Emergencies Flashcards
Anaphylaxis
Adult
ABCDE
Remove causitive agent
Lie flat, legs up
15L non rebreathe
0.5mg IM adrenaline (1:1000)
1 L IV fluid STAT
? Salbutamol/adrenaline Neb
After 2 doses IM
1mg adrenaline in 100ml
1ml/kg/hr then titrate
2-6h observation
Anaphylaxis
Child doses drugs
Adrenaline and IVF
Adrenaline:
>12 = 500mcg
6-12 = 300mcg
<6 = 150mcg
IVF = 20ml/kg
Choking
Adult
Effective cough
- encourage cough
Ineffective cough Conscious: - 5 back blows - 5 abdominal thrusts Unconscious - start CPR
Pre alert Adult Cardiac arrest
Actions
Check pulse (Trolley) Roll, Transfer
Start CPR and clock
Pads and rhythm check
Airway and capnography
IV access and VBG
2 minute cycle; time
Hx
Arrest time, CPR start time, PMH, QoL
Unresponsive patient
Unconscious patient
Stimulate: verbal/pain
Signs of life: Pulse check
Pads and BVM
ABCDE
Cardiac arrest
Drug doses
Adrenaline 1mg IV (1:10000)
Amiodarone 3rd and 5th shocks
- 300mg IV
- 150mg IV
Bradycardia
Signs of decompensation
Shock, syncope, angina, HF
Risk of asystole:
Mobitz II, CHB, ventricular pause >3s
Consider High ICP, hypoxia
Bradycardia
Treatment
Atropine 500mcg IV
Isporenaline 5mcg/min
Adrenaline 2-10mcg/min
Glycopyrronium 200-400mcg
Transcutaneous pacing
Stable Tachycardia
Dx
Narrow complex - irregular: AF - regular: SVT Broad complex - regular: VF ?SVT + BBB - irregular: AF + BBB
Other:
Polymorphic VT
WpW
WpW
Tx
Electrical cardioversion
Consider amiodarone
Do not give
Adenosine, beta/Ca blocker
(Block AV node)
Polymorphic VT
Torsades de pointes
Magnesium 2g IV (over 10 mins)
Do not give amiodarone
Prolongs QT
Fast AF
Tx
Stable Rhythm control? Rate control: Bisoprolol 5-10mg IVF bolus Digoxin 500mcg Amiodarone 300mg (30-60min)
SVT
Treatment
- Modified valsava
- Adenosine (?WpW?asthma)
6,12,18mg - Sync shock
VT
Treatment
Unstable
Sync shock
Stable
Amiodarone 300mg (20-30mins)
Then 900mg over 24h
Unstable tachycardia
Treatment
Sync shock (x3)
- Sedation
- 100,150,200
Amiodarone 300mg (20min) - repeat shocks
Adenosine
Contraindications
WpW
Asthma
Adenosine
Consent
Flushing and chest pain
Massive PE
Dx
Hypoxia, tachycardia Hypotension Signs of Right HF - raised JVP - TWI (V1-4 +/- inferior leads) - S1Q3T3 - right axis deviation - dominant R wave V1
Neutropaenic sepsis
Suspect in these groups…
- Any unwell haematology patient (regardless of treatment or not)
- Any unwell oncology patient within 6 weeks of systemic anti cancer Tx
STEMI
Dx
ST elevation in 2 contiguous leads >2mm chest leads >1mm limb leads ST depression V1-2 \+\-Wellens syndrome (Biphasic TW or deep inversion V1-3)
STEMI
Tx
MONA
Aspirin 300mg
Ticagrelor 180mg PO
?GTN 1-10mg/hr
HHS
(Hyperosmolar hyperglycaemic)
Dx
BG>30
Serum Osmolality>320
Treat as per DKA if:
pH <7.3
HCO3< 15
Ketones >3(b) or 2(u)
Meningitis/ meningococcal sepsis
Tx
Blood cultures Dex 10mg IV Ceftriaxone 2g IV BD \+\- Amoxicillin (Low immune, EtOH, DM, pregnant)
