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Final Year - ICSM > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Aspects of A-E assessment

A

Identify a problem and deal with it as going along…

  • Airway - patent? look, listen and feel –> head tilt + chin lift, jaw thrust, airway adjunct
  • Breathing - RR, O2 Sats (>94% - scale 1, 88-92% - scale 2 if COPD), resp exam, ABG –> Oxygen (15L/min O2 non-rebreather mask)
  • Circulation - HR, BP, CRT, cardio exam –> IV fluids
  • Disability - BM, pupils (PEARL - pupils equal and reactive to light), GCS/AVPU, abdo/neuro exam
  • Exposure - assess everything but not all at the same time –> calf tenderness, bleeding, bruising, rashes etc.

NOTE: if put in intervention say to examiner I would reassess previous steps e.g. A&B if gave IV fluids are there any changes

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2
Q

Anaemia Ix? Mx?

A

Ix: FBC, haematinics, B12/folate, OGD

Blood transfusion threshold: Hb <70 or <80 AND ACS

Other options: Fe infusion, ferrous fumarate

NOTE: anaemia can exacerbate chest pain/ACS

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3
Q

Significance of Atorvastatin + Clarithromycin?

A

Drug-drug interaction –> risk of liver damage + rhabdomyolysis

Withhold atorvastatin

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4
Q

Critical drugs - DO NOT EMIT when put on NBM in hospital

A
  1. Parkinson’s drugs (Levodopa, Carbidopa)
  2. Antiepileptics (Na Val, Carbamazepine, Lamotrigine, Levetiracetam)
  3. Antiretrovirals (-avir)
  4. Steroids (long-term)

Routes –> patches, IV, NG tube

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5
Q

Alcohol withdrawal management?

A
  1. Chlordiazepoxide (decreasing regimen + PRN) - prevent alcohol withdrawal Sx (anxiety, shakes etc.) + CIWA scoring (dose increased inf CIWA score increases)
  2. Pabrinex (thiamine, B1) - prevent Wernicke’s encephalopathy (ophthalmoplegia, ataxia, confusion)
  3. Bloods - coagulation (injury, bleeds), LFTs
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6
Q

Major hemorrhage GI Mx?

A

High risk of variceal bleed:

  • MASSIVE –> balloon tamponade
  • Assess - A-E approach:
    • Circulation –> blood transfusion (Hb <70) but if haemodynamically unstable and waiting give IV fluids
    • Drugs
      • IV Terlipressin(/Somatostatin) - blanked vascoconstriction
      • Ceftriaxone/Norfloxacin (apparently helps outcomes)
    • Intervention - endoscopic band ligation​​

F1 essentials: 2x large bore cannula, VBG, G&S + X-Match, bleep the bleed registrar (arrange endoscopy)

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7
Q

When carrying out confusion assessment, what should you compare to?

A

Make sure to compare to baseline not what you would perceive as normal

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8
Q

Constipation in elderly patients:

  • Common drugs causing constipation?
  • How would you Ix constipation?
  • How would you Ix urinary retention?
  • How would you Mx urosepsis?
A

Drugs causing constipation:

  • Opioids e.g. codeine
  • CCBs e.g. amlodipine
  • Fe supplements
  • Anticholinergics e.g. atropine
  • Bisphosphonates e.g. alendronate
  • Parkinson’s drugs e.g. L-dopa

Ix:

  • Constipation - stool chart + PR exam
  • Urinary retention - bladder scan, catheterise, urine dip + MC&S

Mx Urosepsis:

  • Sepsis 6 - 3 in (O2, IV fluids, abx), 3 out (BC, VBG, UO)
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9
Q

Delirium definition? Common causes?

Delirium screen breakdown? Mx?

