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Emergencies PACES Flashcards

1
Q

What NEWS score is considered significant?

A

5 or more in total or 3 or more in one domain

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2
Q

Prior to performing an A to E approach, what would you do?

A

Safety net any other patients and inform SHO/reg that there are potentially X unwell patients

Request an SBAR handover from the nurses and the NEWS scores

Ask the nurses to have the drug chart and the notes by the bedside, and identify the ceiling of care

Ask for PPE to be prepared

If the patient is likely to require surgery, keep them NBM and perform a group and save

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3
Q

How would you assess the airway?

A

If the patient is vocalising, assume the airway is patent

Look inside the mouth and remove obvious objects and dentures

Listen for upper airway noises - stridor, snoring, gurgling

Do: large bore suction under direct vision if secretions are present

Do: manoeuvres to establish patent airway i.e. head tilt/chin lift, jaw thrust (with C spine control in trauma)

Do: adjuncts as tolerated to establish patent airway, such as nasopharyngeal or oropharyngeal airway

If airway is still compromised, call the arrest team (2222)

Ask the nurse to put on monitoring at this point. If the patient is in peri-arrest, ask for the crash trolley now.

“If I’m happy that the airway is patent or being managed by a suitably qualified colleague, I’d move on to assess breathing.”

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4
Q

How do you assess breathing?

A

Observations: SpO2, RR
Look: respiratory distress, chest expansion (if even between sides)
Listen: air entry, added sounds
Feel: trachea, chest expansion, percussion

Investigation:

  • ABG (CCOT nurses may be able to get this in advance, nurses can take VBGs)
  • Portable CXR

Management
Do - non-rebreather mask and 15L/min O2
Do - bag valve mask if poor or absent breathing effort
If tension pneumothorax then perform immediate needle decompression
If poor or absent respiratory effort then call cardiac arrest team

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5
Q

How do you assess circulation?

A

Observations: HR, BP
Look: colour, diaphoresis, oedema, bleeding, cyanosis, distended neck veins
Feel: temperature, central pulses (carotid/femoral), CRT
Listen: heart sounds

Investigations:

  • 12 lead ECG
  • Blood pressure
  • IV access + bloods (FBC, U&E, LFTs, coagulation, group and save, troponin)
  • Catheter: input / output

Management
If no pulse - call cardiac arrest team
Do: get venous access and send bloods
Do: get VBG with bloods or ABG if spO2 <95
Do: give fluids if hypotension or high pulse - 500mL stat unless pt in over heart failure

sepsis, STEMI, arrhythmia, haemorrhage

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6
Q

How do you assess disability?

A

Assess consciousness (AVPU or GCS)
Observations: Glucose
Pupils - size, reaction to light
Feel tone in all 4 limbs
Drug chart

Management
Do give glucose if <4 mmol/l, 100mL of 20% glucose IV

stroke, hypoglycaemia

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7
Q

How do you assess exposure

A

Observations: temperature
Focused examination:
- Skin
- Abdomen
- Calves
- Lines / drains

Investigations:

  • USS/ FAST scan
  • Urinalysis + pregnancy test

Management:
Do warm patient if hypothermic
Look all over body for injuries - MUST keep patient covered to protect dignitiy

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8
Q

Following the acute setting, what needs to be done

A

COVID nudge test if not already done
Referral to team
Document in notes
Update family
Thromboprophylaxis
Update seniors

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9
Q

What are some common causes of peri-arrest?

A

Arrhythmia
MI
Hypovolaemia
Sepsis
Hypoglycaemia
Hypoxia
Pulmonary oedema
PE
Metabolic (hypo or hyperkalaemia)
Tension pneumothorax

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10
Q

What are the components of qSOFA (quick sequential organ failure assessment)?

A

RR > 22
GCS < 15
SBP < 100

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11
Q

What is the difference between severe sepsis and septic shock?

A

Severe sepsis: sepsis with evidence of organ hypoperfusion (e.g. hypoxaemia, oligaemia, confusion)
Septic shock: severe sepsis with hypotension despite adequate fluid resuscitation

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12
Q

What are the sepsis 6?

A

Give oxygen (15 L through non-rebreather)
Give IV fluids (bolus = 20 mL/kg)
Take blood cultures
Take lactate
Monitor urine output
Give broad-spectrum antibiotics

ALL WITHIN 1 HOUR

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13
Q

When should sepsis patients be escalated further?

A

SBP fails to reach > 90 mm Hg
Lactate remains > 4 mmol/L

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14
Q

How should haemorrhagic shock be managed?

