Emergency management

Question 1

Management of Status Epilepticus (seizure for 5min

Answer 1

ABCDE approach
Oxygen
Ensure IV access
Arterial Blood gas
Bloods for glucose, FBC/UE/CRP, Calcium/Phosphate/Magnesium, drug levels if the patient is on anti-epileptic medications

Anaesthetic review to ensure the airway is managed
IV lorazepam 4mg
A second dose of lorazepam should be given if no response
In the absence of IV access, PR diazepam or buccal midazolam can be administered.
If the initial benzodiazepine fails, further continuous anticonvulsant can be used = IV phenytoin
If seizures continue to persist, intubation and general anaesthesia is necessary

Question 2

Definitive management of STEMI

Answer 2

PCI

Question 3

Management of DKA

Answer 3

Fluid bolus (500ml over 30 mins)
Keep doing it until systolic >90
After 1hr start a fixed rate insulin infusion
Then 1L over 1hr, 1l over 2hr, 1l over 4hr of fluid
Then once glucose <14mmol you can give dextrose with some potassium in it based on potassium levels

Question 4

Treatment of VT (high HR with broad QRS) and signs of shock (low BP)

Answer 4

Synchronised DC cardioversion