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(Y5) ACT conditions management > Emergency > Flashcards

Emergency Flashcards

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1
Q

Anaphylaxis Tx

A

0.5mg 1 in 1000 IM adrenaline

10mg Chlorphenamine IM/IV

200mg Hydrocortisone IM/IV

+/- 5mg nebulised salbutamol

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2
Q

Management of ?hypovolaemic shock

  • Ix
  • Tx
A

Ix:

  • FBC (hb), U&Es, LFTs
  • Cross match
  • ABG (metabolic acidosis from hypoperfusion?)
  • ECG
  • FAST scan (assess for haemorrhage)
  • CXR and AXR

Tx

  • A + B (O2)
  • Raise legs
  • Fluid challenge (500ml 0.9% NaCl over 15 mins) –> give up to 2L then consider blood
  • Aim: SBP >90, HR <100, UO >0.5ml/kg/hour

Stop bleeding

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3
Q

When is the major haemorrhage protocol indicated

A

30-40% blood loss
SBP <90
HR >110
? traumatic injury (e.g. splenic rupture or RTA)

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4
Q

What is given in the major haemorrhage protocol

A

4U RBC + 4U FFP
+ tranexamic acid

Give RBC and FFP in ratio 1:1 if bleeding does not stop.
Also platelets + cryoprecipitate

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5
Q

Cardiogenic shock

  • definition
  • Ix
A

Tissue hypoperfusion due to reduced CO due to damage to the heart.

Ix

  • Cardiac markers (troponin, BNP)
  • ECG
  • Echo
  • FBC, U&Es, LFTs, Ca2+
  • ABG
  • CXR (pneumothorax, pulmonary oedema, cardiomegaly)
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6
Q

Management of cardiogenic shock

A

If airway is compromised refer to senior.

Usually treated in CCU/ITU

  • vasopressors
  • cautious fluid resuscitation (risk of HF)
  • hourly ECG or arterial line for CCM
  • monitor UO (catheter)
  • NIV

Treat underlying cause
- e.g. MI

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7
Q

When does septic shock need to be managed in critical care

A
  • NEWS >7
  • Lactate >4mmol/L
  • Hypotension not responding to tx (vasopressors needed)
  • Inotropes needed (hypotension refractory to vasopressors and MI has been ruled out)
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8
Q

What is present in septic shock

A
  • Lactate >2mmol/L

- Vasopressors required to keep MAP >65mmHg

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9
Q

Management of sepsis

A

Elevate legs

Blood cultures (ideally from 2 sites) 
Urine output (monitor, ?catheter) 
Fluid challenge 
Antibiotics (within 1 hour) 
Lactate levels
Oxygen (if hypoxic)
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10
Q

Ix in acute respiratory failure

A

Oxygen saturations

ABG (type 1 or type 2)

CXR (underlying pathology)

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11
Q

Management of acute respiratory failure

A

Oxygen. Aim for:

  • 94-98% in type 1
  • 88-92% in type 2

NIV if:

  • kPa <8 despite 60% oxygen
  • CO2 rising in type 2
  • escalate and ? if need for intubation

Treat underlying cause

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12
Q

Ix if ? paracetamol overdose

A
  • Paracetamol levels (4h post-ingestion)
  • LFTs, prothrombin, INR
  • Blood glucose
  • U&Es, FBC
  • ABG (metabolic acidosis)
  • Toxicology screen (urine)
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13
Q

When to treat paracetamol overdose with NAC

A

> 150mg/kg ingested = NAC ASAP

4-8h since ingestion = if paracetamol levels above treatment line on nonogram

> 8 hours since ingestion = give NAC while awaiting paracetamol levels

> 15 hours since ingestion and >75mg/kg ingested

Staggered overdose

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14
Q

When is activated charcoal indicated in paracetamol overdose?
- dose?

A

<1h since ingestion

50mg PO

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15
Q

NAC regime

A

1st bag = 150mg/kg over 1 hour

2nd bag = 50mg/kg over 4 hours

3rd bag = 100mg/kg over 6 hours

Monitor for anaphylactoid reaction.
If occurs STOP + restart at slower rate when reaction has resolved.

