emergency medicine Flashcards
pin point pupils
opioid overdose
management for pin point pupils
naloxone
acute hypoglycaemia management
IV dextrose
what sats should you aim for in COPD
88-92%
what sats are normal
>94%
what is normal RR
12-20
what is normal pulse
60-100bpm
what is abnormal GCS
<8
what should you carry out if GCS is <13and how quickly
CT head within 1hr
differentials for acute chest pain
- MI - ACS - aortic dissection - tearing pain radiating to back - tension pneumothorax - tracheal deviation, displaced apex, DONT DO CXR - PE - pleuritic, calf swellings, hx indicating DVT - oesophageal rupture - severe retching/ haematemesis, severe retrosternal pain GORD, MSK, pericarditis (worse leaning forward), pneumonia
investigations for acute chest pain
obs bloods: troponin, FBC, U&Es ECG CXR consider D-dimer if low prob VTE, CTPA if suspect PE
65ys right sided chest pain discharged 2 days ago after an elective knee replacement no PMH, non smoker BP: 140/80 HR: 110 afebrile sats 91% RR: 20 rapid regular pulse and diffusely swollen but not erythematous left leg with clean surgical scar most likely diagnosis
PE
64yrs chest pain thats worsened over 2 days run down sore throat 1wk ago PMH: HTN, hyperlipidaemia diffuse chest pain - better on leaning forward temp: 37.9 BP:140/84 HR:76 friction rub is heard on cardiac auscultation ECG: ST elevation in nearly every lead most likely diagnosis
pericarditis - post viral complication
20yr girl downs syndrome collapse two days after last period febrile widespread erythematous rash with exfoliation and warm peripheries what type of shock
endotoxic due to toxic shock syndrome - by staphylococcus vaginal infection if tampon is not removed - more common in people with learning difficulties or psychiatric illness warm peripheries specific to endotoxic and septic shock
14yrs boy collapse whilst eating at restaurant wheeze stridor swelling of lips and tongue type of shock
anaphylactic - due to food allergy
70yrs man fit and well apart from arthritis in knees - diclofenac collapse tachycardia hypotension pale but otherwise normal haemoglobin: 11 urea: 20 creatinine: 70 type of shock
haemorrhagic upper GI bleed - drop in Hb but signs of shock can precede this urea may rise first due to digestion of protein load (Hb) in stomach and causes urea to be disproportionately higher than creatinine production of urea
50yr woman unwell after 24hr hx severe abdo pain and vomiting tender in epigastrium without guarding amylase >3000
fluid depletion acute pancreatitis - amylase high suffer with intravascular fluid depletion due to intra-abdominal fluid sequestration (3rd spacing) and bowel oedema even though no external sign of fluid loss management: aggressive fluid resus
26yr man collapse following sudden central chest pain cold, clammy, sweaty trachea is deviated to left and absent air entry on right side of chest
cardiogenic mostly due to primary myocardial disease can be 2ndry to trauma or tension pneumothorax the mediastinal shift results in reduction of venous return to the heart, cardiac dysfunction and shock
30yrs woman collapse severe lower abdo pain tender, rigid abdo scanty dark brown vaginal discharge type of shock
haemorrhagic ruptured ectopic –> intra-abdominal bleeding management: resus + blood products + surgical management of bleeding
myxoedema
severe hypothyroidism
6yr boy lips swollen stridor, SOB sweaty and clammy allergy to nuts dosage of adrenaline
300mcg of 1:1000 adrenaline IM
dosages of adrenaline
adults and children >12: - 500mcg = 0.5ml children 6-12: - 300mcg = 0.3 ml children <6: 150mcg = 0.15ml
35yr fallen off third step of ladder and hit head on pavement feeling well since accident no reported LOC able to recall GCS 15/15 no neurological abnormality no external injury other than bruise behind his left ear most appropriate management
arrange urgent CT head scan battles sign
what is bruising behind the ear called and what is it a sign of
Battle’s sign sign of possible basal skull fracture
signs of basal skull fracture
Battle’s sign (bruising tot he mastoid process) panda eyes (periorbital bruising) rhinorrhoea (CSF leak from nose) otorrhoea (CSF leak from ears)
young man road traffic collision tachycardia: 120bpm sweating and pale decreased breath sounds on right side decreased chest movement trachea deviated to left asked to insert a large bore cannula where will you place it in this patient
2nd intercostal space, mid clavicular line on the side of the decreased breath sounds
young man road traffic collision tachycardia: 120bpm sweating and pale decreased breath sounds on right side decreased chest movement trachea deviated to left asked to insert a large bore cannula where will you place it in this patient