Rhesus negative woman
Sensitising event
- Complete and incomplete miscarriage after 12 weeks
- Threatened miscarriage with heavy or recurrent bleeding
Primary pneumothorax
Dx and Tx
Breathless +/- rim of air >2cm at level of hilum
Tx
Aspirate 16-18G canula
>2.5L aspirated or unsuccessful
-> intercostal drain
Secondary pneumothorax
Dx and Tx
Any of:
>50yrs, smoker, underlying lung disease
With:
Breathless +/- Tim of air >2cm (hilum)
Tx
Intercostal drain
Neutropaenic sepsis
Tx
Tazocin 4.5g QDS
+
Gentamicin 3-5mg/kg
If
Penicillin allergy
Or myeloma
See protocol
Encephalitis
Tx
Aciclovir 10mg/kg IV TDS
Upper GI/ Variceal bleeds
Abx
<64yr
Ceftriaxone 1g IV OD
>65
Ciprofloxacin 400mg IV BD
Penicillin allergy = cipro
Gentamicin dose
<65
5mg/kg
>65
3mg/kg
eGFR 10-30
2-3mg/kg
eGFR 5-10
2mg/kg
Metastatic spinal cord compression
Suspect if…
Bone mets +
Back pain, worse on lying or moving, prevents sleep
New nerve root pain
(Do not wait for weakness or sensory level)
Ix and Tx!
Metastatic spinal cord compression
Tx
16mg dexamethasone IV
With ranitidine
MRI whole spine
General principle
Unstable
Vs
Stable
Tachycardia
Unstable
- sync DC shock
- sedation ?conscious
Stable
- 300mg Amiodarone IV over 20-30mins
- unless TdP - IV MgSO4 2g (10min)
Upper GI bleed (severe)
Tx
2222 major haemorrhage
2 large bore IV canula
Blood if Hb<10 or significant ongoing bleeding
Vit K 10mg IV
Terlipressin 2mg IV
Tazocin 4.5g
GBS score
?endoscopy
Reverse clotting?
Traumatic cardiac arrest
Pre-alert -> prepare
Trauma team Call Consultant Prioritise HOT H: - Pelvic splint/ tourniquets - IO kit - Blood - Level 1 infuser O: - Intubation/ Capnography T: - Chest drain kit
Traumatic cardiac arrest
Algorithm
Trauma to chest/epigastrium?
- bilateral finger thoracostomy
- penetrating wound <10min down time -> clamshell
HOT +/- CPR Hypovolaemia - pelvic binder/ tourniquets - IV/IO blood Oxygen - I+V Tension PNX - bilat thoracostomy
Stroke
NIHSS IV access, VBG ECG monitor Blood sugar Immediate CT head
?Thrombolyse
ECG
Swallow screen
Aspirin 300mg
Severe HTN
Dx
Consistent BP of either
220/120
ABG (for hypoxia)
Normal bicarb and high CO2
Dx and Tx
Acute T2RF
Requires ventilation
?naloxone
ABG (for hypoxia)
High bicarb, high CO2, low pH
Dx and Tx
Decompensated chronic T2RF
Life threatening
Requires help ventilating
?naloxone
CPAP starting pressure
5-8cm H2O
BiPAP starting pressures
and increases
IPAP and EPAP
10 and 5 cm H2O
If hypercapnic
- increase IPAP by 2
If Hypoxic
- increase IPAP and EPAP by 2
Max 25/15
Max BiPAP
25/15 cm H2O
IPAP/EPAP
Suspected raised ICP
Tx
30deg head up
sBP>100
sBP>120 in isolated HI
Analgesia
Normothermia
PaCO2 4-4.5
100ml of 5% saline over 10min
Aim Na 150-155
Hypoglycaemia
Dx and Tx
<4mmol/L
(<3 neuro signs)
Give fruit juice or glucogel
1mg glucagon IM
50ml 50%, 100ml 20%, 200ml 10%
Maintenance
10% glucose 100ml/h