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
How do you reverse a paracetamol overdose? (2)
ABCDE
- Activated charcoal if ingested < 1 hour ago
- N-acetylcysteine (NAC)
(For NAC, measure paracetamol levels at 4hrs post ingestion and then plot on normogram to decide if treating)
How do you manage salicylate overdose?
ABCDE
- Haemodialysis if severe
How do you reverse the effects of benzodiazepines in overdose?
Flumazenil
How do you manage a TCA overdose?
ABCDE
- IV bicarbonate to reduce seizure risk and arrythmia’s
How do you treat a lithium overdose?
ABCDE
- Mild - fluid resus
- Severe = haemodialysis
How do you reverse the effects of heparin?
Protamine sulphate
How do you manage a Beta Blocker overdose?
ABCDE
- Bradycardia = atropine
- Resistant cases = give glucagon
How do you treat a myasthenic crisis?
Intravenous immunoglobulin, plasma electrophoresis
How do you treat neuroleptic malignant syndrome?
Dantrolene and lorazepam
How do you treat a thyroid storm?
Carbimazole
IV hydrocortisone
Propanolol
IV fluids
- Look for cause!
How do you treat an addisonian crisis?
IV hydrocortisone
IV fluids
Glucose
Antibiotics
What is the treatment for a demonstrated pulmonary embolism?
ABCDE
Unstable - thrombolysis
Stable - LMWH (for 5 days or until INR >2 for >24hrs)
Long term - Warfarin or DOAC
What is the bullet point management of an NSTEMI? (3)
ABCDE
MONAT
GRACE/ TIMI score to look at risk and further treatment from this point
How do you investigate a possible ACS? (3)
Immediate aspirin and GTN
1) Obs (ABCDE)
2) Bedside (ECG)
3) Bloods (FBC etc. + trop)
How is airway obstruction managed? (3)
Conscious: - Ask to cough (bent over) - 5 back blows - 5 abdo thrusts (then keep alternating BB/ AT)
Unconscious: Recovery position, ambulance, begin CPR (even if pulse)
How do you manage an acute decompensation of liver failure?
- ABCDE Lactulose + neomycin (reduce ammonia) Mannitol to reduce raised ICP Platlets, FFP etc for bleeding Early transplantation to be considered
How does hepatic encephalopathy present?
Anything from mild confusion and slowing to drowsiness, disorientation and coma
How should HHS (HONK) be managed?
Slow fluid rehydration
- Watch for reducing osmolarity
- Only use insulin if acidosis
What is the acronym and the features of life threatening asthma?
33,92 CHEST PEFR < 33% Sats < 92% - Cyanosis - Hypotension - Exhaustion - Silent chest - Tachycardia
How many white cells in a joint aspirate would raised suspicion of septic arthritis?
> 50,000 WCC = Septic (under 50 likely inflam)
> 70% neutrophils = Bacterial
<70% think inflammatory (-ve bifring/ needle shaped = gout)
What is the alternative term for an emergency tracheostomy and where is it situated?
Cricothyroidotomy
(Midline between thyroid and cricoid cartlidge)
- Note long term trachy is below cricoid cartlidge but done surgically here and not in emergencies
A 3 year old girl found fitting. She has a 3 week history of headache, which is worse in the
morning. No history of fits in the family. Rectal diazepam in ambulance stops the fitting. She
regained consciousness but is sleepy. Normal glucose. What should be the next step in
management?
a. Brain US
b. CT head
c. EEG
d. Skull X-ray
e. Lumbar puncture
B- CT Head
As likely SoL, need to r/o raised ICP before doing LP as this can cause coning