2nd intercostal space, mid clavicular line on the side of the decreased breath sounds needle thoracocentesis
where do you place the chest drain in a pneumothorax/ pleural effusions
between the base of axilla and 5th intercostal space and between the lateral edge of the pectoris major and the lateral edge of latissimus dorsi
40yr SOB otherwise fit and well recently prescribed amox by GP for LRTI unable to talk harsh upper airway sounds on inspiration florid rash pulse: 160bpm BP: 80/40 O2: 90% on high-flow O2 most appropriate first step in management
0.5ml of 1:1000 adrenaline solution IM follow ABC (so deal with airways before circulation)
45yr woman falling down stairs at home rib pain unable to complete full sentences due to SOB sats:91% air nurses concerned about deterioration BP: 80/40 HR: 120bpm RR: 40 sats:85% left chest does not move very well no audible breath sounds on left on auscultation
needle thoracocentesis of left chest (tension pneumothorax)
when is a nasopharangeal tube contraindicated
basal skull fracture
what would you do first in opioid overdose
protect airway
22yr F unwell in restaurant red, unable to breath making noises when trying to breath generalised urticarial rash responsive to voice once had allergy to peanuts - may have been peanuts in dessert most likely diagnosis
anaphylaxis
patient with anaphylaxis with SOB and stridor given adrenaline IM 500mcg + high flow O2 was given epipen after previous allergic reaction which three other medications would you give to the patient
200mg IV hydrocortisone 10mg IV chlorphenamine 1000ml Hartmanns solution
anaphylaxis criteria
- sudden onset symptoms - life threatening airway/ breathing/ circulation - skin and/or mucosal changes (flushing urticarial, angioedema) - exposure to known allergen - most reactions occur over several minutes - patient look and feel unwell - may also be GI symptoms (ie. diarrhoea and vomiting)
92yr M
dementia and myelodysplasia
2d hx cough, fever, lethargy, confusion, and reduced urine output
temp: 39
pulse: 180bpm
BP: 77/35
RR: 28
O2 sats 85% on air
care home, mobile with zimmer frame
looks unwell
respiratory distress, course crackles and bronchial breathing at the right base with a dull percussion note
cool peripheries, an irregularly irregular pulse and normal heart sounds
skin changes on torso and abdo (skin mottling)
most likely diagnosis
4 immediate management
sepsis caused by community acquired pneumonia
febrile, tachycardia, hypotensive, end organ dysfunction (confusion, reduced urine output)
age and hx of cough (LRTI)
myelodysplasia will render him immunosuppressed and therefore more susceptible to severe infection
sepsis 6
IV access for bloods (ABG for oxygenation & lactate, cultures, FBC, U&Es, CRP, LFTs, bone profile)
urine output - catheter
high flow O2
antibiotics
20mls/kg fluid bolus - if remains hypotensive then consider vasopressors
after resus phase CXR
what is this skin mottling called
what is it caused by
livedo reticularis or ‘mottling’
caused by reduced blood flow to the skin and therefore oxygenation of the skin
can be a normal phenomenon - particularly in babies and children
in clinical context, it is concerning for a severe sepsis or disseminated intravascular coagulopathy
stabilised patient
CXR - right lower lobe pneumonia with an effusion
pain on right side of chest - morphine
40mins later - cardiac arrest
what type of rhythm
is this a shockable rhythm
what should be given
asystole - flat line but wondering baseline
non-shockable rhythm
give adrenaline every 3-5 mins (given at alternative cycles of CPR)
dont look for a pulse
poor prognosis
resuscitating patient for 6 mins without change in his rhythm
management
adrenaline every 3-5mins
100% O2 via tracheal tube
fluid bolus - 0.9% saline or Hartmanns
team should prepare that resus is unlikely to be successful
35yr M
house fire
alert and responsive
burns to front of face, neck, chest and whole of left arm
skin is erythematous with some patchy white areas, sensation decreased
cap refill time 6s
temp: 36.2
HR: 115bpm
BP:110/79
RR:31
breathing: shallow
given the distribution and extent of his burns what is the percentage
22.5%
rule of nines (palm represents 1% )
face & neck: 4.5%
front of chest: 9%
whole arm: 4.5%
= 22.5%
burns to head neck chest (front) whole of left arm and torso and legs
calculates perentage burns at ~50%
weighs 70kg
calculate fluid requirement in first 24hrs following burn
Parkland Formula: for all adults with burns >15%
fluid requirements in first 24hrs after burn= 4ml x patients weight in Kg x % burn
4 x 70 x 50 = 14000mL
half of the fluid given in first 8hrs from time of burn
2nd half in remaining 16hrs
burns to face and neck
shallow breathing
RR:45
stridor
O2 sats: 95% on air
soot in mouth and nose
appropriate interventions?
