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Medicine Revision > Initial Treatments > Flashcards

Initial Treatments Flashcards

1
Q

ACC

Acute STEMI

A

MONAT (Morphine, Oxygen, Nitrates (GTN spray), Aspirin 300mg, Ticagrelor/clopidogrel)

PCI if within 120 minutes of admission

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2
Q

ACC

Acute NSTEMI/Unstable angina

A

Fondaparinux/LMWH, Aspirin 300mg,
Morphine/nitrates, Ticagrelor/clopidogrel

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3
Q

ACC

Massive PE (Hypotension and/or cardiac arrest)

A

Alteplase

Plus high flow O2 and IV fluids

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4
Q

ACC

Sub-massive PE (Hypoxia, right heart strain, +ve cardiac biomarker)

A

LMWH heparin/fondaparinux

High flow O2 and IV fluids

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5
Q

ACC

Acute Pneumonia

A

Abx (usually amoxicillin), O2, IV fluids, VTE prophylaxis, Analgesia

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6
Q

ACC

Cellulitis with systemic upset

A

IV Antibiotics -usually flucloxacillin+benzylpenicillin, or co-amoxiclav

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7
Q

ACC

DKA

A

IV infusion 0.9% saline (add potassium chloride if needed with K+ results), IV insulin 0.1 units/kg/hr, IV 5% Dextrose once CBG <15mmol/L

Switch to SC insulin once stable

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8
Q

ACC

Hypoglycaemia

A

Quick acting carbohydrate (glucose based), then long-acting carbohydrate

If unconscious and cannot get IV access, use IM glucagon

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9
Q

ACC

Prolonged hypoglycaemic coma

A

IV mannitol + dexamethasone + IV glucose

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10
Q

ACC

Paracetamol overdose

Less than 1 hour

A

Give charcoal

Test paracetamol levels at 4 hours

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11
Q

ACC

Paracetamol overdose

4-8 hours

A

Check levels, then if treatment needed, IV N-acetyl cysteine (glutathione replacement) in 5% glucose

Use TOXBASE

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12
Q

ACC

Paracetamol overdose

8-15 hours

A

IV N-acetyl cysteine (glutathione replacement) in 5% glucose, stop if tests come back normal

Use TOXBASE

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13
Q

ACC

Paracetamol overdose

15+ hours

A

IV N-acetyl cysteine (glutathione replacement) in 5% glucose, give full treatment

Stop based on clotting factors, use TOXBASE

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14
Q

ACC

Delirium tremens

A

Correct electrolyte abnormalities, treat co-morbidities, give parenteral thiamine, prophylactic carbamazepine and chlordiazepoxide

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15
Q

ACC

Acute alcohol withdrawal

Without delirium tremens, with other concerning features

A

Benzodiazepines (usually chlordiazepoxide) and Pabrinex (prophylactic treatment for thiamine deficiency)

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16
Q

ACC

Sepsis

A

BUFALO - (blood cultures), (urine output), fluids, antibiotics, (lactate) and oxygen

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17
Q

ACC

Anaphylactic shock

A

IM adrenaline 500mcg, IV chloramphenamine 10mg, IV hydrocortisone 200mg, fluid bolus, nebulised salbutamol 5mg if wheezy

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18
Q

ACC

Haemorrhagic/hypovolaemic shock

A

IV access, fluid bolus +/- blood, high flow O2, treat cause

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19
Q

ACC

Neurogenic shock

A

Vasoconstrictors

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20
Q

ACC

Sepsis

A

STOP AKI - treat sepsis, stop nephrotoxins, optimise BP, prevent harm (treat complications), review medications

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21
Q

ACC

Hyperkalaemia

A

IV calcium gluconate in large vein over 2 mins, IV insulin/dextrose infusion, nebulised salbutamol

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22
Q

ACC

Pulmonary oedema

A

Sit up and give high flow O2, IV morphine, furosemide

Urgent haemodialysis if no response

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23
Q

ACC

Acute bleeding

A

Fresh frozen platelets if clotting issue, blood transfusion, desmopressin

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24
Q

ACC

Delirium

A

Treat underlying cause

Some sedation may be used if disruptive or very distressed (haloperidol)

25
Q

ACC

Acute exacerbation of COPD

A

Manage O2 88-92%, brochodilators (salbutamol and ipratropium), prednisolone 30mg oral, oral abx if indicated (usually amoxicillin, clarithromycin)

Assess need for non-invasive ventilation (NIV)

26
Q

ACC

Subarachnoid haemorrhage

A

Maintain SpO2, analgesia/antiemetics, manage hypertension, PO or IV nimodipine, IV mannitol

Contact neurosurgical team

27
Q

ACC

Hyponatraemia with mild symptoms

A

Fluid restriction

Identify cause

28
Q

ACC

Hyponatraemia with seizures or signs of raised ICP

A

Give up to 200mL of 2.7% saline over 30 minutes
Vasopressor receptor antagonists

<120mmol/L associated with risk of brain herniation

29
Q

ACC

Hyperkalaemia

A

IV 30mL 10% calcium gluconate (with ECG changes), 10 units actrapid insulin with 50mL of 50 glucose via large vein, calcium resonium/loop diuretics/dialysis

30
Q

ACC

Hypocalcaemia

A

IV replacement - calcium gluconate 10mL over 10 minutes

ECG monitoring

31
Q

ACC

Hypercalcaemia

A

Rehydrate with saline
Bisphosphonates/calcitonin

32
Q

ACC

Aortic dissection

A

Maintain oxygen, cross match, morphine, labetolol

Get cardiothoracic team and an HDU or ICU bed. Aim for BP 100-120mmHg

33
Q

ACC

Pericarditis

A

NSAIDs + PPI, cessation of potential causative drugs, avoid anticoag, antimicrobials

Admit with high temp, leucocytosis, tamponade, immunosuppressed etc.