A

Def: Acute confusional state caused by a physical condition

Causes: U PINCHES ME

  • Urinary retention
  • Pain
  • Infections
  • Nutrition
  • Constipation –> stool chart + PR exam
  • Hydration
  • Endo & electrolytes
  • Stroke
  • Medications & alcohol
  • Environmental

Delirium screen:

  • FBC, U&E, LFT, glucose, BC, Ca, TFTs, B12/folate
  • Urine dip + MC&S
  • CXR, possibly CT-head

Management: Tx cause

  • Conservative: lighting, clocks, 1:1 nursing, adequate hydration, laxatives, involve family/carers
  • SOS (risk to themselves/others):
    • Lorazepam (PO/IM/IV)
    • Haloperidol (PO/IM) - be careful if Parkinson’s –> worsens Sx
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10
Q

How to think about inf for abx? What are the best broad-spectrum abx? Abx for pseudomonas cover?

A
  • where is the infection? e.g. resp, skin, cardio etc.
  • what are the common organisms that cause these infections? mainly G+ve or -ve?

G+ve: staph, strep, C. diff –> pneumonia, skin inf, colitis, sepsis

  • B-lactams:
    • Penicillins (peptidoglycan cell wall) - amox, co-amox, fluclox, tazocin
    • Cephalosporins (cover -ve’s as well) - ceftriaxone, cefuroxime, cefalexin
    • Carbapenems (holy grail) - meropenem
    • NOTE: ESBL (extended spectrum b-lactamase) - bacteria that are not sensitive to Pen + Cephalosporins
    • NOTE: Carbapenemase - resistant to carbapenems as well
  • Macrolides - for pen allergic = Clari, erythromycin
  • Glycopeptides - vancomycin, teicoplanin (good if pen allergic)
  • Oxazolidinones - linezolid (rarely used)

G-ve: E.coli, P. aeruginosa, K. pneumo, salmonella –> UTI, pneumonia, GI inf

  • Aminoglycosides (nephrotoxic –> monitoring) - gent, amikacin
  • Fluoroquinolones - cipro/levo/moxifloxacin
  • NOTE: broad spectrum so some +ve cover

Other antibiotic types:

  • Tetracyclines - doxy
    • Broad-spectrum intracellular pathogens (chlamydia, mycoplasma) –> STIs, pneumonia
  • Nitroimidazoles - metro
    • Anaerobes (c. diff, bacterial vaginosis) –> aspiration pneumo, abscesses
    • NOTE: nitrofurantoin (related compound) - concentrates in bladder –> UTI

Best broad-spectrum abx:

  • Co-amox: most G-ve AND +ve AND anaerobes
    • Does not cover pseudomonas + Neisseria spp.
  • Tazocin: as above AND pseudomonas
    • Does not cover Neisseria gonorrhoea
  • Meropenem: EVERYTHING (bar carbapenemase bacteria)

Abx for pseudomonas cover: gentamicin, amikacin, ciprofloxacin, ceftazidime

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11
Q

Opioids:

  1. Strength of different opioids
  2. Forms of oral morphine
  3. Guide to giving morphine
  4. When to give oxycodone
  5. Breakthrough analgesia
  6. Conversion between opioid doses
A

Strength:

  • Weak - codeine, dihydrocodeine
  • Moderate - tramadol (surgeons love)
  • Strong - morphine, oxycodone, buprenorphine, fentanyl

Oral morphine has 2 forms:

  • Oral morphine has 2 forms:
    • Immediate-release (e.g. oromorph) - max 4-hourly
    • Modified-release (e.g. MST Continus/Zomorph/Morphgesic SR) - 12-hourly (BD) OR 24-hourly (OD)

Guide to morphine:

  1. If can’t tolerate oral e.g. vomiting alot –> oral dose/2 = IV (& SC) dose
  2. Immediate-release PRN (max 4-hourly) –> see how much using
  3. If using a huge amount –> convert to modified-release (12/24-hourly):
    • Add up total daily PRN dose = X
    • 24-hourly = X (OD); 12-hourly = X/2 (BD)

​When to give oxycodone: renal impairment (eGFR <30mL/min)

