Common ACUTE presentations treatments (ABCDE)

Question 1

PE with haemodynamic instability

Answer 1

Thrombolysis

Question 2

Tension pneumothroax

Answer 2

Needle decompression 2nd intercostal space
mid-clavicular line

Question 3

Pneumonia

Answer 3

CURB65 score

CXR - in intermediate or high-risk patients -> blood and sputum cultures, pneumococcal and legionella urinary antigen tests

CRP monitoring is recommend for admitted patients to help determine response to treatment

Question 4

WHat makes up a CURB65 score

Answer 4

Confusion
Urea >7
Respiratory rate >30
Blood pressure <90 systolic
>65 yrs

Intensive care for those w/ score 3 or more

Question 5

Cushing’s reflex - triad of:

Answer 5

Hypertension - widening pulse pressure
Bradycardia
Irregular breathing

Question 6

Holding measure for increased intracranial pressure

Answer 6

Mannitol

Question 7

Anaphylaxis - dose of adrenaline

Answer 7

0.5 ml/mg 1:1000 IM

Question 8

How often should adrenaline be repeated

Answer 8

Every 5 minutes

Question 9

Adult bradycardia treatment:

Answer 9

Atropine 500 mcg
Repeat up to 6 times (3mg total)

Question 10

Bradycardia if atropine not working:

Answer 10

Isoprenaline - 5 mcg IV
Adrenaline IV 2-10 mcg
Transcutaneous pacing

If these don’t work - transvenous pacing

Question 11

Adult tachycardia w/ pulse:

Answer 11

Amiodarone - 300 mg IV over 10-20 mins
900 mg IV over 24 hours

Question 12

Indications for AMIODARONE in tachycardia

Answer 12

Three failed DC shocks in unstable pt.
Refular BROAD COMPLEX TACHYCARDIA

Question 13

When to use Adenosine in SVT

Answer 13

When vagal manoeuvres fail

Question 14

Adenosine dose

Answer 14

6 mg IV
12 mg IV
12 mg IV

Question 15

4Hs - reversible causes of cardiac arrest

Answer 15

Hypovolaemia
Hypo/hyperkalaemia (electrolyte)
Hypothermia
Hypoxia

Question 16

4Ts - reversible causes of cardiac arrest

Answer 16

Tension pneumothorax
Tamponade
Toxins
Thrombosis

Question 17

Cardiac arrest adrenaline dose

Answer 17

10 ml 1:10000 Adrenaline IV every 3-5 minutes

Question 18

Paediatric BLS algorithm

Answer 18

start with 5 rescue breaths
Then 15:2 at a rate of 100-120 BPM

Question 19

Lactate level in shock

Answer 19

> 2.2

Question 20

Pre-operative period: when to stop ACEi/ARBs

Answer 20

1 day before surgery

Question 21

When to stop Warfarin before surgery:

Answer 21

5 days before surgery

Question 22

When to stop LMWH before surgery

Answer 22

24 hours prior

Question 23

Anti-platets drugs: when to stop before surgery

Answer 23

7 days before surgery

Question 24

What to do for anticoagulation if pt. is high risk after stopping warfarin (5 days)

Answer 24

Bridge with LMWH

Question 25

Acute heart failure management

Answer 25

Upright position O2 Loop diuretics Morphine - do not give routinely but if necessary nitrates if concomitant cardiac ischaemia (contraindicated in hypotension)

Question 26

Ventricular tachycardia Mx. in pt. stable vs. unstable pt.

Answer 26

If stable: Antiarrhythmics may be used If unstable (hypotensive, chest pain, heart failure, syncope) immediate cardioversion is indicated

Question 27

Pre-eclampsia tx.

Answer 27

Referral to secondary care Oral Labetalol (Nifedipine if asthmatic) Delivery is definitive management -> timing is situation dependent

Question 28

Acute asthma - Ix.

Answer 28

Clinical diagnosis CXR to rule out infection and pneumothorax ABGs - usually normal Bloods and sputum cultures if evidence of infection

Question 29

ACS investigations:

Answer 29

Bloods - FBC, UEs, LFTs, Mg, Ca, TROPONINS, Glucose, Coagulation profile, cross-match O- X - CXR (signs of heart failure) E - ECG S - specials = Coronary angiography

Question 30

Acute LVF investigations:

Answer 30

Bloods - FBC, UEs, LFTs, Mg, Ca, TROPONINS, Glucose, Coagulation profile, cross-match, phosphate, lipids, BNP O - X- CXR (ABCDE) kerley b-lines, alveolar shadowing etc. E - ECG Special tests: Echocardiography, BNP

Question 31

Ruptured AAA ix.

Answer 31

Bedside US if available CT angiography

Question 32

Gallstones Ix.

Answer 32

LFTs Abdomonal USS CT for surgical planning

Question 33

CBD stone Mx.

Answer 33

IV hydration (prevent renal injury) ERCP

Question 34

Acute pancreatitis Mx.

Answer 34

Supportive NBM IV hydration - 1L/4 hours (Hartmann's) IV antibiotics only if infection/free air on AXR May need ICU

Question 35

Acute pancreatitis Ix.

Answer 35

Amylase/lipase Abdominal USS (exclude other causes/ check for cause stones etc.) CT if diagnostic uncertainty LFTs derranged Apache II/Glasgow scoring

Question 36

Acute mesenteric ischaemia Ix.

Answer 36

VBG: Increased Lactate Abdominal CT Angiography