ISCE cards Flashcards
STEMI
Ix - ECG, FBC, LFTs, U&Es, lipids, troponin, D dimer (if chest pain non-specific), blood pressure
Mx - A-E approach. Call senior. Give 300mg aspirin. Refer to cardiology. If PCI available, do within 2 hours. If not available, give ticagrelor and aspirin for fibrinolysis.
Secondary prevention: aspirin + clopidogrel. Lifestyle changes. ACEi, beta blocker, statin.
NSTEMI
Ix - ECG, FBC, LFTs, U&Es, lipids, troponin, D dimer (if chest pain non-specific), blood pressure.
Mx - A-E approach, call senior/cardiology. Give ticagrelor and aspirin. If unstable, will need angiography to investigate if PCI needed.
Secondary prevention: aspirin + clopidogrel. Lifestyle changes. ACEi, beta blocker, statin.
Acute heart failure
Mx - IV loop diuretics
O2
Nitrates (only give if cardiac ischaemia and not hypotensive)
CPAP (if in resp failure)
If in cardiogenic shock:
- dobutamine
- ventricular assist
- noradrenaline
Chronic heart failure
Ix - Pro-BNP, lipids, blood gas?, FBC, LFTs, U&Es, ECG
Mx - 1st line: ACEi + beta blocker
- 2nd line: aldosterone/mineralocorticoid antagonist
Both options increase K+ so monitor
Peri-arrest bradycardia
Mx
1st - IV atropine 500mcg up to 3g max
2nd - transcutaneous pacing
3rd - isoprenaline/adrenaline infusion
Peri-arrest tachycardia
Mx
3x DC shocks
If no improvement:
- Broad complex: if irregular needs underlying cause treated. If regular give loading dose amiodarone and 24hr infusion.
- Narrow complex: If irregular likely AF so give beta blockers or cardiovert if less than 48 hours. If regular do vagal manoeuvres followed by adenosine.
Pericarditis
Ix - ECG (saddle-shaped ST elevation, PR depression), transthoracic echo, inflammatory markers, troponin
Mx - admit if unstable or feverish. Avoid physical exertion. Give NSAIDs and colchicine.
Aortic dissection
Ix - chest XR, CT angio, tranoesophageal echo, lactate, FBC, U&Es, LFTs.
Mx - A-E assessment, call vascular surgeons. Analgesia, control blood pressure. Potentially need surgery.
Infective Endocarditis
Ix - blood culture, FBC, CRP, U&Es, LFTs, obs, ECG, urine dip, transthoracic echo
Mx - IV abx, surgical valve replacement
Angina
Ix - FBC, CRP, ECG, exercise-stress ECG
Mx - aspirin + statin. lifestyle changes. Sub-lingual GTN. Beta blocker and/or calcium channel blocker (NOT VERAPAMIL)
AF
Ix - ECG (can offer ambulatory if coming and going), FBC, CRP, LFTs, U&Es, obs, clotting, TFTs
Mx - assess A-E if unstable. If <48hrs can be cardioverted. Beta blocker/calcium channel blocker/digoxin for rate control. Offer DOAC depending on clot risk.
Hypertension
Ix - clinic BP, ambulatory BP, investigate for potential underlying cause
Mx - If signs of end-organ damage -> hospital admission for specialist management. Otherwise:
ACEi/ARB for most under 55s
Amlodipine for over 55s or under 55s of Afro-Caribbean heritage
If still raised then above can be used in combination
If still raised indapamide can be added
Acute exacerbation of COPD
Ix - ABG, Chest XR, sputum culture, FBC, CRP
Mx - A-E approach. Call senior help. Oxygen therapy, Salbutamol neb. Ipratropium bromide if no improvement. Oral steroids should be given for all exacerbations. Non-invasive ventilation is the last line.
Asthma attack
Ix - peak flow, ABG, chest XR, FBC, CRP
Mx - Assess A-E. Oxygen. Salbutamol nebs. Oral/IV steroids. Ipratropium bromide if no improvement. Call senior help. Single dose IV MgSO4. Abx if evidence of infection.
Pulmonary Embolism
Ix - Wells score, CTPA, chest XR, D dimer
Mx - DOAC in stable patients. If unstable, thrombolysis should be given. Oxygen therapy can be given if desaturated. Call for senior help.
