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Prescribing Safety Assessment > Emergency management > Flashcards

Emergency management Flashcards

1
Q

Treatment algorirthm for adult tachycardia

A

1. Adverse features?

  • Shock
  • Syncope
  • MI
  • HF

2. YES/UNSTABLE

  • synchronized DC shock (3 attempts)
  • Amiodarone 300mg IV over 10-20 min and repeat shock
  • Amiodarone over 24 hrs

3. NO adverse features/ STABLE:

4. QRS narrow?

5. Narrow
Regular: SVT

  • Use vagal manoeuvres
  • Adenosine 6mg rapid IV bolus
  • if unsuccessful give 12mg
  • if unsuccessful give further 12mg

Irregular: AF, Atrial flutter

  • B-blocker or dilitiazem
  • consider digoxi or amiodarone if heart failure

6. Broad

Regular: Ventricular tachycardia

  • Amiodarone 300mg IV over 20-60mins, then 900mh over 24hrs

Irregular: Ventricular fibrillation

  • Amiodarone
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2
Q

STEMI management

A
  1. ABC O2 (15l) by non-rebreather (if hypoxic, unless COPD)
  2. History and examination
  3. Aspirin 300mg oral
  4. Morphine 5-10mg IV with cyclizine 50mg IV
  5. GTN spray/tablet
  6. PCI (preferred) or thrombolysis
  7. B-blocker e.g. Bisoprolol 2.5mg oral (unless LVF or asthma)
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3
Q

NSTEMI management

A
  1. ABC O2 (15l) by non-rebreather (if hypoxic, unless COPD)
  2. History and examination
  3. Aspirin 300mg oral
  4. Morphine 5-10mg IV with cyclizine 50mg IV
  5. GTN spray/tablet
  6. Clopidogrel 300mg oral and either LMW heperin or fondaparinux 2.5mg od SC
  7. B-blocker e.g. bisoprolol 2.5mg
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4
Q

Acute left ventricular failure (LVF)

A
  1. ABC O2 (15l) by non-rebreather (if hypoxic, unless COPD)
  2. History and examination
  3. Sit patient up
  4. Morphine 5-10mg IV with cyclizine 50mg IV
  5. GTN spray/tablet
  6. Furosemide 40-80mh IV (repeat again as required)
  7. if inadequate response, isosorbide dinitrate infusion +- CPAP)
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5
Q

Anaphylaxis

A
  1. ABC O2 (15l) by non-rebreather (if hypoxic, unless COPD)
  2. History and examination
  3. Remove cause
  4. Adrenaline 500 micrograms of 1:1000 IM
  5. Chlorphenamine 10mg IV
  6. Hydrocortisone 200mg IV
  7. Asthma tx e.g. salbutamol if wheeze
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6
Q

acute exacerbation of asthma

A
  1. ABC
  2. History and examination
  3. 100% oxygen by non-rebreather mask
  4. Salbutamol 5mg nebulised with oxygen
  5. Hydrocotison 100mg IV (if severe) or prednisolone 40-50mg oral (if moderate)
  6. Ipatropium (500 micrograms NEV)
  7. Aminophylline (if life threatening)
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7
Q

COPD

A
  1. ABC
  2. History and examination
  3. 100% oxygen by non-rebreather mask- beware of T2RF- review using ABG- 28% via venturi may be safest
  4. Antibiotics if infective exacerbation
  5. Salbutamol 5mg nebulised with oxygen
  6. Hydrocotisone 100mg IV (if severe) or prednisolone 40-50mg oral (if moderate)
  7. Ipatropium (500 micrograms NEV)
  8. Aminophylline (if life threatening)
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8
Q

secondary pneumothorax (patient has lung disease alrwady)

A

Chest drain if:
- >2cm or
- SOB or
- >50 yo

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9
Q

tension pneumothorax (clinical distinction but oftion tracheal deviation +- shock)

A

emergency aspiration and then chest drain

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10
Q

Primary pneumothorax

A
  • <2cm and not SOB- discharge wuth outpatient follow-up in 4 weeks
  • > 2cm rim on CXR or feels SOB, then aspirate and if unsuccessful aspirate agaim and if still unsuccessful, then chest drain
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11
Q