  • Immediate-release: oxycodone oral solution, oxynorm
  • Modified-release: oxycontin
  • NOTE: same logic as above

Breakthrough analgesia:

  • Oral morphine/oxycodone
  • 1/10-1/6 of total daily dose of modified-release morphine

Example: 60mg Oromorph –> 30mg MST BD + 6-10mg breakthrough dose

Conversion - 10mg oral morphine:

  • Oxycodone - 5mg oral (x/2), 2.5mg IV (x/4)
  • Tramadol/Codeine - 100mg oral/IV (x*10) - NOTE: codeine has no IV option
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12
Q

What should you always check for elderly patients?

A
  • Polypharmacy
  • Physical & cognitive baseline
  • Bowels & bladder
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13
Q

Septic shock definition? Neutropenic sepsis criteria & abx Tx?

A

Septic shock = sepsis + haemodynamic instability

Neutropenic sepsis:

  • Neutrophils <0.5
  • Temp >38 degrees
  • Tx = Tazocin
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14
Q

How to determine different causes of shock & Tx?

A
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15
Q

Emergency station common topics

A
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16
Q

If incomprehensible noises during acute station what do I do?

A

GCS measurement:

  • Eyes (4)
  • Voice (5)
  • Movement (6)
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17
Q

Opiate overdose Tx? What if patient becomes unrousable again?

A

IV access –> STAT dose naloxone 400mcg - after 1-min of no improvement –> 800mcg

Stay by the bedside until improved resp rate

If the patient becomes unrousable again - Naloxone has a short half-life so may still be opioid toxic –> Naloxone infusion

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18
Q

Dx if haemodynamically unstable + melaena? What would you do? What type of blood is given?

What if you don’t know what caused the bleed?

A

Upper GI bleed

Activate major haemorrhage protocol -2222, call seniors, contact gastro reg on call

O ‘-ve’ blood initially then group-specific/cross-matched

If can’t get history assume variceal in nature –> IV abx broad-spectrum + Terlipressin (vasoconstriction - less blood loss)

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19
Q

How do you confirm anaphylaxis with blood test?

A
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20
Q

Anaphylaxis Mx (acute & chronic)

A

ABCDE

  • Stop suspected cause
  • Secure airway, give 100% oxygen, +/- intubate if respiratory obstruction imminent
  • IM 0.5mg adrenaline (1:1000)
  • IV 10mg chlorpheniramine
  • IV 100mg hydrocortisone
  • Treat bronchospasm – salbutamol +/- ipratropium

Going forward:

  • Maintain fluids + monitor pulse oximetry, ECG and BP
  • If still hypotensive, may need transfer to ICU and an IVI of adrenaline +/- aminophylline (bronchodilator) and nebulised salbutamol

After acute episode:

  • Admit to ward and monitor ECG, monitor for 6hrs for biphasic reaction
  • Measure mast cell tryptase 1-6 hours after = confirm anaphylaxis
  • Continue chlorpheniramine
  • Suggest MedicAlert bracelet with name of culprit allergen
  • Teach about self-injected adrenaline & give auto-injector
  • Skin prick tests showing specific IgE to help identify allergens to avoid
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21
Q

Sepsis definition? Septic shock def?

A

Life-threatening organ dysfunction caused by dysreg host response to infection

Septic shock = persistent hypotension (<90/MAP <65) or lactate >2 despite fluid resus (30ml/kg)

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22
Q

What is qSOFA score?

A

qSOFA = risk of ITU admission/death at the point of presentation with sepsis

  • Hypotensive, altered mental status, tachypnoea (>22)
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23
Q

What is sepsis 6?

A

3 in, 3 out

All within 1hr

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24
Q

Metformin use, impaired renal function + acidosis - what is going on?

A

Metformin induced lactic acidosis

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25
Q

Elderly, T2DM, hyperglycaemia, hypernatremia - what is going on?

