CritCare/emergency managements

Question 1

COPD definitive management

Answer 1

• Oxygen 88%-92%
• Nebulised Salbutamol+Ipatropium
• Oral pred/IV hydrocortisone
• Senior support (theophylline, magnesium sulfate)

Question 2

Asthma Definitive management

Answer 2

Oxygen 94%-98% Nebulised Salbutamol+Ipatropium Oral pred/IV hydrocortisone Senior support (theophylline, magnesium sulfate)

Question 3

DKA definitive management

Answer 3

• 0.9% Saline IV
• Fixed rate insulin infusion 0.1 units/kg/hr
  Stop short acting continue long acting
• BM<10g/dL Glucose start 5% glucose
• Add K+ to correct U+E’s

Question 4

HHS definitive management

Answer 4

• 0.9% SalineIV
• Fixed rate insulin infusion 0.05unit/kg/hr
• Potassium as per u+e’s

Question 5

Hypoglycaemia definitive management

Answer 5

• If consciouss give sugary snack/short acting carb and re-check BMs in 15 mins, repeat x3
• If unconsciouss give 0.5% glucose IV, if no IV access give 1mg glucagon IM

Question 6

Ischaemic stroke definitive management

Answer 6

• If there is a clear time of onset and it is <4.5hrs since then - alteplase
• If the above not met management is: aspirin, VTE proph

Question 7

Haemorrhagic stroke definitive management

Answer 7

• Refer immediatly to neuro
• Air way protection
• Admit to stroke unit or ICU
• BP control
• VTE prophy

Question 8

Tension Pneumothorax definitive management

Answer 8

• Widebore/grey cannula into 2nd ICS mid-clavicular line

Question 9

Sepsis definitive management

Answer 9

• O2 in, lactate out
• Fluids in, UO out
• Blood cultures (2in 24 hours at least –>1 before IV ABx) out, IV ABx in
• Culture anything else necessary

Question 10

Anaphylaxis definitive management

Answer 10

• 0.5mg 1:1000 adrenaline IM, dose may be repeated every 5 to 15 minutes
• 0.9% saline
• IV or oral pred
• Remove offending drugs

Question 11

PE definitive management

Answer 11

• O2
• IV 0.9% saline
• Anti-coag: heparin 80 units/kg IV bolus then18 units/kg/hour IV infusion adjusted to APTT
• Alteplase if low BP

Question 12

DVT definitive management

Answer 12

If no active bleeding, PE or pregnancy

• Rivaroxiban
• Mobiliisation
• TED stockings

Question 13

Hyperkalaemia definitive management

Answer 13

• IV calcium gluconate
• IV 0.9% saline
• Corrent other electrolyte abnormalities
• If severe >6.5 insulin and glucose + neds salbutamol

Question 14

Antidoates to ODs

Answer 14

• Warfrin - Vit K
• Opiod - naloxone
• Paracetamol - n-acetylcysteine
• Beta-blockers - glucagon
• TCA - sodium bicard
• Benzodiaz - flumazenil

Question 15

Sx of benzo, beta blocker and TCA OD

Answer 15

Benzo	
* Impaired attention and memory (anterograde)	
* Drowsiness, slurred speech, ataxia
Beta blocker	
* Hypo-opniec, hypotensive, bradycardic	
* Light headed dizzy
TCA	
* Tachycardia,drowsiness, adry mouth, N&V,urinaryretention,confusion,agitation, headache

Question 16

Bowel Obstruction definitive management

Answer 16

• IV 0.9% saline
• NG tube
• Laprotomy
• Analgesia

Question 17

ACS emergency management

Answer 17

• B - Breath
• R - Reassure
• O - Oxygen
• M - Morphine 10mg IV
• A - Aspirin 300mg orally
• N - Nitrates 400 microgram sublingual spray
• C - Clopidogrel 300 mg orally is STEMI
• E - Enox/Fondaparineux 2.5 mg OD s/c if pt to have coronary angiogram or CKD give unfrac heparin
  If STEMI or new LBBB PCI