Emergency Situation management and Emergency Drugs

Question 1

Describe the inital emergency management of a patient with a STEMI, including medications, doses and route of admin

Answer 1

1. Take a brief history and physical exam
2. Run a 12 lead ECG and observe on cardiac monitor
3. Check for any allergies before giving medication
4. Aspirin: 300 mg STAT

Question 2

What is the time window for treating a STEMI with primary PCI?

Answer 2

Offer coronary angiography, with follow‑on primary PCI if indicated, as the preferred coronary reperfusion strategy for people with acute STEMI, if:

• presentation is within 12 hours of onset of symptoms and
• primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.

Question 3

How do you manage a patient with acute coronary syndrome without ST elevation?

Answer 3

• Pain relief (morphine and anti-emetic)
• Aspirin 300mg loading dose
• LMWH prophylaxis for 48hrs
• Repeat ECG
• GRACE score risk assessment
  
  • Ticagrelor 180mg if risk >3%
• In patient angiography

Question 4

What drugs must patients who have a STEMI be started on before they leave hospital?

Answer 4

• Aspirin 75mg OD
• 2nd antiplatelet for at least 12 months
• Statin e.g atorvastatin 80 mg
• ACEi

Question 5

How do you manage an acute exacerbation of COPD?

(Patient presents with history of increasing cough, breathlessness or wheeze)

Answer 5

1. Brief history - ask about smoking status, exercise capacity
2. ABCDE assessment - take bloods and get IV access
3. Give O2 via a venturi facemask (blue 2L)- aim for O2 sats 88-92%
4. Do an ABG, request CXR to rule out pneumothroax or infection
5. Nebulised salbutamol 5mg and ipratropium 500 mcg/ 6 hours driven by air
6. Steroids: 30 mg Prednisolone STAT
7. Consider antibiotics if WCC or CRP raised or purulent sputum - amoxicillin 500mg/ 8h PO
8. If no response, consider IV aminophylline - load with 250mg over 20 mins
9. If no repsonse, consider NIV.
10. Call respiratory reg if no response, if still using accessory muscles despite maximal treatment call DART team as may need intubating

Question 6

What is the dose of epinephrine used in anaphylaxis?

Answer 6

500 micrograms IM (0.5ml 1 in 1000)

Give every 5 minutes

Question 7

What is the dose of hydrocortisone used in anaphylaxis?

Answer 7

200mg IV TDS

Question 8

What dose of epinephrine is used in cardiac arrest?

Answer 8

1mg (1 in 10, 000) IV injection

Every 3-5 minutes as required

Question 9

What does of chlorphenamine is given in anaphylaxis?

Answer 9

10mg IM QDS

Question 10

What dose of aspirin is given in an MI?

Answer 10

300mg STAT then 75mg OD

Question 11

What dose of clopidogrel is given in an MI?

Answer 11

300mg Stat then 75mg PO

Question 12

What dose of calcium gluconate is given in hyperkalaemia?

Answer 12

10-20ml of 10% calcium gluconate by slow IV injection

Question 13

How much insulin / dextrose infusion should be given in DKA?

Answer 13

1unit/ ml ( mixed with sodium chloride 0.9%)

Infuse at 0.1 units/kg/hour

Question 14

How much insulin/ dextrose can you give in hyperkalaemia?

Answer 14

10 units insulin and 25g dextrose IV

Question 15

How much insulin/dextrose do you give in HSS?

Answer 15

0.05 units/kg

Question 16

How do you manage hypoglycaemia? (Mild, moderate and severe)

Answer 16

Mild: 15-20g of quick acting carbs, 90-120ml of lucozade

Moderate: 1.5-2 tubes of glucogel, 1mg glucagon IM. If BM less than 4mmol/L then repeat 3 times

IV glucose 10% at 100ml/hr

Severe: 10% 150ml glucose

Question 17

How much dizepam is given in status epilepticus?

Answer 17

10mg STAT then 10mg again agter 10 minutes at a rate of 1ml/minute (5mg) IV

Can give extra 10-20mg again after 10-15 minutes PR

Question 18

How much lorazepam is given in status epilepticus?

Answer 18

4mg then 4mg 10 mins later by slow IV insusion into large vein

Question 19

What dose of salbutamol is given in acute asthma attack?

Answer 19

5mg nebuliser driven by O2 every 20-30mins

Question 20

How much prednisolone is used in acute asthma exacerbation?

Answer 20

2mg/kg OD (up to 60mg) for 3 days

40-50mg daily for at least 5 days

Question 21

How much morphine is given for pain in acute settings?

Answer 21

10mg IM/SC/PO 4 hourly

If elderly 5mg

Question 22

How much naloxone is given in opiod overdose?

Answer 22

400micrograms by IV injection then 800 micrograms -up to 2 doses at 1 minute intervals - then increase up to 2 mg for 1 dose

Question 23

What IV fluid bolus is given in emergency settings?

Answer 23

500ml sodium chloride 0.9% over 10-15 mins

Question 24

Which antibiotic is used in meningitis? (UHL guidelines)

Answer 24

Ceftriaxone 2g