Pneumonia
Ix - CURB-65, Chest XR, sputum sample, legionella urinary antigen (if high risk), FBC, CRP, blood gas, U&Es
Mx - if severe, A-E approach, call senior, start sepsis 6 protocol. In community, manage with amoxicillin
Pneumothorax
Ix - chest XR, FBC, D dimer, troponins if associated chest pain, ECG
Mx - if less than 2cm air then conservative mx. If more than 2cm then aspirate, if not successful then insert chest drain. Lifetime ban from scuba diving, smoking should be discouraged to prevent recurrence. Can fly again 1 week post check up XR
Pleural Effusion
Ix - chest XR, FBC, D dimer, troponins if associated chest pain, ECG, USS, CT (to look for underlying cause)
Mx - aspiration (can also be investigated for cause), sepsis 6 if concerned
COPD
Ix - peak flow, spirometry, Chest XR, FBC
Mx - smoking cessation, pneumococcal vaccine, annual influenza vaccine, pulmonary rehab. SAMA/SABA is 1st line. If worsening must determine if asthmatic features:
W/ asthmatic features: start LABA + ICS. If still not effective, add LAMA for triple therapy.
W/o asthmatic features: LABA + LAMA
Asthma
Ix - peak flow, spirometry, FeNO testing
Mx - 1st line: SABA
2nd line: SABA + low dose ICS
3rd line: SABA + ICS + LTRA
Bronchiectasis
Ix - peak flow, spirometry, CT
Mx - physical training (e.g. inspiratory muscle training), postural drainage, antibiotics for exacerbations, immunisations
Lung cancer
Ix - chest XR, bronchoscopy, CT, EBUS, FBC, LFT, bone profile, U&Es
Mx - chemo/radio/surgery
Pulmonary fibrosis
Ix - peak flow, spirometry, chest XR, ANA +ve, FBC, U&Es
Mx - pulmonary rehab, O2 therapy
TB
Ix - Mantoux test (latent TB), sputum smear, sputum culture, chest XR, NAAT (rapid test)
Mx - Active TB: rafampicin, isoniazid, ethambutol, pyrazinamide for 2 months. Rifampicin and isoniazid for further 4 months.
Latent: 3 months isoniazid + rifampicin. OR 6 months of pyrazinamide
Ectopic Pregnancy
Ix - vital signs, pregnancy test, FBC, LFTs, U&Es, CRP, TVUSS
Mx - If unstable take ABCDE approach. Refer gynae. If embryo <35mm, unruptured, asymptomatic, no heart beat and low hcg then expectant management. If <35mm, unruptured, no heart beat and low HCG then can be treated with methotrexate. In all other cases should be treated surgically. Give analgesia.
If compromised fertility can opt for salpingotomy as opposed to salpingectomy.
Cholangitis
Ix - LFTs, U&Es, FBC, CRP, USS
Mx - Refer gastro. Analgesia. IV abx, ERCP
Acute hepatitis
Ix - FBC, U&E, CRP, LFTs, hepatitis serology
Mx - A - no tx
B - antivirals
C - antivirals
D - none
E - none
Bowel obstruction
Ix - FBC, CRP, LFTs, U&Es, lactate, abdo XR, abdo CT,
Mx - Refer surgeons. Analgesia. NBM, IV fluids, nasogastric tube, surgery, (if risk of perf give abx)
Appendicitis
Ix - FBC, U&E, LFTs, CRP, lactate, pregnancy test, urinalysis, USS, CT if clinical doubt
Mx - ABCDE approach. Refer gastro surgeons. Analgesia. Appendicectomy
Pancreatitis
Ix - FBC, U&Es, LFTs, CRP, amylase, lipase, USS/contrast CT to look for underlying cause
Mx - Fluid resuscitation, measure urine output, analgesia, attempt oral intake but if not possible then nasogastric tube can be used, abx if infective picture.
Peritonitis
Ix - FBC, U&Es, LFTs, CRP, cultures, paracentesis
Mx - cefotaxime
Variceal haemorrhage
Ix - endoscopy, FBC, LFTs, lactate, clotting, group and save
Mx - ABCDE approach. Call for senior help. Terlipressin and abx. Treated using endoscopic management.
