Emergency Management Flashcards
Hyperkalaemia
10ml 10% calcium gluconate 100ml 20% glucose + 10u insulin (Actrapid) Salbutamol 5mg nebuliser Calcium resonium 15mg PO or 30mg PR Haemofiltration (if anuric)
Acute pulmonary oedema
PODMAN
Position - Sit up
Oxygen - give controlled O2
Diuretic (20-40 mg intravenously (slowly) produces transient venodilation and subsequent diuresis - and fluid restriction
Morphine* 2.5mg IV
Antiemetic metoclopramide 10mg IV
Nitrates (unless SBP<100) - two puffs sublingual, or 1-3 mg buccal isosorbide dinitrate
If no response consider CPAP and haemofiltration
*Opiates: the use of opiates is controversial and opiates should not be given to patients with acute decompensated heart failure
Anaphylaxis/angioedema
GET HELP!
Remove trigger, maintain airway, 100% O2
• Intramuscular adrenaline 0.5 mg
(Repeat every 5 mins as needed to support CVS)
• IV hydrocortisone 200mg
• IV chlorpheniramine 10 mg
• If hypotensive: lie flat and fluid resuscitate
• Treat bronchospasm: NEB 5mg salbutamol
• Laryngeal oedema: NEB adrenaline
Massive Haemoptysis - definition and management
Massive Haemoptysis
>240mls in 24 hours
OR
>100mls / day over consecutive days
Management of Massive Haemoptysis
ABCDE
Lie patient on side of suspected lesion (if known) Oral Tranexamic Acid for 5 days or IV
Stop NSAID’s / aspirin / anticoagulants
Antibiotics if any evidence of respiratory tract
infection
Consider Vitamin K
CT aortogram – interventional radiologist may beable to undertake bronchial artery embolisation
Tension pneumothorax
Large bore intravenous cannula into 2nd ICS MCL
Chest drain into the affected side
Pulmonary embolism
Oxygen if hypoxic
Fluid resuscitation (if hypotensive)
Thrombolysis should be considered if a massive PE is confirmed on Echo or CT scan - consider without imaging if there is
substantial clinical suspicion and cardiac arrest is imminent
check for contraindications
Should be fully anticoagulated
Pneumothorax
As per BTS guidelines:
Primary – If symptomatic and rim of air >2cm on
CXR give O2 and aspirate. If unsuccessful
consider re-aspiration or intercostal drain. Removedrain after full re-expansion / cessation of air leak. Secondary – as above but lower threshold for ICD If persistent air leak >5 days (bronchopleural
fistula) refer to thoracic surgeons
Discharge advice – No flying or diving until
resolved
Indication for urgent chest drain insertion for a new effusion
Underlying empyema (pH of pleural fluid <7.2 or visible pus on aspirate)
Initial STEMI management
Give:
Diamorphine (2.5-10mg IV, plus antiemetic)
Oxygen -CONTROLLED, SATS 94-98
Nitrates (GTN spray 2 puffs sublingually)
Aspirin (300mg)
Clopidogrel 300-600mg (then 75mgOD)
plus start atorvastatin 80mg ON, bisoprolol 2.5mg OD,
Thrombolysis - indications and contraindications
< 12 hours onset pain
+ any 1 of the following:
- ST elevation >1mm in 2+ consecutive limb
leads - ST elevation >2mm in 2+ consecutive chestleads
- Posterior infarct
- New onset LBBB
Thrombolysis Contraindications
Absolute: Haemorrhagic stroke or Ischaemic stroke < 6 months CNS neoplasia Recent trauma or surgery GI bleed < 1 month Bleeding disorder Aortic Dissection
Relative: Warfarin Pregnancy Advanced Liver Disease Infective Endocarditis
Management of Regular Supraventricular Tachycardia (SVT)
ABC + O2 + IV access Vagal Manoeuvres Adenosine SEEK HELP Antiarrhythmic DC cardioversion if haemodynamically unstable
Management of Broad Complex Tachycardia
ABC (if pulseless = arrest protocol) No adverse signs: Amiodarone / Lidocaine K+/Mg2+ if needed Sedation and DC cardioversion
Adverse signs:
Sedation
DC cardioversion
Amiodarone / Lidocaine
Warfarin management in overdose and major bleed
Overdose: INR <6: Decrease / omit Warfarin INR 6-8: Stop Warfarin. Restart when INR<5 INR >8: If no bleeding stop Warfarin & give 0.5- 2.5mg vitamin K if risk of bleeding.
Major bleed: Stop Warfarin. Give prothrombin complex concentrate (Beriplex) contains factors II, VII,IX, X or FFP. Give 5mg vitamin K. Get HELP!
Anaphylaxis in adults/ children >12
Adrenaline - 500 micrograms (0.5ml 1 in 1,000) IM
Hydrocortisone - 200 mg IM
Chlorphenamine - 10 mg IM or slow IV
VF/VT Cardiac Arrest
Ratio of chest compressions to ventilation is 30:2
chest compressions are now continued while a defibrillator is charged
adrenaline 1 mg is given once chest compressions have restarted after the third shock and then every 3-5 minutes (during alternate cycles of CPR).
Amiodarone 300 mg is also given after the third shock