A

2 L of crystalloid
If this fails to resuscitate –> X-match
Give FFP and packed red cells (1:1) aiming for platelets > 100 and fibrinogen > 1

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15
Q

Which medications are used in the management of anaphylaxis?

A

Adrenaline 0.5 mg IM (0.5 mL of 1:1000)
Repeat every 5 mins as necessary
Chlorphenamine 10 mg IV
Hydrocortisone 200 mg IV
IV fluid bolus if shocked

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16
Q

What should be done after the a patient with anaphylaxis has been stabilised?

A

Admit to ward
Monitor ECG
Continue chlorphenamine 4 mg per 6 hours PO if itching
Suggest MedicAlert bracelet
Prescribe autoejector
Consider skin-prick testing or specific IgE

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17
Q

Outline the management of aortic dissection.

A

Fast bleep cardiothoracic surgery
Transfer to ITU
Use hypotensives (e.g. labetalol) to maintain SBP 100-110
Document and debrief

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18
Q

Outline the management of a ruptured AAA.

A

Fast bleep vascular surgery and anaesthetics
Take the patient straight to theatre
Gain IV access
Administer O- if necessary
Keep SBP < 100 mm Hg

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19
Q

Outline the initial management of a STEMI.

A

Morphine 5-10 mg IV (repeat after 5 mins if necessary)
Metoclopramide 10 mg IV
Oxygen 15 L via non-rebreather
Nitrates
Aspiring 300 mg PO (with clopidogrel or ticagrelor)

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20
Q

What doses of second antiplatelet agents are used with aspirin in the prevention of atherothrombotic events in ACS?

A

Clopidogrel 300 mg followed by 75 mg
Ticagrelor 180 mg STAT followed by 90 mg BD

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21
Q

Which medications should patients who have had an MI take home?

A

Dual antiplatelet therapy (continue for 12 months)
GTN spray
Beta-blocker
ACE inhibitor
Statin

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22
Q

Outline the management of acute heart failure.

A

Diamorphine 1.25-5 mg IV (caution in liver failure or COPD)
Furosemide 40-80 mg IV
GTN spray 2 puffs sublingual (consider isosorbide mononitrate infusion 2-10 mg/hour)

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23
Q

What should be considered if a patient in acute heart failure deteriorates?

A

Further dose of 40-80 mg furosemide
Consider CPAP
Increase nitrate infusion
Refer to ITU

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24
Q

How should a patient with acute heart failure be managed once they have been stabilised?

A

Monitor daily weight and observations
Repeat CXR
Switch to oral furosemide or bumetanide
ACE inhibitor if LVEF < 40%
Consider beta-blocker and spironolactone
Consider biventricular pacing or transplantation
Consider digoxin and warfarin

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25
Q

Outline the management of broad complex tachycardia in a haemodynamically UNSTABLE patient.

A
  • DC cardioversion
  • Hypokalaemia and hypomagnesaemia
  • Amiodarone 300 mg IV over 10-20 mins through a central line
  • Procainamide and sotalol in refractory cases
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26
Q

Outline the management of broad complex tachycardia in haemodynamically STABLE patients.

A

Correct electrolyte abnormalities
Amiodarone 300 mg IV over 10-20 mins
If it fails –> DC cardioversion

NOTE: after correction of VT, patients should be given maintenance antiarrhythmic therapy (e.g. sotalol)

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27
Q

Outline the management of torsades des pointes.

A

Stop predisposing drugs (e.g. TCAs)
Correct hypokalaemia
Give magnesium sulphate 2 g over 10 mins

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28
Q

Outline the management of narrow complex tachycardia.

A

Vagal manoeuvres
Adenosine 6 mg IV bolus (followed by 0.9% saline flush)
If unsuccessful –> after 2 mins give 12 mg bolus
If unsuccessful –> after 2 mins give 12 mg bolus
Alternative: verapamil 2.5-5 mg over 2 mins

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29
Q

How should AF in an unstable patient be treated?

A

Emergency cardioversion
If unavailable –> IV amiodarone
Control ventricular rate: verapamil 40-120 mg/8 hrs PO or bisoprolol 2.5-5 mg/day PO
Start anticoagulation with LMWH

NOTE: cardioversion is only recommended if it can be done within 48 hours of the onset of symptoms

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30
Q

Which medications should patients with AF be given to take away?

