DME

Question 1

What would a patient who has asthma be taking?

Answer 1

Reliver inhaler - salbutamol
Preventer inhaler - inhaled corticosteroid (-asone or onide)
Leukotriene receptor antagonist (LRTA)
Long acting beta antagonist (LABA)
Maintenance and reliever therapy (MART)

Question 2

What lowers the threshold for patients with asthma for calling an ambulance?

Answer 2

Patients on LRTA’s. LABA’s, MART’s, long acting muscarinics.
If they are on 3 or more asthma drugs
Had a previous life threatening asthma attack
Has been to hospital with their asthma in the past year
Has been struggling a lot with their asthma recently

Question 3

How does adrenaline work?

Answer 3

Blocks histamine release - reducing allergic response
Dilates airways - easier breathing
Reduces “leakiness” of blood vessels - reduces swelling and increases blood pressure
Constricts blood vessels, increases heart rate and force of heartbeat

Question 4

Why would you give adrenaline?

Answer 4

Treating anaphylaxis

Question 5

How do you give adrenaline?

Answer 5

• Age appropriate intramuscular dose
• Middle 1/3rd of the anterolateral thigh (muscle with few nerves and blood vessels)
• Stretch - avoids subcutaneous route
• Aspirate
• Repeat every 5 minutes if life threatening features persist

Question 6

How does aspirin work?

Answer 6

Prevents platelet plug and clot formation
Increases blood flow to the heart

Question 7

How do you give aspirin?

Answer 7

300mg tablet, once only - contraindicated if allergic to aspirin
Chewed/dissolved in water and swilled around the mouth

Question 8

When is glucagon indicated?

Answer 8

Severe hypoglycaemia

Question 9

How does glucagon work?

Answer 9

Hormone that is opposite of insulin that converts any stored energy in fat/liver into glucose and releases it into the blood, makes glucose available for the brain to use.

Question 10

How do you give glucagon?

Answer 10

1mg adult dose once only
Subcutaneous injection into the abdomen - pinch and bevel up 45 degrees, insert 2/3rd of needle

Question 11

When is glucose indicated?

Answer 11

Mild-moderate hypoglycaemia

Question 12

How does glucose work?

Answer 12

Quick acting carbohydrate - gives rapid increase in blood glucose levels - more energy available for the brain to use.
Long acting carbohydrate - slower, maintained peak in blood glucose. Prevents the patient becoming hypoglycaemic again.

Question 13

How do you give glucose for mild-moderate hypoglycaemia?

Answer 13

1 dose of quick acting glucose is 15-20g (1 glucojuice, 4-5 glucotabs, 2 tubes glucogel)
Route depends on severity, mild - oral, moderate - buccal
Can re-categorise after 15 mins (up to 3 times as required)
If still hypo after 3 doses call 999
Give 18g long acting carbohydrate if the patient can self help

Question 14

When is GTN indicated?

Answer 14

Treatment for ACI

Question 15

How does GTN work?

Answer 15

Relaxes blood vessels and increases blood supply to the heart muscle

Question 16

When is GTN contraindicated?

Answer 16

Systolic BP <90mmHg or central cap refil >2s
- allergy to nitrates
- aortic stenosis
- PDE-5 inhibitors - Spedra (last 12 hours), viagra (last 24 hours), cialis (last 48 hours)

Question 17

How do you give GTN spray?

Answer 17

Prime it in the air - once or twice
Ask patient to open their mouth with the tongue to the roof of their mouth and hold their breath whilst the dose is delivered.
1-2 sprays under the tongue
Repeat as required, if still safe to do so after 5 minutes
If slow/minimal resolution within 4 activations, treat as ACS
Max dose: 6 activations

Question 18

When would you use midazolam?

Answer 18

Tonic-clonic seizures, indicated in prolonged >5mins or serial 3 or more in 1 hour seizures

Question 19

How does midazolam work?

Answer 19

Reduces nerve cell firing in brain and muscle, can cause low resp rate, hypoxia, low heart rate and low blood pressure.
Reduces seizure activity
Reduces shaking

Question 20

Why is salbutamol used?

Answer 20

Treatment for wheeze/asthma

Question 21

How do you give salbutamol?

Answer 21

Use a spacer
Dose is dependent on severity with a max of 10 activations in a 10-20 minute period.
Wheeze, moderate asthma or anaphylaxis - 2 activations every 2 minutes.
Acute severe asthma - starting dose at 4 activations, then 2 every 2 minutes up to the max as required.
Life threatening - 6 activations then 2 every 2 minutes

Shake the inhaler between activations
Remember to give each activation seperately
Use the adapted technique - each activation over 5 tidal breaths.