34
Q

ACC

Pneumothorax

Non-tension

A

Chest drain and oxygen if needed

Surgery if bilateral or lung fails to expand

35
Q

ACC

Tension pneumothorax

A

Needle decompression, 2nd ICS MCL

Always insert chest drain immediately after

36
Q

ACC

Opiate overdose

A

Naloxone (may require multiple doses) & respiratory support

Consult TOXBASE

37
Q

ACC

Tricyclic antidepressant overdose

A

No reliable antidote
IV bicarb, IV lipid emulsion, treat symptoms

Consult TOXBASE

38
Q

ACC

Stroke

A

Correct hypoglycaemia, maintain O2, Aspirin if haemorrhage excluded

Admit to stroke unit asap

39
Q

ACC

TIA

A

300mg aspirin immediately, clopidogrel long-term, no driving until seen by specialist

Aspirin may contraindicated (bleeding disorder, anticoagulatants)

40
Q

ACC

Acute exacerbation of asthma

Moderate or severe

A

Sit pt up, 15L high flow O2, nebulised salbutamol 5mg, ipratropium bromide 500mcg, IV hydrocortisone 200mg OR PO prednisolone 40mg

Senior can add IV magnesium sulphate, check for pneumothorax & sepsis

41
Q

ACC

Asthma

Life threatening

A

Back to back salbutamol, consider IV amiophylline (senior), IV salbutamol

Contact critical care outreach team, follow ALS in cardiac arrest

42
Q

ACC

Seizures

First fit

A

Maintain airway, manage conservatively. Consider rectal diazepam, buccal midazolam or IV lorazepam

Most self-limiting and stop spontaneously

43
Q

ACC

Status epilepticus

A

Maintain airway + 15L O2, IV lorazepam* 1-2mg slow bolus (or 10mg diazepam, phenytoin IV 20mg/kg, thiamine for alcohol/malnutrition cause, IV magnesium sulphate for pregnancy related

*if no IV access, use buccal midazolam/rectal diazepam

44
Q

GOSH

Nausea and vomiting in pregancy

Minor

A

Eat small meals, increase fluids, acupressure, antiemetics

45
Q

GOSH

Reflux in pregnancy

A

Sleep propped up, avoid spicy food, alginates/antacids, H2 receptor antagonists

46
Q

Constipation in pregnancy

A

Increased fruit and fibre intake, water, fibre supplements, osmotic laxatives

47
Q

GOSH

Symphis pubic dysfunction in pregnancy

A

Physiotherapy, simple analgesia, limited leg abduction at delivery

48
Q

GOSH

Backache and sciatica in pregnancy

A

Adjust sleeping position, relaxation, massage, physiotherapy, analgesia

49
Q

GOSH

Carpal tunnel syndrome in pregnancy

A

Sleeping with hands over bedside, splints, ?surgical referral

50
Q

GOSH

Haemorrhoids in pregnancy

A

Avoid constipation, ice packs, digital reduction, suppositories

Surgical referral if thrombosed

51
Q

GOSH

Varicose veins in pregnancy

A

Regular exercise, compression, hosiery, consider VTE prophylaxis

52
Q

GOSH

Urinary symptoms in pregnancy

A

Avoid caffeine, avoid late fluid at night

53
Q

GOSH

Vaginal discharge in pregnancy

A

Exclude STI & rupture of membranes
Reassure that it is normal

54
Q

GOSH

Acute fatty liver of pregnancy

A

Stabilise & treat symptoms
Delivery is definitive management

55
Q

GOSH

Itching and rashes in pregnancy

A

Exclude infectious causes
Check for obstetric cholestasis - treat with ursodeoxycholic acid for symptoms, induce at 37 weeks
Otherwise emollients and reassurance

56
Q

Hyperemesis gravidum

A

Often reassurance and simple advice sufficient
If dehydrated and not tolerating oral fluids, requires admission, check serum electrolytes and LFTs, IV hydration, antiemetics (promethazine 1st line)

If prolonged, may require vitamin supplements, particularly thiamine

57
Q

GOSH

Small for gestational age

Dopplers normal

A

Carry out growth scans every 2-3 weeks, aim for IOL at 37 weeks

58
Q

GOSH

Small for gestational age

Dopplers abnormal & baby-pre-term

A

Consider delivery, give steroids

59
Q

GOSH

Prolonged pregnancy

A

Offer ‘stretch and sweep’ at 41 weeks

Medicine Revision (2 decks)

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