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ACC > Common Management > Flashcards

Common Management Flashcards

1
Q

Explain the stages till giving a blood transfusions

A
  1. Consent the patient
  2. Cross-match or group & save (PRCs, Platelets, FFB (clotting factors, albumin)
  3. Prescribe it on relevant chart (each unit must be prescribed separately. Duration 2 hours
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2
Q

ECG changes for ACS:
Inferior
Anterior
Lateral

A

II, III, aVF
V1-V4
V5-V6, I & aVL

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3
Q

How to confirm STEMI and acute treatment

A

ABCDE
ECG
Bloods: FBC, U&E, CRP, glucose, cardiac markers, D-dimer

If new ECG changes: ST elevation or T wave inversion.

ROMANCE

Oxygen
Aspirin 300mg PO (if not given)
Buccal GTN 
Clopidogrel 300mg
Diamorphine 2.5mg-5mg IV
Anti-emeitc 
(+/- bisoprolol)

Ring cath lab:
PCI (within 12 hours) or thrombolysis

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4
Q

Chronic management of ACS

A

Lifestyle factors: Smoking, diet, excessive

Pharm:

  • Dual anti-platelet
    1) aspirin 75mg OD
    2) Clopidogrel 75mg or Ticagrelor 90mg
  • ACEi Ramipril 2.5mg
  • B-blocker: bisoprolol 2.5mg
  • Statin: atorvostatin 80mg
  • GTN spray
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5
Q

How to diagnose ketoacidosis

treatment

A

Type 1 diabetic + trigger (infection, not taking insulin, surgery, alcohol, MI)

Patient: abdo pain, drowsy, N&V, dehydration (thirst), heavy laboured breathing

High BM > 11mmol/L
Urinary (dipstick ++) or cap ketone test (>3mmol)
Acidotic <7.3

ABCDE
Ask for protocol

NaCL 0.9% IV infusion 1:2:2:4:4:6

Insulin Actrapid 0.1units/kg/hr in 0.9% NaCL 50ml (own chart)

If:
glucose < 14mmol start 10% glucose 125ml/hr

If:
K: 3.5-5 = 40mmol KCL added into infusion
<3.5 call senior help

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6
Q

Treatment Upper GI bleed

A 
ABCDE
Bloods: FBC, U&amp;E, crossmatch &amp; clotting
ABG (look at Hb)
- consider blood transfusion (PRC)
IV access: 2 large bore cannulas + resus
PR

Glasgow-Blatchford Score
Will determine if need endoscopy (assess cause and stop bleed)

Long term
PPI (non-variceal)
Terlipressin: vatical bleeding e.g glypressin 2mg IV

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7
Q

Head injury assessment

A

ABCDE
Full neurological (arm & legs)
Check pupils /glucose/gcs
basal skull fracture: battle sign

Hx:
mechanism of injury 
LOC
witness
amnesia retrograde, anterograde 
Ass symtoms: vomit, nausea, headache, dizzy
other injuries 
Check Hx of bleeding easily, anticoagulation, prev brain surgery
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8
Q

When to CT head after head injury and how to safety net

A
  • GCS <13 o.a, <15 2 hrs
  • suspected skull fracture
  • basal skull
  • post traumatic seizure
  • Focal neuro deficit
  • More than 1 episode of vomit
  • Warfarin
  • LOC or amnesia + >65, Hx bleeding, dangerous MOI, more than 30 min retrograde amnesia

Safety net:

  • worsening headache not better with para
  • drowsy
  • confusion, strange behaviour
  • loss of use of part of body
  • Dizzy, loss of balance
  • Visual or hearing changes
  • Blood or clear fluid from nose/ear
  • Unusual breathing
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9
Q

When to immobilise C-spine

How to immobilise

A

Suspected neck injury and any of:

  • > 65 yrs
  • immediate pain at time of injury
  • GCS < 15 at time
  • Midline pain/tenderness
  • Altered sensation/weakness
  • Dangerous MOI

3 points: collar, head blocks, back support

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10
Q

6 points before they can be cleared from c-spine injury

A
  • fully alert and oriented
  • no head injury
  • no drugs or alcohol
  • no neck pain
  • no neurological problems
  • no other significant ‘distracting injuries
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11
Q

Investigations for hypoglycaemia

A
  • Blood: FBC, U&Es, LFT
  • Blood glucose
  • Insulin or C-peptide
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12
Q

Treatment for hypoglycaemia

A

If conscious

  1. 20g of fast acting glucose (4 glucose tablets)
  2. Re-peat BM in 10 mins
  3. If > 4mmols give long acting carb (toast)
  4. Fails to rise after 4 attempts 1mg glucagon IM or IV 10% glucose over 15 mins

Semi-consious: glucogel 1.5-2 tubes

Unconscious:
ABCDE
IV 200mls 10% glucose in 15 mins
IV 100mls 20% glucose in 15 mins
Glucagon 1mg IM
Repeat BM 15 mins
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13
Q

Stroke acute management

A

ABCDE
(neuro exam)
Hx:
- when symptoms started, symptoms worsening, static or improving
- intracranial pathology, clotting problems, bleeding problems, pregnancy, recent trauma, surgery, invasive problems

Once stable:
request emergency CT
Consider thrombolysis or aspirin 300mg PO STAT
re-assess
refer to acute stroke ward

If AF: CHADVASC

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14
Q

Treatment for meningitis

A

Treat before investigations
Community: IM benzylpenicillin 1.2g
Hospital: IV ceftriaozone 2g

Investigations:
IV access: culture, blood (clotting, ESR), VBG
Throat Swab
PCR
CT 
LP
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15
Q

Seizure

A 
Start timing:
- Oxygen
- Safe environment, recovery position
- Monitor 
3-4 mins: venous access: FBC, U&amp;E, LFT, Ca2+, glucose, blood culture, anticonvulsant levels
If glucose <3.5: 100ml 20% glucose

At same time take Hx

5 min
call senior 
consider airway adjunct 
IV access: lorazepam 4mg repeat at 10 mins if not effect or Diazepam 10mg 
If alcoholic give pabrinex

20 mins gibe phenytoin 20mg/kg and contact anaesthetics

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16
Q

Management for alcohol withdrawal

A
  1. chlordiazopoxide (2-4 weeks)
  2. IV pabrinex I+II
  3. CIWA-Ar score
  4. B vitamins and Thiamine
  5. Fluids
  6. Management of blood sugar
17
Q

Investigation for paracetamol overdose

A 
serum paracetamol level
FBC, U&amp;E, Clotting
Liver test: INR, AST, ALT (increase 24hr-72hr after)
Glucose
ECG
Find time of dose > plot on graph
18
Q

Management of paracetamol overdose

A

> 75mg/kg in last 1 hour: activated charcoal

N-acetylcystiene IV

  • unknown time of ingestion
  • time exceeds 8 hours
  • staggered dose
  • patient is unconscious
  • overline on graph
19
Q

benzodiazepine overdose: sign & treamtoer

A

↓GCS, ataxia, anterograde amnesia, ↓RR

Flumazenil

20
Q

codeine overdose sign and management

A

↓GCS, pinpoint pupils, ↓RR, bradycardia, coma

Naloxone
check for patches on elderly

ACC (7 decks)

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