Emergency Flashcards
AMPLE
allegies meds past hx last ate/ drank event
3 major radiographs of trauma
chest
lateral cervical spine
pelvis
Secondary survey
4 people to log roll
examine thoracolumbar spine, listen to lung fields, examine perineum, do rectal exam
Ix, documentation etc
In cardiac arrest, who should get adrenaline and when?
In shockable rhythms, 1 mg IV adrenaline after alternate shocks
Or every 3-5 mins
Emergency medical mx STEMI
Aspirin 300 mg (thereafter 75 mg/ daily)
Ticagrelor 180 mg (thereafter 90 mg BD - don’t give if hx bleeding or already anticoagulated)
Morphine 2.5-5 mg (1 mg/min) - further dose if needed
Cyclizine 50 mg IV
GTN spray - consider IV if BP ok/ no sildenafil
Emergency medical mx acute HF
IV furosemide 40-80 mg bolus
(followed by infusion 5-20 mg/h)
consider IV GTN
stop CCBs and NSAIDs, if possible
if hypotensive can omit beta-blockers/ ACEi - but try not to stop
Emergency medical mx sinus bradycardia
only needs mx if symptomatic
atropine 600 - 1200 mcg IV
if persistent, pacing
How best to terminate AF of recent onset?
IV fleicainide
How best to treat AF in presence of HF or acute ischaemia?
IV amiodarone
consider cardioversion
Medical mx stable VT
Lidocaine 1.5 mg/kg IV
Mx DVT
Book USS (if can’t be done within 4 hours, treat)
Rivaroxaban 15 mg BD (from day 22 just 15 mg OD maintenance)
If contraindicated, dalteparin, UH or warfarin (dalteparin bridging)
Mx PE
If life-threatening, IV heparin (alteplase too if haemodynamcally unstable). Arrange echo and/ or CTPA.
If non life-threatening, do Wells.
Either D-dimer, or rivaroxaban therapy.
(LMWH if preg)
Mx opiate OD
naloxone 0.4 mg IV (repeat every 2-3 mins until depression is reversed)
can be given IM/ SC if no access
doesn’t work well for buprenorphine
Mx benzo
IV flumazenil
caution if pt may have taken other psychotropic drugs, or if benzo-dependent (eg epileptic)
Mx acute asthma
2.5 - 5 mg salbutamol nebs (oxygen-driven, at least 6 L/ min) - REPEAT EVERY 15-30 MINS
500 mcg ipratropium bromide - every 6 hours (helps in 1/3 patients)
40-50 mg oral pred, or hydrocortisone 100 mg IV 6-hourly (CONTINUE FOR 5 DAYS)
Consider IV Mg, aminophylline
Should be reviewed by GP within 2 days of asthma attack and by asthma specialist within 4 weeks
When should spontaneous pneumothorax be admitted
tension!
Primary - usually not
Secondary (ie underlying lung disease)
aspirate usually if over 2 cm
Mx acute upper GI bleed
Endoscopy!
Low-risk: 40 mg BD oral omeprazole
High-risk: HDU, restore fluid volume, if no imminent OGD give IV omeprazole (same dose)
Mx bleeding oesophageal varices
Resuscitate
Terlipressin 2 mg IV (repeat every 4-6 h) - start before diagnostic endoscopy
Abx prophylaxis (send blood cultures + MSU)
15-20 ml TDS oral lactulose (prevent encephalopathy)
(beta-blockers are prophylaxis)
Immediate Ix for bloody diarrhoea
Blood (FBC, U&Es, CRP, LFTs) Stool x2 (MC&S + C.diff toxin)
Sigmoidoscopy
AXR
Mx acute severe UC
Mild-to-moderate: topical mesalazine suppositories (proctitis), foam enemas (distal) or liquid enemas (L-sided colitis)
Fluids + potassium
LMWH
How to differentiate between DKA and HHS?
Urinary ketones in DKA only
Initial investigations for DKA
Bloods: FBC, U&E, BG, lactate, VBG, culture
Urinalysis, ECG, CXR
Mx DKA
NaCl 1 litre (over 10-15 mins)
NaCl 1 litre (over 1 hour)
Catheterise if oliguric
Actrapid 50 units in saline (up to a volume of 50 mL)
If 14 mmol or less, infuse 10% glucose at 100 mL/h - don’t stop insulin
Check electrolytes every 2h via VBG
Check BM every 1h
Mx hypoglycaemia if conscious
X2 glucogel, x4 glucotabs, or other high-sugar
check BM after 15 mins
follow up with starchy food
don’t omit insulin dose
Mx hypoglycaemia if unconscious
If IV access, 100 mL 10% glucose
or 1 mg IM glucagon
Immediate mx Addisonian crisis
Cannula. Take bloods (U&Es, glucose, cortisol)
0.9% saline (corrects dehydration and hyponatraemia)
100 mg IV bolus hydrocortisone
repeat 6-hourly for 1-2 days (until able to take oral
Thrombolysis time for stroke
4.5 h
What stroke assessment should be done in A&E?
Rosier
Stroke Ix
FBC ESR Coag screen (consider thrombophilia screen if under 60) U&Es Glucose Cholesterol
ECG
CXR
Echo if under 65/ significant cardiac pathology
(Urgent echo and cultures if suspected endocarditis)
If ischaemic, doppler carotid/ vertebral
Mx stroke
thrombolysis if indicated
300 mg aspirin
300 mg clopi
lower BP gradually if super-high (if moderately high, is pretty normal)
Imaging for ?carotid dissection
MRI with cross-sectional views of carotid artery
Seizure mx
Make pt safe
TIME
Give oxygen, check glucose
(IF ALCOHOL, GIVE PABRINEX BEFORE GLUCOSE)
Inter-ictal establish IV access
Status epilepticus mx
4 mg IV lorazepam (2 mins)
OR 10 mg IV diazepam
OR 10 mg buccal midazolam
[STAT doses not PRN]
repeat within 10-20 mins
Give usual AEDs if already on treatment
STAGE 2 (skip to this if already had 2 doses in last 24h) Phenytoin (others not licensed, but may be preferable)
After 30-90 mins, may need GA
What is apomorphine?
Anti-Parkinsonian med!
What is the dose of adrenaline for anaphylaxis?
Where is it administered?
0.5 mL 1:1000 (i.e. 0.5 mg)
antero-lateral medial aspect of thigh. Repeat as needed every 5 mins
Mx for anaphylaxis
Adrenaline
ABCDE
Fluids 500 mL - 1000 mL, keep repeating
10 mg chlorphenamine, IM or slow IV
Consider corticosteroids
Consider salbutamol
Measure tryptase levels within 4 h
Observe for 6-12 h
