Emergencies

Question 1

Sepsis Mx

Answer 1

IV Abx within 1hr
IV fluids 500ml bolus over 15min (In 1hr if SBP <90 or lactate >2)
High flow 02 target 94-98%

Take blood cultures (before Abx), monitor urine output, and lactate

Hunt for the source

Question 2

Analyphaylactic shock

Answer 2

Secure the airway and remove the source if possible

IM adrenaline 0.5mg (0.5ml 1:1000) - Rpt every 5 min PRN
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV

Titrate IV 0.9% Nacl against BP

Question 3

Post analyphactic shock

Answer 3

Admit monitor ECG . Serum trypase 1-6hrs post attack
Skin prick test for IgE
2 x epipens and education of how and when to use
Document!!

Question 4

ACS STEMI

Answer 4

ECG = 1st line if evidence of ST elevation.
Bloods - troponin,etc
Aspirin 300mg Ticagrelor 180mg (alternative to clopidogrel) PO

Morphine 5mg and metacloprimide 10mg IV

If PCI available within 120 mins = PCI!
- If not fibrinolysis and transfer to PCI centre

Question 5

ACS NSTEMI

Answer 5

ECG, troponin.
Sats <90% low flow O2
GTN spray as required, morphine + metaclopramide

Aspirin 300mg PO

Calculate Grace score

• Conservative strategy low risk pt
• Invasive strategy

Question 6

Invasive strategy ACS NSTEMI

Answer 6

Rise in troponin, dynamic ST changes, 2ndary criteria = DM,CKD, high GRACE

Give fondaparinaux 2.5mg OD SC and ticagrelor 180mg OD PO

Cardiology referral ?PCI if ongoing angina, arrhythmias, etc

Question 7

Severe pulmonary oedema

Answer 7

Sit upright, high flow O2 if hypoxaemic. ECG to check for arrhythmias
Diamorphine 1.25mg
IV furosemide 80mg

Question 8

Acute severe asthma

Answer 8

Assess severity = PEF, ability to speak, RR, HR, O2 sats

O2 high flow target sats 94-98%
5mg salbutamol nebulised
- If severe/life threatening add ipatropium 0.5mg/6hr
Hydrocortisone 100mg IV

Reassess every 15 mins
If PEF <75% repeat SABA nebs 15 mins
If poor response = 1.2mg MgSO4 IV

ECG monitor for hypokalemia

Question 9

Discharge post acute asthma

Answer 9

Pt with PEF >75% within 1hr can be discharged

Otherwise stable on medication for 24hrs - prednisolone 40mg OD 7 days
Check inhaler technique, GP appt in 2 days, Resp clinic in 4 wks, personal PEF, steroid and bronchodilator therapy

Question 10

Acute COPD

Answer 10

NEB SABA (salbutamol 5mg/4hr) and SAMA (ipratropium 500microgram/6h)

CXR, ABG, FBC

Controlled O2 if sats <88% or PaO2 < 7kpa. Use venturi aim for sats 88-92% just according to ABG aim for PaO2 >8 with rise in PaCO2 <1.5

Steroids = IV 200mg hydrocortisone, 30mg PO prednisolone

If evidence of infection = Abx

Consider NIV if pH falling, RR>30 or PaCO2 rising

Question 11

PE

Answer 11

O2 15l/min if hypoxic
LMWH

?underlying causes