high flow O2 by non-rebreath mask at 15L/min
urgent anaesthetic review by senior anaesthetist with view to early intubation
inhalation and airway burns,
airway oedema - needs intubation by anaesthetist
what are indications for referral to a regional burns unit
Burns > 10 % TBSA in an Adult
Burns > 5 % TBSA in a Child
Full thickness burns > 5% TBSA
Burns of face, hands, feet, perineum, genitalia, and major joints
Circumferential burns
Chemical or electrical burns
Burns in the presence of major trauma or significant co-morbidity
Burns in the very young patient, or the elderly patient
Burns in a pregnant patient
Suspicion of Non-Accidental Injury
what burns patients should be catheterised
what level of urine output should be maintained with fluids
patients with burns >20% or intubated should be catheterised
patients with perineal burns or 15-19% catheterisation should be considered
fluids should be titrated to urine output to maintain at least 0.5ml/kg/hr urine output
mother brings 4y M to ED
spilt boiling water on left forearm
erythematous and sensitive to touch
~ 3x4cm on forearm
first step management
hold under cool running water for 20mins and wrap with cling film
no creams or gels needed
ice packs not recommended as they can cause frost burns
what analgesia is appropriate for 4yr old with burn on forearm
oral paracetamol loading dose 20mg/kg and then 15mg/kg thereafter
and ibuprofen 10mg/kg
if pain not controlled, one off dose of intra-nasal diamorphine
codeine not recommended in children
burn described as painful and sensitive to touch
erythematous and wet with blistered areas
how would you describe the depth of the burn
partial thickness - moist and red, usually broken blisters, normal cap refill. involve the dermis. painful unless deep dermis, then slow cap refill
superficial burns - dry, minor blistering, erythema. painful. sunburn or minor scalds. involve epidermis
full thickness burns - dry, charred, white. painless and absent cap refill. destroyed epidermis and dermis and began to destroy underlying SC tissue.
how would a burn 3x4cm on forearm be managed on 4yr old patient after inital first aid and analgesia
de-roof blistered areas
dress with non-adherent dressing
review in dressing clinic in 48hrs
prophylactic abx not indicated unless burn is infected
blisters de-roofed to assess depth of burn
no indication to refer to regional burns unit
78yr F
severe respiratory distress for past few hrs
known COPD
pronounced wheeze but no audible crepitations
ABG:
pH: 7.44 (7.35-7.45)
pCO2: 4.9 (3.5-4.5)
pO2: 5.1 (7.5-10)
BE: +4 (-4 to +2)
HCO3: 28 (22-26)
lactate 2.6 (0.5-1)
type of respiratory failure
most appropriate initial management
type 1 respiratory failure
60% O2 via fixed rate delivery device (venturi)
watch O2 sats and patients consciousness level and repeat VBG to see CO2 level in 20 mins if no deterioration prior to that
patient with respiratory distress given high flow O2
PMH: COPD
patient begins to feel better
RR settles but still audible wheeze from end of bed
CXR consolidation in right lower lobe
diagnosis
three appropriate managment
infective exacerbation of COPD
back to back nebulized salbutamol and atrovent
abx
prednisolone 40mg orally (IV if unable to swallow)
difference between type 1 and type 2 respiratory failure
type 1 respiratory failure:
pO2 < 8
normal pCO2
type 2 respiratory failure:
pO2 <8
high pCO2
causes of epistaxis
Local trauma:
- Nose picking
- Facial trauma
- Foreign bodies
- Nasal or sinus infections
- Nasal septum deviation
Environmental:
- Dry/cold conditions
- Prolonged inhalation of dry air (oxygen)
Iatrogenic:
- NG tube insertion
- Nasotracheal intubation
Medicinal:
- Topical corticosteroids and antihistamines
- Solvent inhalation
- Snorting cocaine
- Anticoagulants
Coagulopathic:
- Inherited coagulopathies
- Splenomegaly
- Platelet disorders
- Chronic alcohol abuse
- AIDS
Vascular abnormalities:
- AV malformation
- Hereditary haemorrhagic telangiectasia
- Endometriosis
65yr F
spontaneous epistaxis from right nostril
haemodynamically stable
active bleeding point visualised on nasal septum in right nostril
bleeding has not stopped despite pressure for 15 mins
next appropriate management
cautery with silver nitrate
initial management: pressure to anterior aspect of nose for 15-20mins
patient sit forward
cautery only applied to one side of nasal septum, cauterising both sides –> septal perforation
if epistaxis continues after cautery what is the next most appropriate step in management
rapid rhino into each nostril
type of nasal tampon consisting of an outer later of carboxycellulose that promotes platelet aggregation, with an inflatable balloon that compresses nasal cavity on insertion tamponading the bleeding site
comes in 2 sizes - smaller to compress anterior nasal cavity
larger to compress posterior cavity also
both nostrils packed to tamponade bleeding vessels effectively
what can you do if the rapid rhino is unsuccessful
can remove the rapid rhino and place a Foley catheter in nose into oropharynx
blow balloon up
then repack nose
ensures both posterior an anterior nasal cavity are properly packed
how long should the rapid rhinos remain in place
24hrs
admitted or if well can go home and return next day for assessment and removal
40yr M
found unresponsive outside a supermarket
temp: 35.5
HR:90
BP: 100/60
RR: 8
pupils constricted bilaterally but reactive
opens his eyes to painful stimulus, withdraws from pain and is making incomprehensible sounds
what is his GCS
GCS= 8
lowest score for anything is 1
eyes out of 4
voice out of 5
motor out of 6
E= 2 + V=2 + M=4
patients with a GCS of 8 or less are at risk of being unable to protect their own airway and may need intubation and ventilation
ABG
pH: 7.24 (7.35 - 7.45)
PCO2: 8.9 (4.7-6)
PO2: 6.4 (11-13)
HCO3: 24 (22-26)
what does this show
what type of respiratory failure
respiratory acidosis
type 2 respiratory failure
40yr M
found unresponsive outside a supermarket
temp: 35.5
HR:90
BP: 100/60
RR: 8
pupils constricted bilaterally but reactive
opens his eyes to painful stimulus, withdraws from pain and is making incomprehensible sounds
diagnosis
most appropriate first line treatment
opioid toxicity - constricted pupils and reduced RR
IV naloxone
treatment for tricyclic antidepressant overdose
IV sodium bicarbonate
treatment for Addisons crisis (can present with collapse)
IV hydrocortisone
treatment for methanol and ethylene glycol poisoning
fomepizole/ IV ethanol
19yr W
60kg
ingested 16 tablets of 500mg paracetamol 3hrs ago in suicide attempt
nausea but otherwise asymptomatic
first line management step
take bloods at 4hrs post ingestion for INR, venous gas, U&Es, LFTs, paracetamol level and FBC
toxic dose of paracetamol is 75mg/kg - patients need urgent assessment above this level - bloods at 4hrs
if 4hr paracetamol levels above treatment line then need NAC
patients ingested >150mg/kg that you will be unable to act on blood results with 8hrs of ingestion need NAC started immediately
this patient ingested 133mg/kg (500x16 /60)
19yr W
paracetamol overdose
nausea but otherwise asymptomatic
coming to the end of their 21hrs of NAC treatment
ingested 100mg/kg of paracetamol, no concerning features requiring referral to liver unit
what further tests does she need to be safely discharged
at the end of 21hrs NAC re-check INR, plasma creatinine, venous pH or plasma bicarbonate and ALT