A

HHS (hyperosmolar hyperglycaemic state)

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26
Q

What is a T1 hypersensitivity reaction? (anaphylaxis)

A

IgE mediated mast cell degranulation & histamine release

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27
Q

Anaphylaxis to penicillins - cross-reactivity?

A

3% to 3rd-gen cephalosporins - so ideally avoid

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28
Q

Fever, rash, lymphadenopathy, deranged LFTs, eosinophilia - Dx?

A

Drug reaction with eosinophilia and Systemic Sx (DRESS)

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29
Q

Contact of a patient with meningococcal meningitis - do what?

A

Cipro 500mg STAT dose (2g IM Ceftriaxone if pregnant)

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30
Q

G-ve diplococci on CSF gram stain?

A

Neisseria meningitides

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31
Q

Encapsulated yeast on india ink staining of CSF?

A

Cryptococcal meningitis (in HIV)

32
Q

TCA overdose - features? Ix? Mx?

A

Features:

  • Anticholinergic - dry mouth, blurred vision, dilated pupils
  • Cardiac - sinus tachy, arrhythmia, vasodilation
  • CNS -reduced GCS, seizures, delirium

Ix: ECG, blood gas

Mx: A-E approach

  • Sodium bicarbonate 8.4% - arrythmias & QTc prolongation
  • No features/Ix findings after 6hrs = discharge
33
Q

Reduced GCS, pupillary changes, resp depression - Dx?

A

Sedative toxidrome - opiates, barbituates, benzos, baclofen, clonidine

34
Q

Confusion, autonomic dysfunction, neuromuscular hyperactivity - Dx?

A

Serotonin syndrome

35
Q

Adult with head injury what imaging to do? Signs of basal skull fracture?

A
36
Q

7th (& 3rd) CN palsy following head injury indicates what?

A

Basal skull fracture

37
Q

Depressed skull fracture (open head injury) - Mx?

A

IV abx + tetanus booster

38
Q

Headaches + poor concentration after head injury

A

Post-concussion syndrome

39
Q

Mannitol/hypertonic saline is used for what neurologically?

A

Osmotic diuretic used to acutely lower ICP

40
Q

Unilateral ptosis + down & out eye + fixed dilated pupil indicates what?

A

3rd nerve palsy

41
Q

Inability to abduct eye after head injury?

A

6th nerve palsy - false localising sign w/ raised ICP

42
Q

Status epilepticus - def? Triggers in epilepsy? Mx?

A

Tonic-clonic seizure ≥ 5 mins or ≥ 2 seizures without complete neurological recovery between

  • Refractory = continued despite using ≥2 antiepileptic drugs (AEDs) incl benzo.

Triggers in epilepsy:

  • drug withdrawal, dose change, non-compliance
  • Intercurrent illness, metabolic derangement
  • Drugs lowering seizure threshold:
    • abx (penicillin, cephalosporins, metro, isoniazid, imipenem)
    • TCA, Aminophyline
    • Cyclosporin, Tramadol
43
Q

Alcohol withdrawal seizures - when?

A

12-24hrs after last drink - CIWA score

44
Q

Acute paralysis + dysarthria following Tx for hyponatremia?

A

Osmotic demyelination syndrome

45
Q

Focal weakness following seizure?

A

Todd’s paralysis

46
Q

Absent p-waves, tall tented T-waves, broad QRS complexes?

A

Hyperkalaemia

47
Q

Sharp chest pain relieved by leaning forward, saddle-shaped ST-segment on ECG?

A

Pericarditis (secondary to uraemia)

48
Q

Polyarthropathy, fractures & calcific skin lesions on a background of CKD?

A

Renal osteodystrophy

49
Q

How do you treat ph<7 on blood gas in DKA?

A

Ask for senior support –> they would give dilute 1.26% bicarbonate to bring pH up to 7 but no higher

After this improvement will occur spontaneously

DO NOT USE 8.4% BICARBONATE

50
Q

What is the lethal triad of trauma? Mx?