A 
Use CHADS-Vasc to calculate need for anticoagulation (1 or more requires warfarin) 
Rate control (beta-blocker or CCB) 
Rhythm control (flecainide if no structural heart disease, otherwise amiodarone)
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31
Q

Outline the investigations that you would request for a suspected acute asthma attack.

A

Bedside: PEFR, ECG, ABG, SaO2
Bloods: FBC, U&E
Imaging: CXR?

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32
Q

Outline the management of severe acute asthma.

A

Nebulised salbutamol 5 mg with oxygen
IV hydrocortisone 100 mg (or PO prednisolone 40-50 mg)
If it worsens
- add ipratropium bromide nebuliser 0.5 mg
- stat dose of magnesium sulphate 1.2-2 g IV over 20 mins

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33
Q

If a patient with a severe asthma is showing signs of improvement, how should they be cared for?

A

Nebulised salbutamol every 4 hours
Prednisolone 40-50 mg OD for 5-7 days
Monitor PEFR and oxygen saturations

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34
Q

How should a patient with life-threatening acute asthma be escalated if initial treatment fails to cause an improvement?

A

Refer to ICU
May need ventilatory support (e.g. intubation)
May need intensified treatment (e.g. IV aminophylline, IV salbutamol)

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35
Q

Outline the management of an infective exacerbation of COPD.

A

BRONCHODILATOR: nebulised salbutamol 5 mg/4 hr + nebulised ipratropium 0.5 mg/6 hr
OXYGEN: at 24-28% via venturi mask aiming for 88-92%
STEROIDS: IV hydrocortisone 200 mg (or oral prednisolone)
ANTIBIOTICS: trust guidelines (e.g. amoxicillin or doxycycline)

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36
Q

How should the treatment of a patient with an infective exacerbation of COPD be escalated if they fail to respond to initial treatment?

A

Consider IV aminophylline
Consider NIV
Consider intubation and ventilation
Consider respiratory stimulant (e.g. doxapram)

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37
Q

Which investigations may be useful in patients with acute pancreatitis?

A

Bedside: glucose
Bloods: amylase, lipase, FBC, U&E (calcium), LFTs, ABG, glucose
Imaging: USS, erect CXR, AXR (rule out other causes of acute abdomen), ERCP

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38
Q

Outline the management of acute pancreatitis.

A

Assess severity using Modified Glasgow Criteria
NBM
IV fluids to achieve normal vital signs (3rd spacing)
Insert catheter to monitor urine output
Analgesia (IM pethidine 75-100 mg/4 hr or morphine)
If worsening –> ITU (may need ERCP)

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39
Q

Outline the management of a primary pneumothorax.

A

No SOB + < 2 cm rim of air on CXR –> consider discharge and repeat CXR in a few weeks
SOB + > 2 cm rim of air on CXR –> aspiration
- if unsuccessful –> repeat aspiration
- if unsuccessful –> insert chest drain

40
Q

Outline the management of a secondary pneumothorax.

A

No SOB, age < 50 yrs + < 2 cm rim of air –> aspiration
- if successful –> admit for 24 hours
- if unsuccessful –> insert chest drain
SOB, age > 50 yrs and > 2 cm rim of air –> insert chest drain

41
Q

Outline the management of tension pneumothorax.

A

Insert a large-bore needle that is partially filled with saline into the 2nd intercostal space in the MCL on the side of the suspected pneumothorax - remove plunger to allow air to bubble through the syringe
OR: into the safe triangle

42
Q

Outline the management of PE in a stable patient.

A

Oxygen
Morphine 5-10 mg IV with 10 mg metaclopramide
SC tinzaparin 175 U/kg/24 hrs (or UFH 10,000 IV bolus)

43
Q

How does the systolic BP affect the management of PE?

A

SBP > 90 mm Hg –> warfarin loading regimen (e.g. 5-10 mg warfarin PO)
SBP < 90 mm Hg –> IV colloid infusion + contact ICU –> dobutamine 2.5-10 µg/kg/min IV –> IV noradrenaline infusion –> consider thrombolysis

44
Q

Describe the ongoing management of PE after the immediate situation has been dealt with.

A

Reduce risk of recurrence (e.g. compression stockings)
LMWH should be continued with warfarin until INR > 2 for 24 hours or 5 days after starting warfarin (whichever is longest)
If obvious cause of VTE –> 3 months warfarin
If no obvious cause of VTE –> continue for 3-6 months

45
Q

How is a massive PE in a haemodynamically compromised patient treated?

A

10 mg alteplase followed by 90 mg infusion over 2 hours

46
Q

What crucial blood tests should be requested in patients with an acute upper GI haemorrhage?