Pneumonia

A

CURB-67
- confusion
- Urea >7.5mmmol/l
- RR >30
- BP <90
- >65 yo

If <1 - home treatment
>2 - inpatient treatment

  1. ABC
  2. History and examination
  3. High flow oxygen
  4. Antibiotics e.g. amoxicillin or co-amoxiclave
  5. paracetamol
  6. if low BP or riased HR - IV fluids as normal
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12
Q

pulmonary embolism

A
  1. ABC
  2. History and examination
  3. high flow oxygen
  4. Morphine 5-10mg IV
  5. DOAC or LMWH
  6. If low BP: IV fluid bolus -> contact ITU
  7. Consider thrombolysis
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13
Q

GI bleed

A
  1. ABC and O2 - 15l non-rebreather mask
  2. History and examination
  3. 2x large bore cannulas
  4. Catheter and strict fluid monitoring
  5. 500ml Sodium Chloride over 15 mins
  6. Cross match 6 units
  7. Correct clotting abnormality e.g. give fresh frozen plasma or platelets
  8. Camera (endoscopy)
  9. Stop cultprit drugs e.g. NSAIDs, aspirin, warfarin and heparin
    10.
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14
Q

bacterial meningitis

A

GP will normally give 1.2g benzylpenicillin of suspicion of meninigitis

    1. ABC
  2. History ad examination
  3. High flow oxygen
  4. IV fluids
  5. 4-10mg dexamaethasone IV unless severely immunocompromised
  6. LP
  7. 2g cefotaxime IV
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15
Q

Status epilepticus

A
  1. ABC
  2. History and Examination
  3. Oxygen

Seizure lasting more than 5 minutes:
4. Lorazepam 2-4mg IV or midazolam buccal
5. if still fitting after 5 mins repeat benzodiazepine
6. Inform anaesthetist
7. If still fitting after 5 mins give Phenytoin 15-20 mg/kg IV
8. If still fitting after 5 mins give Propofol
9. Intubate and ventilate

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16
Q

Haemorrhagic stroke

A

If CT shows haemorrhage do not give aspirin or thrombolysis- discuss with neurosurgery

17
Q

Ischaemic stroke

A
  1. ABC
  2. History and examination
  3. if onset <4.5 h consider thrombolysis
  4. In some centres thrombectomy may be available for certain patients if onset <24hr
  5. Aspirin 300mg
  6. Transfer to stroke unit
18
Q

DKA

A

Triad
- hyperglycaemia
- Acidosis
- Ketosis

  1. ABC
  2. History and examination
  3. IV fluids e.g. 1 l over 1 hour, then 1l over 2h, then 1l over 3 etc)
  4. Fixed rate insulin e.g. 50 units actrarapid in 50 ml 0.9% saline at 0.1 units/kg/hour
  5. Monitor capillary glucose and ketones hourly
  6. Can add potassium to fluids -> may become hypokalaemic with insulin
  7. when glucose is <14 mmol add 10% dextrose at 125ml/h to prevent hypoglycaemia
19
Q

HSS

A
  • Hyperglycaemia >35
  • Hyperosolar: osmolality over 340 mmol/l - calculated by (x2 Na +2K) +Urea + glucose)
  • Nonketotic
  1. ABC
  2. History and examination
  3. IV fluids e.g. 1 l over 1 hour, then 1l over 2h, then 1l over 3 etc)
    4.Fluids alone may work. If required lower rate of insulin than in DKA
  4. Monitor capillary glucose and ketones hourly
  5. Can add potassium to fluids -> may become hypokalaemic with insulin
  6. when glucose is <14 mmol add 10% dextrose at 125ml/h to prevent hypoglycaemia
20
Q

Hypoglycaemia BM <2 mmol/l

A
  1. If patient can eat- give glucose gel
  2. If unable to eat give 100ml 20% glucose over 15 minutes
  3. If unable to eat and no cannula- IM glucagon 1mg
21
Q

AKI

A
  1. ABC
  2. History and exam
  3. Cannula and catheter, strict fluid monitoring
  4. IV fluid 500ml stat then 1l 4 hourly
22
Q
A

Prescribing Safety Assessment (12 decks)

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