if all bloods meet following criteria –> discharge:
- INR is 1.3 or less AND
- ALT < 2x upper limit of normal AND
ALT not > than double the admission measurement
if bloods abnormal continue NAC and repeat all bloods in 8-16hrs:
- INR >1.3 OR
- ALT >2x upper limit of normal OR
- ALT more than doubled since admission measurement
patients with chronically elevated ALT may not need ongoing NAC (N-acetylcysteine) if ALT has not changed significantly- discuss with national poisons centre
paracetamol overdose
bloods done at 4hrs post ingestion
paracetamol levels above treatment level
what further management does this patient need
NAC immediately for 21hrs to avoid hepatotoxicity
referral to psychiatry in due course
risk assessment and appropriate management of suicide risk whilst NAC is running
23yr F
SOB
6wks post partum
emergency caesarean for failed induction at term
otherwise fit and well
breathlessness progressively worse over week associated with mild chest pain
more unwell today and haemoptysis
temp: 37.8
pulse: 130
BP: 100/60
RR:30
O2 sats: 92% on air
what are some differentials for this patient
what three key bedside investigations would you perform
PE (can produce low grade fever and haemoptysis)
myocarditis (patients can get postpartum myocarditis and decompensate into pulmonary oedema and cardiovascular collaose - much less common)
pulmonary oedema
LRTI
ABG
ECG
measure calves
ABG taken on 40% O2
pH: 7.52 (7.35-7.45)
pO2: 11.2 (11-13)
pCO2: 2.0 (4.7-6)
HCO3: 25 (22-26)
BE: -2 (-2 to +2)
what type of respiratory failure
interpret ABG
type 1 respiratory failure
patient has significant hypoxia (given she is reveiving 40% and O2 levels just normal)
respiratory alkalosis
- the low CO2 caused by raised RR to compensate for hypoxia, Co2 diffuses at a faster rate than O2
patient agitated
holding chest and shouting she feels like she is dying
HR dropped to 25bpm
become very quiet and still
open airway and check for signs of life - none
CPR and airway management
what should you check for
what management
check for a pulse
- in cardiac arrest the rhythm is pulseless electrical activity
- pulseless electrical activity is any form of organized complexes that does not produce a cardiac output
management: adrenaline (as its a non-shockable rhythm)
cardiac arrest team think most likely cause of cardiac arrest is PE
patient has now had 8 mins of ALS and remains in cardiac arrest
what is the next most appropriate step in management
administer thrombolysis
after administering ALS continued for at least an hour following
CTPA should be done once patient is stable
interpret the ABG on 100% O2
pH: 6.99 (7.35 – 7.45)
O2: 13 (11-13)
pCO2: 10 (4.7-6)
K+: 7.5 (3.6-5.2)
lactate: 13 (0.5-1)
BE: -6 (-2 to +2)
HCO3: 14 (22-26)
management
mixed metabolic and respiratory acidosis
patient is hypoxic despite 100% O2- problem with V/Q ratio
K+ high which could cause further cardiac arrest
lactate high expected in cardiac arrest patient
management:
- calcium chloride IV - for cardioprotection
- insulin + dextrose - to force K+ back into cells
what are the shockable rhythms
Ventricular Tachycardia
Ventricular Fibrillation
Supraventricular Tachycardia
what is the management for shockable rhythms
defib + adrenaline 10mcg/kg (alternate cycles) then amiodarone 5mg/kg
23yr F
SOB
6wks post partum
emergency caesarean for failed induction at term
otherwise fit and well
breathlessness progressively worse over week associated with mild chest pain
more unwell today and haemoptysis
went into cardiac arrest
now intubated and ALS has been in progress for 5 mins
what are the most likely reversible causes of cardiac arrest?
