Emergency drugs and doses Flashcards
1
Q
Anaphylaxis management
A
- Secure airway - 100% oxygen
- Adrenaline 0.5mg IM
- Steroids (hydrocortisone) to turn off secondary immune response
- Antihistamines
- Observation (at least 12 hours incase there is a second peak)
- Tryptase measurements - measured initially and after 12 hours to confirm diagnosis
2
Q
Name the headaches
- first and worst headache
- thunderclap headache
- unilateral headache and eye pain
- cough-initiated headache
- headache worse in the morning or bending forward
- persisting headache and scalp tenderness in over 50yo
- headache with neck stiffness or fever
A
- first and worst headache: subarachnoid haemorrhage
- thunderclap headache: subarachnoid haemorrhage
- unilateral headache and eye pain: cluster headache / acute glaucoma
- cough-initiated headache: raised intracranial pressure
- headache worse in the morning or bending forward: raised ICP
- persisting headache and scalp tenderness in over 50yo: GCA
- headache with neck stiffness or fever: meningitis
3
Q
Initial management of sepsis
A
- Broad spectrum antibiotics within 1h
- IV fluids
- Oxygen for target sats
- Liase with seniors and critical care team
4
Q
Name some precipitants for anaphylactic shock
A
Drugs - penicillin, contrast media in radiology
Latex
Stings, fish, peanuts, strawberries
5
Q
Management of acute STEMI
A
- ECG
- IV access - bloods, troponin etc
- Brief assessment
- Aspirin 300mg PO
- Ticagrelor 180mg
- Morphine 5-10mg IV
- Anti-emetic (metoclopramide 10mg IV)
- Oxygen if hypoxic
- PCI if in 120m
- Fibrinolysis if PCI not available
6
Q
Management of NSTEMI
A
- ECG
- O2 if hypoxic
- Morphine (5-10mg IV)
- Anti-emetic (metoclopramide 10mg IV)
- Nitrates GTN spray
- Aspirin 300mg PO
- GRACE score, troponin levels:
- High risk = Fondaparinux, ticagrelor, B-blocker, angiography
- ACEi, atorvastatin, anticoagulation for all patients (secondary prevention)
7
Q
Acute severe asthma management
A
- assess severity of attack (HR, PEF, ability to speak, sats, RR)
- Supplemental O2 to maintain sats 94-98%
- Salbutamol neb 5mg with O2
- Hydrocortisone 100mg IV or prednisolone 40-50mg PO
- Re-assess every 15m and repeat salbutamol neb if needed / add ipratropium
- Consider magnesium sulphate 1.2-2g (senior input)
8
Q
Acute exacerbation of COPD management
A
- Salbutamol 5mg nebuliser + ipratropium 500mcg
- CXR, ABG (identify cause)
- Controlled oxygen therapy (88-92% sats if retaining CO2)
- Steroids: IV hydrocortisone 200mg or prednisolone 30mg OD (7-14days)
- Antibiotics if infection (amoxicillin)
- If no response, non-invasive ventilation can be used
9
Q
Tension pneumothorax management
A
- Large bore (14-16G) needle with syringe into 2nd intercostal space mid clavicular line, remove plunger to allow trapped air to bubble through syringe until a chest tube can be placed
- CXR
- Insert chest drain
10
Q
Management of a PE
A
- Oxygen if hypoxic
- Morphine 5-10mg IV with anti-emetic if in pain
- IV access and start LMWH/fondaparinux
- Low BP = 500mL IV fluid bolus
- Haemodynamically unstable = thrombolysis with alteplase
- Long term anti-coagulation
11
Q
Initial treatment for bacterial meningitis presenting at GP?
A
IM benzylpenicillin & admit to hospital
12
Q
Treatment for meningitis in hospital setting?
A
- Assess GCS
- Blood cultures early
- Broad spectrum IV antibiotics - ceftriaxone or cefotaxime
- Steroids - IV dexamethasone to reduce morbidity, tissue inflammation and neuronal damage
- Lumbar puncture - definitive diagnosis to diagnose meningitis
- Inserted in L3-L4 intervertebral space
- Certain circumstances where we do CT head before LP - check
13
Q
Treatment for encephalitis
A
Mortality 70% if left untreated!
- Aciclovir within 30m of patient arriving for 14d for HSV or VZV
- Ganciclovir if CMV suspected
- supportive therapy in ICU if needed
- phenytoin for seizures if needed
14
Q
Management of status epilepticus
A
- Open and secure airway
- Oxygen 100% + suction if needed
- IV access for bloods
- IV bolus of lorazepam 4mg
- Second dose of IV bolus lorazepam 4mg after 10-20m if no response
- Phenytoin infusion if seizures continue - BP and ECG monitoring required
- ICU help and anaesthetist help
15
Q
DKA management
A
- Fluid 1L 0.9% saline over 1h
- Bloods
- Insulin and check BG and ketones hourly
- Assess need for K+ replacement
- Catheter if not passing urine by 1h
- IV glucose when glucose <14mmol/L to prevent hypo! (sliding scale)
