GP On Call Flashcards
Initial Rx of DKA
- isotonic 0.9% saline 1-1.5l/hr for the first hour
- then fluid status reassessed
Biguanides
- example
- MoA
Biguanides
- Example: Metformin
- MoA: Biguanides prevent the liver from converting fats and amino-acids into glucose. They also activate an enzyme (AMPK) which helps cells to respond more effectively to insulin and take in glucose from the blood
Sulfonylureas
- example
- MoA
Sulfonylureas
Example: Gliclazide
MoA: Sulphonylureas are insulin secretagogues – they bind to ATP-sensitive potassium channels in the pancreas and lead to increased insulin secretion by beta cells
Features of moderate asthma exacerbation
Moderate asthma exacerbation:
- Increasing symptoms
- PEFR >50-75% best or predicted
- No features of acute severe asthma
Features of severe asthma exacerbation
Acute severe asthma - any one of:
- PEFR 33-50% best or predicted
- Respiratory rate ≥25 breaths/minute
- Heart rate ≥110 beats/minute
- Inability to complete sentences in one breath
Features of life-threatening asthma exacerbation
Life-threatening asthma - any one of the following:
- altered conscious level
- exhaustion
- arrhythmia
- hypotension
- cyanosis
- silent chest
- poor respiratory effort
- PEFR <33% best or predicted
- SpO2 <92%
- PaO2 <8 kPa, ‘normal’ PaCO2 (4.6-6.0 kPa)
Mechanism of action of furosemide in left ventricular failure
Furosemide → venous dilation and facilitating diuresis → reduced afterload
Indications for coronary angioplasty in acute STEMI
In acute STEMI offer coronary angiography with follow-on primary PCI if:
- presentation is within 12 hours of onset of symptoms
AND
- primary PCI can be delivered within 120 minutes
*If primary PCI cannot be delivered within the next 120 minutes, use immediate fibrinolysis instead
What to do at GP surgery (A&E) a patient has suspected MI?
- attach the patient to a cardiac monitor
- ensure a defibrillator is available
- administer high-flow oxygen
- 300 mg chewable aspirin
- gain IV access to permit administration of 5-10 mg diamorphine IV, 10 mg metoclopramide IV
- The patient should be transferred as quickly as possible to a coronary care unit
Indications for secondary care admission in a patient known to have angina experiencing anginal pain
Immediate referral to secondary care in anginal pain if:
- Pain >20 mins at rest → unstable angina (should be managed as per ACS)
- new-onset angina with limitation of daily activities
- recent destabilisation of previously stable angina (with moderate or severe limitation of daily activities)
- post-MI angina
Doses of adrenaline in anaphylaxis (for different ages)
IM doses of 1:1000 adrenaline:
- Adult 500 micrograms IM (0.5 ml)
- Child more than 12 years: 500 micrograms IM (0.5 ml)
- Child 6 -12 years: 300 micrograms IM (0.3 ml)
- Child less than 6 years: 150 micrograms IM (0.15 ml)
Administer a second dose after 5 minutes if no improvement
When to administer the second dose of adrenaline in the Rx of anaphylaxis
Administer a second dose after 5 minutes if no improvement
Initial treatment of status epilepticus
- Rectal diazepam – 10mg diazepam via a rectal application tube containing 2.5ml of 4 mg/ml of diazepam
- Buccal midazolam – 10mg midazolam via a 2ml pre-filled syringe of 5 mg/ml oromucosal solution of midazolam
- IV lorazepam – 4mg of lorazepam in a 4 mg/ml vial
Definition of status epilepticus
Status epilepticus
- > 5mins of convulsive seizure
OR
- seizures which occur one after another without recovery
Risk factors for ectopic pregnancy
Risk factors: PID, previous ectopic, previous gynaecology surgery, IUCDs, fertility treatment, smoking, increasing age and appendicitis (causing tubal damage)
*ectopic pregnancy can present atypically so consider this diagnosis in a female patient with abdominal/pelvic pain, amenorrhoea/known pregnancy (4-12/40) or vaginal bleeding
Presentation of a patient with hypothermia
- core body temperature <35°C
- bradycardia
- shivering
- cold/pale/dry skin
- lethargy
- irrational behaviour
- slow/shallow breathing
When thrombolysis is indicated if a patient presents with acute symptoms of CVA?
+ other management
- thrombolysis is recommended up to 4.5 hours since the onset of symptoms
- admit urgently
- give TPA (alteplase) for reperfusion unless contraindications
- repeat CT scan 24 hours post thrombolysis
- stat dose 300mg aspirin ASAP, continued for 2 weeks, followed by dipyridamole/clopidogrel
What to do if we suspect temporal arteritis?
In suspected temporal arteritis:
- take ESR blood test
- treat immediately with prednisolone 60mg once daily
- refer same day to Ophthalmology
- if no visual symptoms, assess response to steroid at 48 hours
ECG changes in a patient with PE
- SI, QIII TIII is the “classic” finding but is neither sensitive nor specific for PE
- sinus tachycardia
- RBBB
- right ventricular strain pattern
- right axis deviation
What section 2, 4 and 3 and allow to do? (psychiatry)
- Section 2 → admission for assessment and treatment for 28 days
- Section 4 → emergency detention for up to 72 hours and is usually converted to a Section 2 on admission to hospital
- Section 3 → admission for treatment of a mental disorder for up to 6 months
Management of suspected bacterial meningitis in a child in GP surgery
- Benzylpenicillin infant 300mg IV/IM as proximally as possible to part of limb that is still warm
- Alternative is cefotaxime
- Child 1-9 years 600mg
- Child 10 or older 1200 mg
- Transfer to hospital via 999 ambulance
- Could consider giving fluids but not if this delays transport
- Current guidelines suggest not to give antibiotics in the absence of a non-blanching rash but to wait until transfer hospital so CSF sample can be taken
- After child has left you have a legal duty to notify Consultant in Communicable disease control (CCDC)
- CCDC ensures close contacts get prophylaxis ciprofloxacin/alternatively rifampicin
Antibiotics and doses (different ages) for a child with suspected bacterial meningitis in GP surgery
- Benzylpenicillin infant 300mg IV/IM as proximally as possible to part of limb that is still warm
- Alternative is cefotaxime
- Child 1-9 years 600mg
- Child 10 or older 1200 mg
Obs ranges for a child up to 12 y old
(HR, BP, RR)
Traffic light system for the colour of skin, lips, tongue
Traffic light system for activity levels
Traffic light system for respiratory signs
Traffic light system for circulation and hydration
Traffic light system for ‘other’ signs
