Emergency Management Flashcards
19yo M presents from an ambulance with swelling of the face, wheeze and difficulty breathing. They are tachycardic and sweating. Patients mother says he had been around a bowl of nuts. What is MLD and how do you manage it?
Anaphylactic shock
1) Give 100 O2 or intubate if appropriate
2) Give adrenaline IM 0.5mg - 0.5ml of 1 in 1000(repeat every 5min as guided by BP, pulse and resp rate)
3) Gain IV access chlorphenamine 10mg IV and hydrocortisone 200mg IV
4) IV 0.9% saline (500ml-2L) according to BP. If wheeze treat for asthma
5) If BP still not raised admit to ITU
Name three ways a patient can present in acute heart failure?
Acute pulmonary oedema
Peripheral odema
Cardiogenic shock
Name 3 possible causes of acute heart failure?
ACS ACS complications Arrythmias Infections Drugs (NSAIDS, CCB, BB's)
How do you manage acute heart failure?
ABCDE + sit upright
Oxygen if hypoxic
1) IV Furosemide 40-80mg
2) IV Morphone + antiemetic
3) IV nitrate (f BP >110)
4) LMWH
5) Ianotropic support if shocked
NIV (CPAP)
How do you manage a patient who is unstable with a broad or narrow complex tachycardia?
Syncronised DC shocks
A patient has an acute exacerbation of her COPD, in an emergency setting how do you respond?
ABCDE
1) Oxygen controlled, titrate 88-92%
2) Nebulised salbutamol
3) + Nebulised ipratropium
4) + IV hydrocortisone / oral prednisolone
(If infective cause possible add amoxicillin/ clarithromycin/ doxycycline)
5) Repeat nebs and consider IV aminophylline
6) Consider CPAP
7) Get ITU support
What are the 7 steps of acute asthma exacerbation management?
1) Start 100% O2 (15L, NRB)
2) Nebulised salbutamol (5-10mg)
3) Nebulised Ipratropium (0.5mg)
(Nebs repeated every 15min as PRN)
4) Hydrocortisone 100mg IV +/ or Prednisolone 40mg IV
5) Add magnesium sulphae 1.2mg IV
6) Add aminophylline IV
7) ITU transfer
How do you manage a non-tension primary pneumothorax?
SOB and/or rim of air >2cm = Aspirate
(2 attempts then chest drain)
If <2cm and not symptomatic then discharge with outpatient CXR
How do you manage a non-tension secondary pneumothorax?
SOB/ >50yrs/ rim of air >2cm = Chest drain
If 1-2cm smaller = Aspirate
If <1cm = Admit for observation
What are you management steps in a suspected pulmonary embolus?
ABCDE
1) Oxygen 100%
2) Morphine
3) If shocked and high wells score, consider thrombolysis, otherwise do bloods and CTPA
4) As standard management
Walk through the emergency management steps of an upper GI bleed
ABCDE
- Bloods (FBC, U+E, LFT. glucose, clotting screen and cross match)
- Include 2 cannula’s to get fluids and blood in at same time
2) IV saline (1L)
3) O neg (or group specific if cross match done)
4) Consider FFP, platlets and vitK if clotting abnormalities
5) Set up central line to improve fluids going in
What are the management steps of status epilepticus?
Airway (open and maintain, recovery position)
B- Oxygen 100 if needed
C- IV access and bloods (U+E, LFT, FBC, glucose, Ca)
(If alcoholism - consider thiamine, if hypo not excluded consider glucose)
1) Correct hypotension with fluids
2) Lorazepam 2-4mg (if no response in 2mins give second dose)
3) Phenytoin run through a filter
What is the management of DKA?
ABCDE
(Bloods include glucose, U+E, bicarb). Also do ABG
1) Insulin (aiming to drop glucose by 5ml/hr)
+ Fluid (1L stat, 1L over 1 hour, 1L over 2hrs, 1L over 4hours)
2) Continue fluids and keep checking K+ as may need replacement
How do you manage an addisonian crisis?
ABCDE
(Bloods aim for cortisol and ACTH if poss)
1) Hydrocortisone 100mg IV stat
2) Fluids
3) Monitor glucose for hypoglycemia
What resus fluid is first line?
500ml saline over 15mins
