Emergency Management Pathways

Question 1

When would you call ICU in a patient with hypovolaemic shock?

Answer 1

If no improvement after 2 boluses

Question 2

How would you manage haemorrhagic shock?

Answer 2

Crystalloid boluses
Packed red cells and FFP in 1:1 ratio
Platelets
Tranexamic acid 1g bolus followed by 1g infusion

Question 3

What is involved in sepsis 6?

Answer 3

1. Ensure senior clinician attends
2. Oxygen if required e.g. sats below target range
3. Bloods and cultures (blood cultures, glucose, lactate, FBC,
   U&Es, CRP, Clotting. Consider lumbar
   puncture/ other samples as indicated)
4. IV empirical antibiotics
5. IV fluids
6. Monitor NEWS, urine output, hourly lactate if high initially

Question 4

When must all aspects of sepsis 6 take place?

Answer 4

Within 1 hour

Question 5

What is the BUFALO acronym?

Answer 5

Blood Cultures (other cultures, tests)
Urine output
Fluids
Antibiotics
Lactate
Oxygen

Question 6

What is the normal value for lactate?

Answer 6

<2

Question 7

What dose of adrenaline is given in anaphylaxis and by what route?

Answer 7

0.5mg IM
0.5ml of 1:1000

Question 8

When should adrenaline dose be repeated and what is this guided by?

Answer 8

Every 5 minutes
Guided by BP, pulse and respiratory function

Question 9

What other drugs can you give after adrenaline in anaphylaxis (incl route and dose)?

Answer 9

Chlorphenamine 10mg IV
Hydrocortisone 200mg IV

Question 10

Do you give fluids in anaphylaxis?

Answer 10

Yes, normal fluid resuscitation, titrate with BP

Question 11

What may be required if initial treatment for anaphylaxis is not effective?

Answer 11

ICU admission
IVI adrenaline
Maybe aminophylline and neb salbutamol

Question 12

When would you measure mast cell tryptase levels in anaphylaxis?

Answer 12

After 1-6 hours

Question 13

What dose of aspirin is given in ACS?

Answer 13

300mg

Question 14

What dose of ticagrelor is given in ACS?

Answer 14

180mg

Question 15

What dose of morphine is given in ACS?

Answer 15

5-10mg IV

Question 16

What is the time cut off for PCI?

Answer 16

If can be delivered within 2 hours

Question 17

What risk score can be used in patients with non ST elevation ACS to determine management?

Answer 17

GRACE score

Question 18

Initial management for pulmonary oedema

Answer 18

Sit patient upright
High flow oxygen
IV diamorphine
IV furosemide (40-80mg) infusion
GTN if BP>90, set up nitrate infusion later if BP still okay

Question 19

If initial management of pulmonary oedema fails, what can you do?

Answer 19

Further furosemide 40-80mg
CPAP
Further nitrate infusion if BP okay

Question 20

What treatment do you give if the heart is underfilled in cardiogenic shock?

Answer 20

Plasma expanders

Question 21

What treatment do you give if the heart is overfilled/well-filled?

Answer 21

Inotropic support e.g. dobutamine infusion

Question 22

OSHITMAN acronym

Answer 22

Oxygen
Salbutamol nebs (2.5mg-5mg, back to back)
Hydrocortisone 100mg IV (prednisolone 40mg PO if able)
Ipratropium 500microgram nebs

After this is more specialist
Theophylline/aminophylline infusion
Magnesium sulphate 2g IV
Anaesthetic support for intubation and venilation

Question 23

COPD exacerbation management

Answer 23

Oxygen aim for 24-28% oxygen with sats of 88-92
SHIT
Antibiotics if signs of infection e.g. amoxicillin, doxycycline
BiPAP if resp acidosis after treatment

If worsening call senior/anaesthetist for intubation

Question 24

What are the components of CURB 65?

Answer 24

Confusion
Urea >7mmol/l
RR >30
BP <90/60
Age >65

Question 25

When does a patient with a suspected PE not need a Wells score?

Answer 25

If haemodynamically unstable

Question 26

What Wells score makes a PE likely?

Answer 26

> 4

Question 27

What to do with patients with Wells >4?

Answer 27

CTPA
If not possible immediately start anticoagulation

Question 28

What to do with patients with Wells <=4?

Answer 28

D-dimer
If positive then CTPA

Question 29

Recommended anticoagulants for PE?

Answer 29

Apixaban
OR
Rivaroxaban

Others available e.g. LMWH then dabigatran or edoxaban

Question 30

What bloods should you take when starting anticoagulation in PE?

Answer 30

full blood count, renal and hepatic function, prothrombin time (PT) and activated partial thromboplastin time (APTT)

Question 31

first thing to do in status epilepticus?

Answer 31

Open and secure airway, adjuncts as required

Question 32

What drug should be given first in status epilepticus and how?

Answer 32

Lorazepam IV (4mg)

Question 33

When should second dose of lorazepam be given if no response?

Answer 33

After 10-20 minutes

Question 34

What to give if second dose of lorazepam ineffective?

Answer 34

Phenytoin infusion (monitor ECG and BP)

Question 35

When should you call an anaesthetist in status epilepticus for support?

Answer 35

After 20 minutes of management

Question 36

Management of raised ICP

Answer 36

Correct hypotension
Raise head of bed to 30-40*
Hyperventilate if intubated to lower CO2
Mannitol
Steroids only if oedema surrounding tumour
Restrict fluid

Question 37

Management of DKA

Answer 37

IV fluid resuscitation (crystalloid)
Once resuscitated, IV insulin infusion
Monitor potassium with VBG and base replacement on these results

Question 38

What percentage of glucose to give in hypoglycaemia if patient unconscious?

Answer 38

10%

Question 39

Bloods for addisonian crisis

Answer 39

Cortisol and ACTH
U&Es

Question 40

Addisonian crisis initial management

Answer 40

Hydrocortisone 100mg IV stat
IV fluid resuscitation
Glucose IV if hypoglycaemic
Continue IV hydrocortisone infusion