Condition: Management: Flashcards
Asthma
Attach sats probe, auscultate chest
* HIGHFLOW OXG
* SLB → presence of wheeze 5 mins NO MAX Discontinue it if HR >140
* IPR → acute/ severe/ life threatening asthma not responding to salbutamol 6-8L 500mcg ONCE
* HYC → severe / life-threatening asthma IV Slow 2 mins – 100mg ONCE
* ADM → 1 in 1,000, life threatening asthma lateral thigh 500mcg 5 mins NO MAX
6-8L 5mg IM antero-
* Assess for tension pneumothorax*
reasses, relisten to chest
Anaphylaxis
- VS , remove trigger
- lie flat( raise legs)/sit up(aid breath)
- ADM IM → 1 in 1,000 antero-lateral thigh 500mcg 5 mins NO MAX
- High flow OXG & ECG
- SCP → SBP <90 mmHg
repeat 500-1000 ml MAX 2L. - SLB → wheeze presence 5 mins NO MAX Discontinue it if HR >140
6-8L 5mg ONLY after ADM and the pt is stable
Give intramuscular (IM) adrenaline early (in the anterolateral thigh) for Airway/Breathing/Circulation problems.
A single dose of IM adrenaline is well tolerated and poses minimal risk to an individual having an allergic reaction. If in doubt, give IM adrenaline.
Repeat IM adrenaline after 5 minutes if Airway/Breathing/Circulation problems persist. Self-administration of IM adrenaline (via an EpiPen® or similar) is not always reliable. Do not assume that any self-administered adrenaline has been delivered effectively.
Lie the patient flat (elevate legs if hypotensive). A sitting position is acceptable if that makes breathing easier for the patient. If patient is pregnant, lie her on left side. Avoid any sudden change in posture.
ACPO
- SIT UPRIGHT
- Sats, AUSC CHEST
- assess JVP,
- continuous ECG
- OXG titrate 94 – 98%
- GTN → breathlessness due HF pulmonary oedema SBP>110
- FRM → pulmonary oedema / respiratory distress, due to acute HF (IV slow - 2 mins) 40mg ONCE CONTRA: Cardiogenic shock
Addisons:
- VS + ECG
- HYC→ adrenal crisis (including Addison’s crisis)
IV slow over 2 mins 100mg ONCE - SCP → SBP <90 mmHg
- Pain relief
Hx: bracelet, PMH, allergies
MI
- VS+ ECG ASAP
- defib close due risk VF
- ASP → clinical / ECG evidence of MI OR 300mg ONCE - CONTRA: allergy, under 16 yrs, active GI bleeding, clotting disorders, hepatic
failure with jaundice - SCP <90
- GTN → cardiac chest pain with SBP > 90mmHg SL 400-800mcg – 5-10 mins – NO MAX – CAUTION – posterior or RV MI – CONTRA: hypovolaemia, head trauma, cerebral haemorrhage, Viagra in last 24hrs, GCS 3, known severe aortic or mitral stenosis
- MOR → analgesia Morphine SBP >90 mmHg IV dilute
NaCl - Initial dose 10mg – MAX 20mg - CONTRA: resp depression, hypotension, head
injury, hypersensitivity
time critical features
major <C>ABCD problems
12 LEAD - STEMI, BBB w other clinical features
correct <C>ABCDE
time crit transfer</C></C>
STEMI .> PPCI. Heart Attack Centre
minimise delay to reperfusion -manage en route
atmist pre-alert
where initial ECG does not indicate stemi, repeat every 10mins, normal 12LEAD not use exclude ACS
aspirin GTN
O2 <94
continous cardiac monitoring
SOCRATES - morphine, IV PAR,NO2 where morphine contradicted
COPD:
- sit upright, sats probe, auscultate chest
- Titrate OXG to 88 – 92%
- SLB → exacerbation COPD 6 mins 5mg 5mins NO MAX limit neb to 6mins
- IPR → exacerbation COPD unresponsive SLB 6 mins 500mcg ONCE
- HYC → acute exacerbation COPD over 2 mins 100mg ONCE
- SCP- SBP<90
Epilepsy/Seizure:
- environment is safe
- High flow OXG
- VS (BM & BP IMPORTANT) and ECG
- Assess injury caused from seizure (examine for non- blanching rash)
- DZP → prolonged convulsions (5 mins or more) OR repeated convulsions (more than 3 in an hour) AND who are currently convulsing
Heat Stroke
- VS ECG OXG 94-98
- cooling air-conditioning, remove all clothing, fan, water mist, tepid sponging → icepack thin cloth neck, axilla, groin
- Correct symptoms if possible (SCP, ODT, OXG)
- Pain relief, no antipyretic
for hyperthermia - infection, medications, recreational drugs (amphetamine, cocaine, ectasy)
Fluids - no delay/no warm fluids
TBI:
- C-spine
- VS& 15L O2, tirate 94-98%
- Monitor ETCO → 4.6-6 kPa
- Pain relief , MOR contra for head injury with gcs below 9, or P on avpu)
- Wound care
- Fluid therapy → isolated head injury titrated to maintain SBP 110
- TXA → over 18-year-olds, GCS 12 and below and injury, occurred within last 3 hours 1g over IV over 10mins 1g – Can be given as IM – CONTRA: bleeding started 3+ hrs ago, obvious resolution to haemorrhage, critical intervention required
Gastroenteritis:
• VS (BP, BM + ECG)
• Pain relief → IV Paracetamol –
• SCP→ hypotensive SBP <90
• ODT nausea or vomiting
Sepsis:
• Pre-alert (‘? sepsis’)
• VS (temp, BP, BM, HR, SpO2)
& NEWS2
• OXG High Flow
• SCP→ SBP <90
clinical signs of infection– 500ml over 15mins – MAX 2000ml
• meningitis suspected (non-blanching rash AND/OR signs/symptoms suggestive of e.g.
neck stiffness/photophobia) →
BNP - CONTRA: known severe penicillin allergy
• Pain relief
Rhabdo:
• VS BP, HR, ECG, etc)
• Keep flat
• OXG indicated
• Pain relief → IV PAR– Severe
• SCP→ hypotensive SBP <90
Tensión Pnuemothorax:
• B adeq?; RR, vol,equal air-entry.
• F, L, A, P
• NCD→ 2nd ICS above the 3rd rib MCL → 2nd placed lateral to
first → put cannula on syringe with 1ml of air
• TXA
•SCP → pen trauma: maintain palpable central pulse (carotid) OR SBP 60
blunt trauma: maintain palpable peripheral (radial) OR SBP 90
General Trauma:
• C-spine
• alert to poss internal bleed, assess blood loss in five places: 1. external 2.chest 3. abdomen 4. pelvis 5. long bones
• TXA →
• SCP → pen torso SBP of 60
blunt/pen limb BP of 90.
Appendicitis:
- VS (BP, BM + ECG)
- Pain relief → IV Paracetamol –
- Fluid therapy → hypotensive SBP <90 mmHg
- Anti emetic →ODT
https://www.youtube.com/watch?v=6LrL4ysi_AE
Roving’s sign: left lower-quadrant palpated -* right lower-guadrant pain
- Psoas sign: right leg extended in left-side position - retrocecal appendix
* Obturator sign: right leg internally rotated in supine position -+ pelvic appendix
