Emergency Management Pathways Flashcards
When would you call ICU in a patient with hypovolaemic shock?
If no improvement after 2 boluses
How would you manage haemorrhagic shock?
Crystalloid boluses
Packed red cells and FFP in 1:1 ratio
Platelets
Tranexamic acid 1g bolus followed by 1g infusion
What is involved in sepsis 6?
- Ensure senior clinician attends
- Oxygen if required e.g. sats below target range
- Bloods and cultures (blood cultures, glucose, lactate, FBC,
U&Es, CRP, Clotting. Consider lumbar
puncture/ other samples as indicated) - IV empirical antibiotics
- IV fluids
- Monitor NEWS, urine output, hourly lactate if high initially
When must all aspects of sepsis 6 take place?
Within 1 hour
What is the BUFALO acronym?
Blood Cultures (other cultures, tests)
Urine output
Fluids
Antibiotics
Lactate
Oxygen
What is the normal value for lactate?
<2
What dose of adrenaline is given in anaphylaxis and by what route?
0.5mg IM
0.5ml of 1:1000
When should adrenaline dose be repeated and what is this guided by?
Every 5 minutes
Guided by BP, pulse and respiratory function
What other drugs can you give after adrenaline in anaphylaxis (incl route and dose)?
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Do you give fluids in anaphylaxis?
Yes, normal fluid resuscitation, titrate with BP
What may be required if initial treatment for anaphylaxis is not effective?
ICU admission
IVI adrenaline
Maybe aminophylline and neb salbutamol
When would you measure mast cell tryptase levels in anaphylaxis?
After 1-6 hours
What dose of aspirin is given in ACS?
300mg
What dose of ticagrelor is given in ACS?
180mg
What dose of morphine is given in ACS?
5-10mg IV
What is the time cut off for PCI?
If can be delivered within 2 hours
What risk score can be used in patients with non ST elevation ACS to determine management?
GRACE score
Initial management for pulmonary oedema
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
If initial management of pulmonary oedema fails, what can you do?
Further furosemide 40-80mg
CPAP
Further nitrate infusion if BP okay
What treatment do you give if the heart is underfilled in cardiogenic shock?
Plasma expanders
What treatment do you give if the heart is overfilled/well-filled?
Inotropic support e.g. dobutamine infusion
OSHITMAN acronym
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
COPD exacerbation management
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
What are the components of CURB 65?
Confusion
Urea >7mmol/l
RR >30
BP <90/60
Age >65
When does a patient with a suspected PE not need a Wells score?
If haemodynamically unstable
What Wells score makes a PE likely?
> 4
What to do with patients with Wells >4?
CTPA
If not possible immediately start anticoagulation
What to do with patients with Wells <=4?
D-dimer
If positive then CTPA
Recommended anticoagulants for PE?
Apixaban
OR
Rivaroxaban
Others available e.g. LMWH then dabigatran or edoxaban
What bloods should you take when starting anticoagulation in PE?
full blood count, renal and hepatic function, prothrombin time (PT) and activated partial thromboplastin time (APTT)
first thing to do in status epilepticus?
Open and secure airway, adjuncts as required
What drug should be given first in status epilepticus and how?
Lorazepam IV (4mg)
When should second dose of lorazepam be given if no response?
After 10-20 minutes
What to give if second dose of lorazepam ineffective?
Phenytoin infusion (monitor ECG and BP)
When should you call an anaesthetist in status epilepticus for support?
After 20 minutes of management
Management of raised ICP
Correct hypotension
Raise head of bed to 30-40*
Hyperventilate if intubated to lower CO2
Mannitol
Steroids only if oedema surrounding tumour
Restrict fluid
Management of DKA
IV fluid resuscitation (crystalloid)
Once resuscitated, IV insulin infusion
Monitor potassium with VBG and base replacement on these results
What percentage of glucose to give in hypoglycaemia if patient unconscious?
10%
Bloods for addisonian crisis
Cortisol and ACTH
U&Es
Addisonian crisis initial management
Hydrocortisone 100mg IV stat
IV fluid resuscitation
Glucose IV if hypoglycaemic
Continue IV hydrocortisone infusion