A

FBC
Group and save
X-match 6 units of blood
Clotting screen
LFT

47
Q

Outline the immediate management of shocked patients with an acute upper GI bleed.

A

Protect airway and keep NBM
Insert two large-bore cannulae
Rapid IV crystalloid infusion up to 1 L
If grade III-IV shock, give O- blood until X-match is complete
Correct clotting anomalies (e.g. PCC, vitamin K)
Consider ICU referral for central venous line
Catheterise to monitor urine output (aim > 30 mL/hour)
Monitor vital signs
Notify surgeons
Endoscopy within 4 hours for variceal bleed and within 12-24 hours if unstable on admission

48
Q

Outline the medical management of acute upper GI bleeds.

A

Major ulcer bleeding –> omeprazole 80 mg IV stat over 40-60 mins followed by 8 mg/hour for 72 hours
Variceal bleeding –> resuscitate then urgent endoscopy for banding or sclerotherapy + terlipressin 2 mg SC QDS

NOTE: if large bleed, Sengstaken-Blakemore tube may be used to tamponade the bleed and lactulose may be given to reduce absorption of nitrogenous products

49
Q

Outline the management of bacterial meningitis.

A

Sepsis 6
Cefotaxime 2 g IV (add ampicillin 2 g/6 hrs IV if immunocompromised or > 55 years)
Call critical care team
If meningitis only: consider adding dexamethasone 4-10 mg/6 hrs IV

50
Q

Outline the ongoing management of a patient with bacterial meningitis who has been stabilised.

A

Discuss antibiotic treatment with microbiology
Isolate in side-room for 24 hours
Treat contacts with ciprofloxacin 500 mg PO

51
Q

Which drug treatment is used for suspected encephalitis?

A

IV aciclovir (10 mg/kg/8 hrs IV)

52
Q

How much insulin should be given to patients with DKA?

A

50 u actrapid in 50 mL of 0.9% saline
Infused continuously at 0.1 u/kg/hour
Aim for a fall in ketones of 0.5 mmol/L/hour
OR rise in venous bicarbonate of 3 mmol/L/hour with a fall in glucose of 3 mmol/L/hour

NOTE: check VBG at 1 hour, 2 hours and 2 hourly thereafter

53
Q

When should glucose be added to the infusion in DKA?

A

10% glucose at 125 mL/hour alongside saline when glucose < 14 mmol//L

54
Q

Outline the management of acute abdomen.

A

Gain IV access
Catheterise and place on fluid balance chart if hypotensive
Analgesia: 100 mg diclofenac PR for renal pathology, or 5-10 mg morphine IV for intra-abdominal pathology
Send blood sample for FBC, U&E, amylase, LFT, CRP and G&S
IV antibiotics if indicated
NBM

55
Q

Outline the management of stroke.

A

15 L/min oxygen if low saturations or SOB
NBM
100 mL/hour 0.9% saline
Treat arrhythmias
Get exact timescale of symptom onset
Request urgent CT scan
Once haemorrhagic stroke ruled out: aspirin 300 mg STAT and thrombolyse with tPA of < 80 yrs and < 4.5 hours or > 80 yrs and < 3 hours

56
Q

Outline the treatment of hyperkalaemia.

A

10 mL 10% calcium gluconate IV over 2 mins (repeat every 15 mins up to 5 doses)
10 IU Actrapid with 50 mL 50% dextrose IV over 10 mins
Consider 5 mg salbutamol nebuliser
Monitor ECG and have access to crash trolley
Check ABG for acidosis

57
Q

How are pre-renal and post-renal causes of AKI treated?

A

Pre-renal: fluid resuscitation with 0.9% saline (250-500 mL bolus) followed by infusion of 20 mL + last hour’s urine output
Post-renal: catheterise

NOTE: pulmonary oedema should be treated with furosemide IV

58
Q

List the indications for dialysis in AKI.

A

Hyperkalaemia unreponsive to medical treatment in an oliguric patient
Pulmonary oedema unresponsive to medical treatment
Uraemia (e.g. encephalopathy)
Severe metabolic acidosis (pH < 7.2)

59
Q

Outline the management of hypokalaemia.

A

Monitor U&E and ECG
40 mmol/L KCl in 1 L of 0.9% saline (unless oliguric –> insert catheter to ensure accurate assessment of urine output)
Admit to ICU for insertion of a central line if > 10 mmol/hr needed
If MILD: oral K+ supplementation (SandoK)

60
Q

Which investigations would be useful in a patient with hyponatraemia?