hypoxia
thromboembolic
most likely PE causing obstruction to blood flow out of right heart and reducing venous return to left heart
became acutely more hypoxic and had cardiac arrest 2ndry to that
48yr F
overdose
unresponsive, unclear what shes taken
2min tonic clonic seizure in ambulance
regular meds: co-codamol, propanolol, diazepam, sertraline, amitriptyline
suicide note and empty bottle of vodka
airway patent
making grumbling noises
breathing normal
abdo soft
temp: 38.7
HR: 121
BP:100/62
RR: 14
pupils dilated bilaterally
in response to painful stimulus she withdraws but her eyes remain closed
what is her GCS
which of her drugs in overdose would explain her presentation
GCS = 7/15
(E=1 (not opening) + V = 2 (incomprehensible sounds) + M = 4 (withdraws from pain))
amitriptyline (TCA)
- TCA overdose cause anticholinergic effects - dilated pupils, tachycardia, drowsiness, dry mouth, urinary retention, confusion, agitation. severe side effects hypotension, cardiac rhythm disturbance, hallucinations and seizures
propanolol overdose –> bradycardia
diazepam –> drowsiness, resp depression, ataxia, hypothermia
sertraline overdose –> vomiting, tremor, drowsiness, dizziness, tachycardia, seizures
patient intubated and on ITU
ABG:
pH: 7.24 (7.35-7.45)
pCO2:4.5 (4.7-6)
pO2: 11.5 (11-13)
HCO3: 18 (22-26)
what abnormality
metabolic acidosis
HCO3 low
pH low - acidotic
CO2 normal so no compensation
propanolol overdose features
bradycardia
diazepam overdose symptoms
drowsiness,
respiratory depression,
ataxia
hypothermia
sertraline overdose symptoms/ signs
vomiting,
tremor,
drowsiness,
dizziness,
tachycardia,
seizures
Tricyclic antidepressant overdose symptoms/signs
causes anticholinergic effects including:
dilated pupils,
tachycardia,
drowsiness,
dry mouth,
urinary retention,
confusion
agitation
Some severe side effects are:
hypotension,
cardiac rhythm disturbance,
hallucinations
seizures
amytripyline overdose
ECG shows widened QRS, ABG shows metabolic acidosis
what is the most appropriate management
IV sodium bicarbonate
amitriptyline is a TCA
treatment for TCA overdose is supportive but widening QRS complex or metabolic acidosis –> treat with sodium bicarb
treatment for beta blocker overdose (propanolol)
IV glucagon - treats the bradycardia
60yr M
falling 2m from ladder
PMH: AF
medications: bisoprolol 2.5mg, warfarin 3.5mg
lost consciousness 1-2 mins
ED 1hr after fall - alert although confused and combative (argumentative)
temp: 36.5
pulse: 80
BP: 162/105
RR:16
eyes open, unable to follow commands but withdraws from pain
not orientated to time or place but can give name and birth date
what is his GCS
after initial assessement, what is the single most important investigation
GCS = 12
E = 4 (open spontaneously) + V = 4 (confused) + M = 4 (withdraws from pain)
CT head
- significant mechanism of injury
- on warfarin - high risk of brain injury
- confusion
paint fall
on warfarin
imaging reveals acute subdural haematoma
INR: 5.1 (normal <1.1)
calcium normal
after discussion with neurosurgery what is the next management step
stop warfarin
5mg IV vitamin K (reverses warfarin)
prothrombin complex concentrate (Octaplex) (short half life so needed with Vit K)
45yr M
PMH: HTN
severe chest pain - started 1hr ago whilst running at gym
while taking hx patient becomes unresponsive, agonal respirations (struggling)
no signs of life, no pulse
two immediate actions
most likely cause of cardiac arrest
call for help
start CPR
(commence basic life support and call for help to commence basic life support)
thomboembolic - cardiac arrest 2ndry to acute MI
also possible PE
what is the rhythm
is CPR always required
is defibrillation always indicated
would the patient have a palpable pulse
ventricular fibrillation
- chaotic and irregular
treatment for VF: CPR + defib
VF does not produced organised myocardial contraction therefore pulseless
following defibrillation and 2 mins of CPR, you stop for rhythm check (shown)
what is your next step
check for a pulse
organised electrical activity - may be compatible with a pulse and therefore change your management from cardiac arrest to post arrest management
if patient did not have a pulse it would be called pulseless electrical activity - non shockable cardiac arrest management
reversible causes of cardiac arrest
causes: 4Hs 4Ts
Hypovolaemia
Hypoxia
Hyperkalaemia, hypokalaemia, hypocalcaemia
Hypothermia
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
toxins (TCA overdose)
benzodiazepine overdose mx
flumazenil
aspirin (salicylate) overdose
IV sodium bicarbonate - if metabolic acidosis (to cause alkalinisation)
activated charcoal - recent overdose
aspirin is a salicylate: causes raised anion gap metabolic acidosis
fluid resus for burns
Parkland formula
total fluid requirement in 24hrs = 4ml x (total burn SA (%)) x (body weight (Kg))
50% given in first 8hrs
50% given in next 16hrs
after 24hrs - colloid (FFP, albumin): 0.5 x %SA x weight
maintenance crystalloid (dextrose saline) 1.5ml x burn x weight
adrenaline doses
ix to determine true episode of anaphylaxis
serum tryptase
Beta blocker overdose mx
glucagon