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16
Q

when is liver transplant indicated in paracetamol overdose

A 
pH <7.3 24 hours after overdose
OR
PT >100
OR
Creatinine >300
17
Q

When to escalate paracetamol overdose to senior

A
  • Clinical signs of liver injury (RUQ pain, N+V, jaundice, asterixis, encephalopathy)
  • AKI (Cr >300)
  • pH <7.3
  • hypoglycaemia
  • deranged clotting
  • lactate >3.5 on admission
18
Q

when is 50mg activated charcoal indicated in salicylate overdose

A

<1h since ingestion

>125mg/kg ingested

19
Q

Mild salicylate overdose

  • plasma levels
  • tx
A

<300mg/L

IV rehydration

K+ infusion if high K+ (aim for 4-4.5)

20
Q

Moderate salicylate overdose
Severe salicylate overdose

  • plasma levels
  • tx
A 
Moderate = 300-700mg/L 
Severe = >700mg/L

IV rehydration and replace K+ (aim for 4-4.5)

1.5L of 1.26% Sodium bicarbonate (urinary alkalisation, aim for pH 7.5-8)

CPAP/NIV

Benzodiazepines if seizures

Cooling if >39o

21
Q

When is haemodialysis indicated in salicylate overdose

A

plasma salicylate level >900mg/L

plasma salicylate level >700mg/L + metabolic acidosis

coma
acute renal failure
pulmonary oedema
seizures

22
Q

Ix if ?salicylate overdose

A

Serum salicylate levels
- 2h after ingestion then every 2 hours until peak.

ABG (mixed respiratory alkalosis and metabolic acidosis)

FBC, U&Es, LFTs, clotting, blood glucose (low)

ECG

23
Q

Ix if ? TCA OD

A

ECG

  • tachycardia
  • PR prolongation
  • QRS prolongation

ABG (metabolic acidosis)

Bloods + urinalysis for other drug screen

24
Q

Tx for TCA OD

A

IV Sodium bicarbonate (if QRS widened)

Anti-arhythmic (not amiodarone)

IV fluids (correct hypotension)

BDZ if seizures

25
Q

Ix if iron overdose

A

Serum iron levels
- immediately
+ after 4 hours (peak levels)

ABG (acidosis)

AXR

FBC, U&Es, LFTs, clotting

26
Q

Initial Tx of iron OD

A

A-E + TOXBASE

IV fluid resuscitation

27
Q

When is whole bowel irrigation indicated in iron overdose

A

<1h since OD

>60mg/kg ingested

28
Q

When is medical treatment indicated in iron overdose

- what is it

A

15mg/kg/hour IV dexferoxamine

>90micromol/L
4-6h post ingestions 
systemic toxicity 
metabolic acidosis 
altered mental state
29
Q

What tests are included in a confusion screen?

  • Bloods
  • Imaging
  • other
A

Bloods:

  • FBC
  • B12, folate, ferritin
  • U&Es
  • CRP
  • LFTs
  • coagulation screen
  • TFTs
  • Ca2+
  • Glucose + Hba1c
BP (lying and standing)
ECG
Visual/hearing test 
urinalysis 
medication review

CXR
CT/MRI head if ? injury

30
Q

How to assess falls risk

A

Timed get up and go test

  • patient asked to stand from sitting
  • walk 3m
  • turn 180 degrees
  • walk back.

If >12s = falls risk

31
Q

When is immediate evaluation needed of an elderly patient who has had a fall

A

Acute change in consciousness
? stroke
? seizure
? hypotension

Head trauma

Persistent pain and inability to weight bear
? fracture

32
Q

when is medication indicated for delirium + what is it

A

Last resort if correcting precipitating factors has been unsucessful.

  1. 5mg Haloperidol (Avoid if parkinsons)
  2. 5mg lorazepam

titrate 2 hourly until response
do not use for >1 week.

(Y5) ACT conditions management (5 decks)

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