Emergency managements Flashcards
What is the management of an NSTEMI?
Base coronary angiography and PCI on GRACE score
Aspirin 300mg
Ticagrelor 180mg (Clopidogrel if high bleeding risk or Prasugrel if having angiography)
Morphine IV
Antithrombin therapy - Fondaparinux
Nitrate - GTN Spray
PCI within 72 hours
What is the management for an acute Angina attack?
Take GTN Spray
Repeat in 5 mins
Repeat in 5 mins
Wait 5 mins and then call ambulance if pain does not subside after 3rd dose
What is the management for a STEMI?
O2 if hypoxic
Aspirin 300g
GTN Spray
Morphine
Antiemetic
If within 120 minutes - PCI
If not - Thrombolysis with Streptokinase or Alteplase
What is the management for an acute COPD exacerbation?
Nebulised 5mg Salbutamol AND Ipratropium Bromide 0.5mg
Controlled Oxygen therapy if SaO2 < 88% or Pa02<7kPa
IV Hydrocortisone 200mg AND Oral Prednisolone 30mg
If infective - I.V Co-amoxiclav and PO Doxycycline
If no response to NEBS consider IV Aminophylline
Consider NIV in patients RR >30 pH <7.35 in T1RF
Consider BiPAP in patients in T2RF
What is the management for a suspected PE?
Calculate Well’s Score
If above 4 , do CTPA and start on DOAC ( 3 months if provoked 6 months if unprovoked)
If below 4, do D-Dimer. Can anticoagulate whilst waiting with DOAC. If D-Dimer negative rule out PE. If D-Dimer positive do CTPA to confirm, then continue DOAC
If massive PE - Do Wells Score, CTPA and thrombolysis with Alteplase
How do you manage a suspected TIA?
Aspirin 300mg
Arrange assessment by TIA clinic within 24 hours
If patient had recurring TIAs arrange urgent admission
Advise patient not to drive until seen by specialist
GP follow up
How do you manage Bell’s Palsy?
If presenting within 72 hours give Prednisolone 50mg for 10 days
Refer to nerve specialist in 3 weeks if no improval
What is the management for anaphylaxis?
ABCDE
IM Adrenaline 0.5 mg (1:1000) , can repeat every 5 mins
IV Fluid resus - 500ml if normotensive, 1L if hypotensive
IV/IM Chlorphenamine 10mg
IV/IM Hydrocortisone 200mg
What management should be done after anaphylaxis?
Referral to allergy specialist
Two Epipens given with advice how and when to use them
What is the dose of Chlorphenamine in anaphylaxis?
10mg IV/IM
What is the management for bradycardia?
0.5mg IV Atropine , repeated every 5 minutes until 3mg
What is the dose of Aspirin?
primary - 300mg PO
secondary prevention - 80mg PO
What is the dose of Clopidogrel?
Primary - 300mg PO
Secondary - 75mg PO
What is the dose of Calcium Gluconate?
Severe acute hypocalcaemia or hypocalcaemic tetany =
10–20 ml slow IV 10% Calcium Gluconate
Severe hyperkalemia (>6.5mmol) or ECG changes
= 30ml slow IV 10% Calcium Gluconate
What should be given for hypoglycaemia?
Glucose by mouth 15-20g (3-4 teaspoons of sugar in water, 150-200ml pure fruit juice, 4-7 glucose tablets) repeated in 15 minutes if necessary
If unresponsive or cannot have PO give 1mg of glucagon IM (1mg/ml so 1ml)
If unresponsive or not responding to glucagon after 10 minutes give 150-200ml 10% dextrose over 15 minutes IV
