Emergencies

Question 1

What is the acute management of anaphylactic shock?

Answer 1

Immediate
500micrograms 1:1000 Adrenaline IM [can be repeated every 5 mins]

Following
200mg Hydrocortisone IV
10mg Chlorphenamine IV/IM
20ml/kg Crystalloid fluid challenge IV [repeat as necessary]
5mg Salbutamol Neb

Question 2

What is the management of a STEAMI?

Answer 2

10mg Morphine slow infusion
10mg Metoclopramide 
Oxygen high flow
2 puffs Nitrates sublingual
300mg Aspirin PO chewable
300mg Clopidrogrel PO

Question 3

What is the management of an acute severe asthma attack?

Answer 3

5mg Salbutamol neb [repeat every 15 mins]
50mg Prednisolone PO
500microgram ipratropium up to twice
2g MgSO4 [consider]

Question 4

What is the acute management of cardiac arrest?

Answer 4

Immediate [COVID]
Check for danger + check for response
Feel for pulse (continue if no pulse)
Call for help + ask for crash trolley and cardiac arrest team (inform of person, building, ward + bay)
Start chest compressions until help arrives

Shockable rhythm (VF + pulseless VT)
Shock at 150J –> 300J –> 400J
Give 1ml 1:1000 IM or 1ml 1:10000 IV after 3rd shock
Give 300mg amiodarone IV after 3 shocks (+ again after 5th shock)

Non-shockable rhythm (PEA/asystole)
1mg Adrenaline IV on first non-shockable rhythm AND every OTHER rhythm check from that point

Question 5

What is the management of hperkalaemia?

Answer 5

1) 10% 30ml Calcium gluconate over 5-10mins
2) 20mg Salbutamol nebs [4x 5mg back-2-back nebs]
3) 10u Actrapid + 25g glucose IV
[Can give polystyrene resins but not appropriate in ED]

Question 6

What is the management of diabetic ketoacidosis?

Answer 6

STAT Insulin: 10u soluble insulin IM or SC
–> IF fixed rate insulin can be started within 15 mins, do this instead

Fluids: 500ml crystalloid over 15 mins (if volume depleted)

Fixed rate insulin: 50u diluted up to 50ml with normal saline and given at rate of 0.1unit/kg/hr

Glucose: 125ml/hr 10% glucose once CBG has fallen below 14mmol/L

Resolution
Blood ketones <0.6mmol/L
Venous pH >7.3

Variable rate insulin: if patient is not eating and ketones are <0.6, switch from fixed rate to variable rate [this sounds the same as preparation for surgery]

Only stop IV insulin 30 minutes AFTER they’ve started eating again

Question 7

How do you manage status epilepticus?
[This recipe is for kids but I think it’ll work on adults as well]
[Adult portions will be in square brackets]

Answer 7

Immediate: secure airway, remove hazards, give oxygen if needed + check glucose

[Adults only:

• Administer 50ml 50% glucose IV if hypoglycaemic
• WITH IV pabrinex]

5 mins

• If IV access = 0.1mg/kg [4mg] lorazepam IV
• If no IV access = 0.5mg/kg Midazolam buccal or 0.5mg/kg [10-20mg] Diazepam rectal

15 mins

• 0.1mg/kg Lorazepam IV
• Call senior
• If NOT on phenytoin = prepare phenytoin
• If ON phenytoin = prepare phenobarbitone

25 mins

• Reconfirm seizure
• Give either [20mg/kg MAX 2g @ 50mg/min max rate] phenytoin or phenobarbitone
• Seek ICU/anaesthetics help

45 mins

• Anaesthetics should be present now
• Opt for Rapid sequence induction

Question 8

What do you give for methaemoglobinaemia?

Answer 8

Causes = aniline dyes, benzene derivatives, chlorquine, dapsone, prilocaine, metoclopramide, nitrates + sulfonamides

Rx: methythionium chloride

Question 9

What general management can be given in most poisonings? For how long can this be given for?

Answer 9

Activated charcoal PO

Within 1hr

Repeated doses can be given in OD of carbamazepine, dapsone, phenobarbitol, quinine + theophyline

Do not treat if OD on petroleum distillates, corrosive substances, alcohols, malathion, cyanides + metal salts