Emergency

Question 1

What is the dose per weight of adrenaline IM in anaphylaxis?

Answer 1

10 microg/ kg (up to 500 microg)

Question 2

What is the management of suspected meningitis septicaemia/ meningococcaemia?

Answer 2

Call 000 for urgent ambulance transfer to hospital

IV or IM benzylpenicillin stat (60mg/kg - up to maximum of 2g) - given before reaching hospital

(ceftriaxone if penicillin hypersensitivity)

Question 3

What dose of adrenaline is in the two forms of epipen, and at what age/ weight should epipen junior be changed to epipen?

Answer 3

Epipen junior = 0.15mg adrenaline
Epien = 0.3mg adrenaline

Epipen used for >20kg (usually 5 years and older)

Question 4

How would you draw up adrenaline for anaphylaxis, and where would you give it?

Answer 4

0. 15mL of 1:1000 adrenaline if <5yo,
1. 3mL of 1:1000 adrenaline if >5yo
2. 5mL of 1:1000 adrenaline if adult/ >50kg

Give IM in anterolateral thigh
Repeat in 5 mins if not improving

Question 5

List 5 points of management for chest pain of suspected cardiac nature

Answer 5

O2 supplementation (only if O2 sat <94% RA)

Aspirin 300mg PO (chewed or dissolved in water)

GTN sublingual e.g. spray 400-800microg, repeat every 5 mins for max 3 doses if needed (only if BP stable)

ECG

Call 000 for urgent transfer to hospital via ambulance

Question 6

List 5 features of thyroid storm

Answer 6

Tachycardia Fever Vomiting Delirium ALOC/ coma Multi-organ dysfunction (usually hepatic)

Question 7

What medication would be used to treat thyroid storm?

Answer 7

• Propylthiouracil 200mg PO 4-6 hourly - block thyroid hormone synthesis
• Lugol solution (iodine) 0.5mL PO TDS - block thyroid hormone release
• Propranolol 40-80mg PO 6 hourly - treat tachycardia

Question 8

What are the features of Addisonian crisis - list 3 clinical features and 2 biochemical features

Answer 8

Nausea, vomiting Severe hypotension Acute abdominal pain Weakness -> drowsiness -> shock/ coma Hyperkalaemia, hyponatraemia +/- hypoglycaemia

Question 9

What is the immediate treatment of Addisonian crisis?

Answer 9

• Call 000 for urgent transfer to hospital
• Establish IV access
• 100mg IV hydrocortisone stat
• Then 50mg IV hydrocortisone 6 hourly until stable
• IV normal saline stat to correct volume depletion (hyperkalaemia usually responds to this alone)