Emergency Medicine

Question 1

Mx acute asthma

Answer 1

ABG indicated if O2 sats <92%. CXR if suspect pneumothorax, infection or life threatening attack.
Nebulised Salbutamol 5mg
Hydrocortisone IV 100mg/ Prednisolone PO 50mg
Nebulised Ipratropium Bromide 0.5mg 4-6 hourly
IV magnesium sulphate 1.2-2g IV over 20min

Question 2

Mx STEMI

Answer 2

Take a brief history, quick physical examination and 12 lead ECG. Bloods should include troponin, glucose and cholesterol (plus FBC & Us&Es)
Morphine 5-10mg IV if indicated
Oxygen high flow reservoir mask if indicated titrate to 94-98%
Nitrates if patient hypertensive or chest pain
Aspirin 300mg

If PCI can be offered within 120 minutes or presentation: give Prasgruel with aspirin/ if alr on an anticoagualant give Clopidogrel with aspirin
If going for radial access give heparin and bailout GPI
If going for femoral access bivalrudin and bailout GPI

If PCI can’t be offered within 120 minutes offer fibrinolysis - Give an antithrombin at the same time. ECG 60-90min after this.

Question 3

Mx NSTEMI

Answer 3

Morphine 5-10mg IV if indicated
Oxygen high flow reservoir mask if indicated titrate to 94-98%
Nitrates if patient hypertensive or chest pain
Aspirin 300mg

Estimate 6 month mortality using GRACE tool.

High risk: unstable - offer PCI. Stable - offer PCI within 72 hours. Give Pragruel or Ticagrelor. Give LMWH.
Low risk: give Ticagrelor.

Question 4

Mx COPD

Answer 4

Titrate O2 to 88-92% target.
ABGs. CXR to rule out pneumothroax & infection.
FBC, U&Es, CRP. Blood culture if pyrexial.
Nebulised bronchodilator Salbutamol 5mg/4h or Ipratropium 0.5mg
Steroids IV Hydrocortisone 200mg
If no response try IV aminophylline

Antibiotics if evidence of infection Amoxicillin 500mg/ Doxycycline 200mg

SEPSIS 6 if relevant

Question 5

Mx tension pneumothorax

Answer 5

large bore cannula (14G-16G) in 2nd intercostal space midclavicular line with saline syringe
pull plunger to allow trapped air out

after this can request CXR and chest drain.

Question 6

Mx pneumothroax

Answer 6

Request CSR to check rim. Check ABG in dysnpoeic pts.

Primary & >2cm/ breathless: chest drain otherwise discharge

Secondary >2cm: chest drain
1-2cm: Aspiration 16-18G cannula
<1cm: give oxygen and admit for 24 hrs.

Question 7

MX DKA

Answer 7

Bloods: VBG. Glucose. Blood ketones. Amylase. Osmolality
ABGs.
Dipstick for Urine ketones.

Fluid replacement with 0.9% sodium chloride 1L in 1 hr
IV insulin 0.1 unit/kg/hr
Once glucose is <15mmoll an infusion of 5% dextrose should be started

Correct electrolyte disturbance. Insulin = hypokalaemia? May need potassium infusion & cardiac monitoring. 0.9% sodium chloride with potassium chloride.

Long acting insulin should be continued and short acting stopped.

Question 8

Mx Hypoglycaemia

Answer 8

20-30g glucose IV 200-300ml of 10% dextrose
OR Glucagon 1mg IV/IM
Once concious give sugary drinks and a meal.