Emergencies Flashcards
If there is a major bleed for a patient on warfarin, what do you do?
Stop warfarin
Give 5-10mg IV vitamin K
Give prothrombin complex
What are the steps for treating a STEMI?
ABCDE and O2 15L non-rebreath Hx O/E Aspirin 300mg oral Morphine 5-10mg IV and Cyclizine 50mg IV GTN spray/tablet Primary PCI/thrombolysis B-blocker (e.g. bisoprolol 2.5mg unless left ventricular failure or asthma) Transfer to coronary care unit
What are the steps for treating an NSTEMI?
ABCDE and O2 15L non-rebreath Hx O/E Aspirin 300mg oral Morphine 10mg IV and Cyclizine 50mg IV GTN spray/tablet Clopidogrel 300mg oral and LMW heparin (e.g. enoxiparin 1mg/kg bd sc) B-blocker (e.g. bisoprolol 2.5mg unless left ventricular failure or asthma) Transfer to coronary care unit
What are the steps for treating acute left ventricular failure?
ABCDE and O2 15L non-rebreath Hx O/E Sit patient up Morphine 10mg IV and Metoclopramide 10mg IV GTN spray/tablet Furosemide 40-80mg If inadequate response, isosorbide dinitrate infusion +- CPAP Transfer to coronary care unit
What are the main differences between treating a STEMI and an NSTEMI?
For a STEMI, PCI or thrombolysis
For an NSTEMI, clopidogrel 300mg oral and LMW heparin (e.g. enoxiparin 2mg/kg SC BD).
What are the similarities in treating STEMI and NSTEMI?
Both give O2 15L non-rebreath
Both give aspirin 300mg oral
Both give morphine sulfate 10mg IV and metoclopramide 10mg IV.
Both give GTN spray/tablet
Both give a B-blocker, such as atenolol 5mg
What are the similarities in treating STEMI, NSTEMI and LVF?
Give morphine 10mg IV and metoclopramide 10mg IV
Give GTN spray/tablet
How do you treat acute left ventricular failure?
15 litre non-rebreather (unless COPD) Sit patient up Morphine 10mg IV with cyclizine 50mg IV GTN spray/tablet Furosemide 40-80mg IV (repeat as needed) If inadequate response, isosorbide dinitrate infusion +-CPAP Transfer to CCU
First steps for adult tachycardia?
ABCDE
Oxygen if necessary and IV access
Monitor ECG, BP, O2 sats, 12-lead ECG
Identify and treat reversible causes, e.g. electrolyte abnormalities
If adult tachycardia and showing adverse features such as shock, syncope, heart failure, or myocardial ischaemia, what should be done?
Up to 3 attempts of synchronised DC shock
Amiodarone 300mg IV over 10-20 mins and repeat shock, followed bu amiodarone 900mg over 24 hours
If ventricular tachycardia and no adverse features, check QRS is narrow. If the QRS is narrow and regular what do you do?
Use vagal manoeuvres Adenosine 6mg rapid IV bolus If unsucessful, give 12 mg If unsucessful again, give 12 mg Monitor ECG continuously
If sinus rhythm is restored, probably re-entry paroxysmal SVT.
Record 12 lead ECG in sinus rhythm and if recurs, give adenosine again and consider choice of antiarrythmic prophylaxis
If not restored,
Seek expert help
Possible atrial flutter, so control rate with beta blocker
If not
If adult tachycardia, narrow QRS and irregular rhythm, what is the probable diagnosis and management?
Atrial fibrillation
Control rate with b-blocker or diltiazem (calcium channel blocker)
Consider digoxin or amiodarone if evidence of heart failure
If regular adult tachycardia and broad QRS, what should management be?
If ventricular tachycardia, amiodarone 300mg IV over 20-60 mins, then 900mg over 24 hours
If previously confirmed SVT with bundle branch block, give adenosine as for regular narrow complex tachycardia (6mg rapid bolus, then 12 and 12 if unsuccessful)
If irregular broad QRS and tachycardia, what is management?
Seek expert help
May be AF with bundle branch block (treat as for narrow, so consider beta blocker or calcium channel blocker)
May be pre-excited AF - consider amiodarone
May be polymorphic VT (e.g. torsade de pointes - give magnesium 2mg over 10 mins)
Treatment for supra-ventricular tachycardia if narrow complex?
Adenosine
Treatment for tachycardia if unstable?
DC shocks (up to 3) And amiodarone
Treatment for torsade de pointes
Magnesium
Treatment for ventricular tachycardia
Amiodarone
Treatment for anaphylaxis
ABCDE, O2, and remove cause
Adrenaline 500 micrograms of 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Asthma treatment if wheeze
Treatment for acute asthma
Salbutamol 5mg neb
Hydrocortisone 100mg IV (if severe or life-threatening) or prednisolone 40-50mg oral (if moderate)
Ipatropium (500 micrograms NEB)
Aminophylline (only if life-threatening)
Acute exacerbation of COPD
Same as asthma, and add antibiotics
Secondary pneumothorax
Chest drain if >2cm or SOB or >50 years old
Otherwise aspirate
Tension pneumothorax
Tracheal deviation +- shock
Emergency aspiration required, then chest drain
Primary pneumothorax
If <2cm rim and not SOB, discharge with 4 week outpatient follow-up
If >2cm rim or SOB, aspirate, if unsuccesful aspirate again, if still unsucessful, chest drain
