Emergencies

Question 1

How would you manage anaphylaxis

Answer 1

Remove cause
ABCDE:
A: secure airway
B: Adrenaline 0.5mg, repeat every 5 mins up to 3 times
C: IV fluids, hydrocortisone 200mg, chlorpheniramine 10mg

Question 2

What would suggest a life threatening Asthma? (7*)

Answer 2

33 92 CHEST
PEFR: 33
O2 sats <92
Cyanosis
Hypotension
Exhaustion (hypoxic/ hypercapnic = tiring)
Silesnt chest
Tachcadia

Question 3

How do you treat an asthma attack? (7*)

Answer 3

O SHIT ME:
Oxygen
Salbutamol 2.5-5mg NEB (back to back)
Hydrocortisone 100mg IV
Iprutropium 500mcg NEB
Theophylline 1g in 1L saline
Magnesium sulphate 2G IV over 20mins
Escalate care

Question 4

How do you treat a COPD exacerbation? (5*3)

Answer 4

OSHIT:
Oxygen (ABG after 15 mins)
Salbutamol 2.5-5mg back to back nebs
Hydrocortisone 100mg IV
Iputropium
Theophylline

Plus:
Antibiotics
Chest physio
?BiPAP

Question 5

How do you treat acute pulmonary oedema? (6*)

Answer 5

PODMAN:
Position (sat up)
Oxygen
Diuretics
Morphine
Anti-emetic
Nitrates

Question 6

How would you treat long term heart failure?

Answer 6

1st line: ACEi + B-blocker + diuretic
2nd line: + aldosterone antagonist
3rd line: + digoxin

Question 7

What arrhythmia are narrow complex tachycardias?

Answer 7

Caused by atrial tachyarrhythmias:

• Sinus tachy
• Paroxysmal CVT
• Atrial fibrillation/flutter

Question 8

Where would you do a needle thoracostomy when treating a tension pneumothorax?

Answer 8

Second intercostal space, mid-clavicular line

Question 9

How would you manage a seizure?

Answer 9

10mins: 10mg diazepam
20 mins: 10 mg diazepam
30 mins: phenytoin 18mg/kg
60 mins: general anaesthetic

Question 10

What is the treatment of a suspected TIA?

Answer 10

Aspirin 300mg PO OD for 2w
Specialist review within 24 hours
> carotid endarterectomy if carotis stenosis >70% or >50% with Sx
Long term drugs

Question 11

What is the treatment of a stroke?

Answer 11

CT head within 1 hour.
If intracranial bleed excluded:
- Thrombolysis (alteplase) if <4.5 hr, if not Aspirin 300mg OD for 2w
Transfer to stroke ward
- SALT, nutritional assessment, early mobilisation

Question 12

What long term drugs would you give after a stroke/TIA?

Answer 12

BP control drugs
Clopidogrel 75mg OD (or anti-coagulation in AF)
Statin

Question 13

What are the high risk criteria for sepsis?

Answer 13

• History: new altered mental state,
• Resp rate > 25 /needs O2
• Systolic BP <90 or >40 below normal
• HR>130, no UO for 18h or <0.5ml/kg/hr
• Skin: mottles/ashen, central cyanosis, non-blanching rash

Question 14

What are the moderate: risk criteria for sepsis?

Answer 14

• History: altered behaviour, impaired immune system, acute deterioration of function, trauma/ surgery/ invasive procedure in last 6 weeks
• Resp rate 21-14
• Systolic BP 91-10
• HR: 91-130; no UO for 12-18 hours or 0.5-1ml/kg/hr
• Temp <36
• Skin: signs of infection