A
  • Hypothermia (reduced circulating volume)
  • Acidosis (LA)
  • Coagulopathy (coag factor consumption and reduced operation from hypothermia)

NOTE: normally happens in severe trauma with sign. blood loss

Mx: trauma laparotomy

51
Q

Fluids:

  • Normal maintenance requirements for the patient if NBM (H20, Na, K, UO)?
  • Maintenance fluids
  • Resus fluids
A

Normal requirements if NBM:

  • H20 - 25-30ml/kg/day (cardiac disease is 20-25)
  • Na - 1-2mmol/kg/day
  • K - 0.5-1mmol/kg/day
  • Glucose - 50-100g/day (prevent ketosis)
  • UO should be >0.5ml/kg/hr

Maintenance fluids - traditional fluid regimen of ‘1 salty + 2 sweet’

  • 1L saline 0.9% + 20mmol KCl (over 8hrs)
  • 1L dextrose 5% + 20mmol KCl (over 8hrs)
  • 1L dextrose 5% + 20mmol KCl (over 8hrs)
  • NOTE: surgeons often prescribe Hartmann’s instead of NaCl as isotonic –> less likely to cause hyponatremia (above regimen provides too much H2O & too much Na)

Resus fluids - 500ml fluid bolus 0.9% NaCl over 15-20 minutes (250ml if HF)

52
Q

How to Tx asystole?

A

IV adrenaline

53
Q

Which airway device provides protection for the lungs from regurgitated stomach contents?

Which airway device is often used in cardiac arrest?

A

Tracheal tube - seal off airway = protection from aspiration

i-gel (supraglottic) airway = easier to place (than tracheal tube)

54
Q

confusion, coarse tremor, jerking leg movements + bipolar disorder - Dx?

A

Lithium toxicity

55
Q

Fat emboli presentation? DDx?

A

Trauma –> multiple fractures

  • Followed by early-onset (within 24 hours) hypoxia, dyspnea, and tachypnea
  • Followed by Neuro findings - acute confusional state/altered GCS/seizures/focal deficits
  • Finally petechial rash (1/3 cases)

DDx: PE (but no neuro Sx)

56
Q

Drugs for cardiac arrest?

A

DC shock (150J biphasic)

Adrenaline 1mg IV (10ml 1:10,000)

Amiodarone 300mg IV (if shockable rhythm)

57
Q

Trauma patient initial Mx?

A

Airway and cervical spine

Next - CT-head + CXR

58
Q

Common tumour markers - hormones, enzymes, tumour antigens, monoclonal abs?

A

Hormones:

  • Calcitonin - medullary thyroid carcinoma
  • ACTH, ADH - small cell bronchial carcinoma (paraneoplastic)
  • beta-HCG - testicular germ-cell tumours, choriocarcinoma

Enzymes:

  • NSE (neurone specific enolase) - small cell lung cancer (70% of untreated patients)
  • ALP - paget disease of bone, mets to bone/liver
  • LDH - detects necrosis e.g. in ovarian cancer, testicular germ cell tumours, lymphomas, Ewing’s sarcoma

Tumour antigens:

  • AFP - hepatocellular carcinoma, teratoma
  • PSA - prostatic carcinoma (or BPH/prostatitis)
  • CEA (carcinoembryonic antigen) - post-op colorectal carcinoma; lacks the specifity or sensitivity to establish a diagnosis of cancer

Monoclonal abs:

  • CA 19-9 - pancreatic, gastric, hepatobiliary carcinoma
  • CA 15-3 - breast carcinoma
  • CA 125 - ovarian carcinoma
59
Q

Most accurate way to assess burns area?

A

Lund and Browder chart

60
Q

Emergency focused Hx?

A

A – Allergies

M – Medications

P – Past Pertinent medical history

L – Last Oral Intake

E – Events Leading Up To Present Illness / Injury

61
Q

Post-op process? Peri-operative RFs? Post-op complications?