A

Hypovolaemic –> low urine sodium
Euvolaemic –> TFT, SST, plasma and urine osmolality
Hypervolaemic –> low urine sodium

61
Q

Outline the management of hyponatraemia.

A

Do NOT correct faster than 8-10 mmol/L/24 hrs
Hypovolaemic –> 0.9% saline
Euvolaemic –> fluid restriction

62
Q

Outline the management of hypocalcaemia.

A

Mild and asymptomatic: monitor, consider vitamin D supplements and calcichew
Severe tetany: 10 mL 10% calcium gluconate IV over 10 mins

63
Q

Outline the management of hypercalcaemia.

A

Correct dehydration with 0.9% saline (3-6 L in 24 hours with the first 1 L going in over 1 hour)
Furosemide may be needed in elderly patients who are prone to pulmonary oedema
Insert catheter to monitor urine output
IV bisphosphonate for bone pain (takes 1 week to work)

64
Q

Which investigations are important to order in patients with status epilepticus?

A

U&E
FBC
LFT
Glucose
Calcium
Toxicology
AED levels
CT/MRI head

65
Q

Outline the management of status epilepticus.

A

Secure the airway (may need adjuncts)
STEP 1: Slow IV bolus of IV lorazepam 2-4 mg
Second dose if no response within 10 mins
Thiamine if alcoholism is suspected
Glucose 50 mL 50% IV if hypoglycaemia is suspected
STEP 2: IV phenytoin infusion 15-20 mg/kg at < 50 mg/min
STEP 3: rapid sequence induction with thiopental and EEG monitoring

66
Q

Outline the management of pneumonia.

A

Treat hypoxia and hypotension if necessary
Antibiotics following local guidelines (e.g. CAP = coamoxiclav and clarithromycin; HAP = tazocin)
Analgesia if pleuritic chest pain
CPAP if no improvement

67
Q

Which investigations should be requested in suspected pneumonia?

A

Bedside: oxygen saturation, ABG, sputum sample, urine sample (Legionella)
Bloods: FBC, U&E, CRP, atypical serology
Imaging: CXR

68
Q

Which investigations would you request in a patient with delirium?

A

Bedside: glucose, ABG, ECG, urine dipstick
Bloods: FBC, U&E, LFTs, blood glucose, blood cultures
Imaging: CXR, CT/MRI

69
Q

Outline the management of bradycardia.

A

Sit the patient up (unless dizzy)
15 L/min oxygen if hypoxic
Give 0.5 mg atropine IV every 2-3 mins (up to max 6 doses)
If unsuccessful –> isoprenaline 5 µg/min
If unsuccessful –> adrenaline 2-10 µg/min
If unsuccessful –> transcutaneous pacing

70
Q

Outline the management of hyperosmolar hyperglycaemic state (HHS/HONK).

A

Rehydrate slowly with 0.9% saline over 48 hours (deficit is typically 110-220 mL/kg)
Equated to 8-15 L for 70 kg adult
First 1 L may be given quickly over 30 mins
Replace K+ when urine starts to flow
Use insulin sliding scale if glucose is NOT falling by 5 mmol/L/hr with rehydration
Keep glucose at 10-15 mmol/L for first 24 hours (avoid cerebral oedema)

71
Q

If a nurse contacts you regarding a patient who has become unconscious, what should you tell them to do?

A

Check for respiratory effort/pulse and begin CPR if absent

72
Q

How should an Addisonian crisis be treated?

A

100 mg hydrocortisone STAT
Followed by 100 mg/8 hrs hydrocortisone

NOTE: they may need fludrocortisone, glucose and fluids

73
Q

What are the components of a SOFA score?

A

Respiratory rate
Bloodpressure
GCS
Liver (bilirubin)
Coagulation (platelets)
Renal (creatinine and urine output)

Sepsis = infection + increase of 2 or more on SOFA

74
Q

Outline the management of NSTEMI.

A

Give oxygen if breathless or SaO2 < 90%
Morphine 5-10 mg IV + antiemetic
Nitrates (GTN spray or sublingual)
Aspirin 300 mg PO + second antiplatelet agent (clopidogrel, ticagrelor, prasugrel)
Oral beta-blocker (e.g. metaprolol) if hypertensive/tachycardic/low LV function
Fondaparinux 2.5 mg OD SC or LMWH 1 mg/kg/12 hours SC
IV nitrate if pain continues
HIGH RISK PATIENT
- Features: rise in troponin, dynamic ST or T wave changes, risk factors
- Begin infusion of tirofiban and refer for inpatient angiography (within 72 hours)
- Angiography may need to be within 24 hours if GRACE score > 140

75
Q

Which additional measures may be used during the A to E approach of a trauma patient?

