8)
C: toxicology screen - urine and serum

CO:100% oxygen
benzodiazepine: IV flumazenil

warfarin: <8 + no bleed = withold, minor bleed +/or > 8 = stop warfarin + vit K, major bleed = stop warfarin, vitamin K + beriplex
paracetamol: n-acetylceisine

116
Q

Hyperkalaemia definitions, ecg findings and management

A

K+> 6 or 5.5 with ECG changes

small p waves, slurred QRS, long PR, tented t

  1. cardiac protection (calcium chloride/gluconate)
  2. shift K+ into cells with salbutamol + insulin/dextrose
  3. remove k from: loop diuretic + calcium resonium
117
Q

hypokalaemia definitions, ecg findings and management

A

<3.5
<2.5 is severe

no T waves, long PR, QT and depressed ST

mild: oral - sando K
severe IV potasium

AFP Prep (1 decks)

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