A

Process:

  • A-E
  • Focused Hx
  • Input (fluid, food) –> Output (urine, drain, stool)
  • Review prev admission Hx + operation note
  • Review Ix e.g. blood, scan, histology
  • Escalation plan (ITU, ward-based care), DNAR status

RFs:

  • Patient - obesity, IS, malnutrition, steroids, DM
  • Operation - contamination/soiling, foreign body, prosthesis, duration

Complications:

  • Immediate <24hrs: haemorrhage, anaesthetic (anaphylactic, hypotension, agitation)
  • Early (3-4 days):
    • Pyrexia - Chest, Catheter, Cut, Cannula, Central venous line, Calf (DVT)
    • Anastomotic leak, collection, paralytic ileus, prosthesis inf
  • Late:
    • Anaemia
    • Malnutrition
    • Dumping syndrome (if vagus nerve severed –> stomach dumps food into duodenum without digestion –> very tired after eating)
    • Reoccurrence
    • Incisional hernia
    • Chronic pain
62
Q

Blood transfusion reactions - Immediate? Delayed?

A

Immediate (<24hrs):

  • Immune:
    • Acute haemolytic transfusion reaction (ABO incompatibility)
      • Anti-A/B abs activating complement pathway –> inflammatory cytokine release
      • Features:
        • Early - fever, low BP, anxiety, red urine
        • Late - low BP, widespread haemorrhage secondary to DIC
    • Transfusion-related acute lung injury (TRALI)
      • Donor abs against recipient HLA antigens (neutrophil, leukocyte)
      • Within 6hrs - sudden dyspnoea, severe hypoxemia, low BP, fever
      • Resolves with supportive care within 2-4 days
    • Anaphylaxis - allergic to protein components in donor transfusion
      • Itchy rash, angioedema, SoB, vomiting, lightheaded, low BP
  • Non-immune:
    • Bacterial infection
    • Transfusion-associated circulatory overload (TACO)
      • Acute/worsening resp compromise/pul oedema up to 12hrs post-transfusion

Delayed (>24hrs):

  • Immune:
    • Delayed haemolytic transfusion reaction (DHTR)
      • Abs to antigens e.g. Rhesus/Kidd
      • 3-13 days post-transfusion
      • Sudden drop in Hb, fever, jaundice, haemoglobinuria
    • Febrile non-haemolytic transfusion reaction (FNHTR)
      • Abs against donor leukocytes/HLA antigens
      • Fever during transfusion, no haemolysis
      • Normally if received multiple transfusions/women with multiple pregnancies
    • Post-transfusion purpura (PTP)
      • Adverse reaction to blood/platelet transfusion when body produces allo-abs to introduced platelets’ antigens –> destroy patient’s platelets –> thrombocytopenia
      • 5-12 days post-transfusion
    • Graft versus host disease (GvHD)
      • After receiving transplanted tissue from a genetically different person
      • WBCs in donated tissue (graft) recognise recipient as foreign –> attack host cells
      • Can also occur in blood transfusion if blood has not been irradiated/treated with approved pathogen reduction system
  • Non-immune:
    • Viral infection
    • Malaria
    • Prions
63
Q

Types of airway management? Airway management procedure?

A

Artificial airway types:

  • Oropharyngeal airway (OPA) - prevent tongue blocking the airway/upper airway muscle relaxation in unresponsive individual (no cough/gag reflex)
  • Nasopharyngeal airway (NPA) - used in responsive individuals/jaw clenched (more risk of soft tissue damage)
  • Endotracheal airway (ETA) with intubation - if can’t breath on their own (need mech ventilation)/planned surgery requiring general anaesthetic, protects the airway from aspiration
  • Supraglottic airway devices - step prior to intubation (elective procedures, cardiac arrests, prehospital airway Mx)
    • Laryngeal mask airway (LMA) - temporary open airway during anaesthesia or life-saving measure during difficult airway intubation (≥ 3 attempts of 10mins each)
    • iGel - as above but prevent aspiration & has port for NG tube insertion

Airway management:

  • Basic (non-invasive):
    • Head tilt & chin lift
    • Jaw thrust
    • Bag-valve mask
  • Advanced (invasive/specialised):
    • OPA/NPA
    • Laryngeal mask airway (LMA)/iGel
    • ETA with intubation
    • Rapid sequence induction (RSI) of anaesthesia & intubation
    • Cricothyroidotomy (emergency procedure - between thyroid & cricoid cartilage)
    • Tracheostomy (2nd/3rd tracheal rings - surgical procedure for temp/permanent intubation)
64
Q

Management of poisoning <1hr since ingestion, conscious, protected airway?

A

oral activated charcoal within 1hr

65
Q

Treatment of high INR? Target?

A
  • Any bleeding: stop Warfarin AND IV vit K slowly
    • If major bleed = ADD dried PCC/FFP
    • INR @24hrs –> continue Tx if INR high, continue Warfarin when INR <5
  • INR >8: stop Warfarin AND oral Vit K
    • INR @24hrs –> continue Tx if INR high, continue Warfarin when INR <5
  • INR 5-8: miss dose of Warfarin –> reduce maintenance dose

Target: 2.5 (2-3 range)

66
Q

Drugs for cardiac arrest?

A

DC shock (150J biphasic)

Adrenaline 1mg IV (10ml 1:10,000)

Amiodarone 300mg IV (if shockable rhythm)

67
Q

Drugs for anaphylaxis?

A

Adrenaline 0.5mg IM (0.5ml 1:1000)

Hydrocortisone 200mg IV

Chlorphenamine 10mg IV

68
Q

Seizure drugs?

A

Lorazepam 4mg IV (diazepam 10mg PR if no IV access)

69
Q

Hypoglycaemia drugs?

A

20% glucose 75ml IV (repeat as needed) over a time period up to 20 mins

  • 2nd line - glucagon 1mg IM (if no IV access, not ideal if anticoagulated as IM + causes nausea/flushing
  • NOTE: risk of aspiration of glucose gel in an unconscious patient
70
Q

Hyperkalaemia drugs?

A

10% Ca gluconate 10ml IV over 5 mins

THEN

10 units Actrapid insulin added over 30 mins AND 100ml 20% glucose

71
Q

Bradycardia drugs?

A

Atropine 500mcg IV (repeat every 3-5mins to max 3mg)

72
Q

SVT drugs?

A

Adenosine 6mg IV (then 12mg then 12mg)

  • Must be given as bolus + flushed quickly via large vein
73
Q

VT drugs (without adverse signs)?

A

Amiodarone 300mg IV over 20-60mins

75
Q

Rapid tranquillisation of agitated patient @risk to self/others - drugs?

A

Lorazepam 1-2mg PO/IM or Olanzapine 5-10mg PO/IM

  • Give oral if possible, give half if elderly/renal impairment
76
Q

Critical drugs - DO NOT EMIT when put on NBM in hospital

A
  1. Parkinson’s drugs (Levodopa, Carbidopa)
  2. Antiepileptics (Na Val, Carbamazepine, Lamotrigine, Levetiracetam)
  3. Antiretrovirals (-avir)
  4. Steroids (long-term) - stopping abruptly –> Addisonian crisis

Routes –> patches, IV, NG tube

77
Q

Opiate overdose Tx? What if patient becomes unrousable again?

A

IV access –> STAT dose naloxone 400mcg - after 1-min of no improvement –> 800mcg

Stay by the bedside until improved resp rate

If the patient becomes unrousable again - Naloxone has a short half-life so may still be opioid toxic –> Naloxone infusion

78
Q

Torsade de Pointes (TdP) - Tx?

A

Broad-complex irregular tachycardia where the size and shape of the QRS varies complex to complex within any given lead (polymorphic)

  • Increased QT interval increases the risk e.g. drugs (clari, amiodarone)

Magnesium sulfate IV 2g over 10 minutes

Final Year - ICSM (21 decks)

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