A

Check for blood on the floor
Arrange FAST scan/pelvic X-ray
For unstable pelvic fractures use a pelvic band to reduce blood loss

76
Q

Outline the algorithm for the major haemorrhage protocol.

A

Take baseline blood samples (FBC, G&S, X-match, Clotting, fibrinogen)
If trauma < 3 hrs: give tranexamic acid (1 g over 10 mins, then 1 g/8 hrs infusion)
Limit use of O-negative blood and use group-specific blood as soon as possible

77
Q

What is the definition of major haemorrhage?

A

Loss of more than one blood volume in 24 hrs
Loss of 50% blood volume in 3 hours
Bleeding in excess of 150 mL/minute

78
Q

Which extra parts of an A to E would you do in a patient with suspected spinal cord compression?

A

D - palpate for spinal tenderness and perform a lower limb neurological examination to assess tone, power, reflexes and sensation
E - percuss the bladder (urinary retention), perform a rectal examination (tone and saddle anaesthesia) - important to consider cauda equina as a differential

79
Q

Outline the management of cord compression.

A

Ix: urgent MRI whole spine within 24 hours
Rx: dexamethasone 16 mg PO
Discuss with neurosurgery
Definitive: RADIOTHERAPY or decompressive surgery

80
Q

What must be done before a CTPA is performed in a patient with suspected PE?

A

Check renal function and ask about allergy to contrast

81
Q

What must always be done before thrombolysing a patient?

A

Discuss with a senior

82
Q

What is Cushing’s reflex?

A

Irregular breathing (Cheyne-Stokes)
Hypertension
Bradycardia

83
Q

Who could angry patients be directed towards?

A

PALS

NOTE: always gain consent from the patient before discussing their care with a family member

84
Q

What is the first step in managing a patient with VT?

A

Put out a peri-arrest call

85
Q

What are the 4 Hs and 4 Ts of cardiac arrest?

A

Hypoxia
Hypovolaemia
Hypokalaemia/hyperkalaemia
Hypothermia
Toxic
Thromboembolic
Tamponade
Tension pneumothorax

86
Q

Which medications should be continued after correction of VT?

A

Establish and treat the cause
Maintenance: amiodarone infusion for 12-24 hours followed by oral sotalol or amiodarone

87
Q

How can recurrence of VT be prevented?

A

Ablation of arrhythmogenic area OR ICD

88
Q

Outline the management of hypothermia.

A

Prepare crash trolley
Confirm temperature with low-reading thermometer (PR) and check every 30 mins
Set up ECG (bradycardia and J waves)
Remove wet clothing
Give warmed humidified oxygen
Slowly rewarm at 0.5 degrees per hour
CARDIAC MONITORING IS ESSENTIAL

89
Q

What is the difference between the Glasgow Blatchford and Rockall scores?

A

Blatchford - used at first presentation
Rockall - used after intervention to determine risk of re-bleed/death

90
Q

Which investigations are important to request in someone who has taken a paracetamol overdose?

A

Paracetamol levels (4 hrs post-dose)
LFTs
Clotting studies
U&E
FBC
Bone profile
ABG (acidosis and lactate)

91
Q

Outline the management of bowel obstruction.

A

IV 0.9% saline
5-10 mg morphine IV
NBM
NG tube aspiration
Correct electrolyte imbalance
Consider giving antibiotics if septic/perforated (co-amoxiclav and gentamicin)

92
Q

Outline the management of acute limb ischaemia.

A

URGENT open surgery and angioplasty
ALERT the vascular surgeons
If embolic: surgical embolectomy or thrombolysis (tPA)
Anticoagulate with LMWH after either procedure and look for source of emboli (e.g. AF, aneurysms)
WARNING: post-op reperfusion injury can lead to compartment syndrome
Compartment syndrome is treated with fasciotomy
It is very painful so patients should be given morphine

93
Q

Who is part of the cardiac arrest team?

A

Medical team on call (Med reg, SHO, FY1)
Anaesthetist
Nurse
Porters
CCOT

94
Q

What are some contraindications for NIV?

A

Pneumothorax
Drowsiness

95
Q

For the treatment of hyperkalaemia, what do you mix the insulin in?

A

10 U Actrapid in 100 mL of 20% dextrose given over 30 mins

PACES (3 decks)

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