Ovarian torsion
Ix - pregnancy test, FBC, U&Es, LFTs, CRP, TVUSS
Mx - Analgesia, refer gynae, diagnostic/treatment laparotomy.
Testicular torsion
Ix - thorough examination. FBC, U&Es, STI screen, LFTs, CRP, urinalysis
Mx - analgesia. Refer urology for urgent surgical exploration.
Epididymo-orchitis
Ix - thorough examination. FBC, U&Es, STI screen, LFTs, CRP, urinalysis
Mx - depends on cause. Treat underlying infection ie, STI/UTI
AAA
Ix - vital signs, FBC, group and save, lactate. CT if stable enough
Mx - urgent senior help. Urgent referral to vascular surgeons.
Endometriosis
Ix - FBC, CRP, STI screen if indicated, TVUSS, diagnostic laparotomy
Mx - NSAIDS/paracetamol. COCP, progestins. If no improvement a GnRH analogue may be an option, or surgical removal of endometrial tissue from the abdomen.
PID
Ix - FBC, urinalysis, STI screen, high vaginal swab, pregnancy test
Mx - abx and analgesia
IBD
Ix - FBC, stool culture, CRP, U&Es, LFTs, foecal calprotectin, tissue transglutanimase, endoscopy, colonoscopy and biopsy,
Mx - Medical: mesalazine, steroids, biologics
Surgical: colectomy
IBS
Ix - FBC, ESR, CRP, tTG, ?colonoscopy if significant concern
Mx - antispasmodics, laxatives/loperamide depending on stool symptoms, FODMAP diet
Coeliac disease
Ix - tissue transglutaminase, IgA, endoscopic intestinal biopsy
Mx - gluten-free diet
Diverticular disease
Ix - FBC, CRP, LFTs, U&Es, FIT, colonscopy, CT
Mx - analgesia. Increase dietary fibre. Mild flairs can be treated with abx. Abscesses or recurrent flairs can be treated with surgeries.
Haemorrhoids
Ix - examination
Mx - increase dietary fibre, laxatives, local anaesthetic/steroid creams, surgery for large haemorrhoids
Peptic ulcer
Ix - H.pylori test, stool sample, FBC,
Mx - PPI, abx if H.pylori +ve
GORD
Ix - CRP, endoscopy, ECG
Mx - PPI, diet modification if known triggers
post partum haemorrhage
Ix - vital signs, group and save, FBC, clotting
Mx - Assess A-E, call senior help. oxytocin/syntometrin, 2 large bore resus cannulae, warmed fluids, blood transfusion, oxygen, catheterise
Miscarriage
Ix - speculum examination, TVUSS, beta HCG, rhesus status, group and save, FBC, vital signs
Mx - Expectant management can be attempted if haemodynamically stable. If expectant management unsuccessful, can be managed medically using misoprostol. If still unsuccessful or if haemodynamically unstable, can be managed surgically.
Hyperemesis Gravidarum
Ix - vital signs, FBC, CK, LFTs, U&Es, urinalysis, ECG, BMI,
Mx - plain, bland foods. Cyclizine and/or prochlorperazine. Admission for IV rehydration.
Pre-eclampsia
Ix - repeated BP readings, urinalysis, foetal HR auscultation, clotting, FBC, U&Es, LFTs, fundoscopy
Mx - ask for senior help/refer gynae. Admission under obstetric team if BP >160/110. Labetalol. CTG. USS for polyhydramnios/IUGR. Give aspirin and clexane. If risk of eclampsia then premature delivery may be needed.
HELLP
Ix - FBC, U&Es, clotting, LFTs, blood film, blood pressure, CTG, urinalysis,
Mx - call senior help. intravenous magnesium sulphate, antihypertensives, blood products and timely delivery
Placenta praevia
Ix - abdominal/vaginal USS, CTG, group and save, clotting, rhesus status, FBC, U&Es, LFTs
Mx - placenta may migrate during pregnancy but if near delivery is still low lying then caesarean is indicated
Placental abruption
Ix - abdominal/vaginal USS, CTG, group and save, clotting, rhesus status, FBC, U&Es, LFTs
Mx - if foetal distress - emergency c-section. If no distress >36 weeks induce for vaginal delivery. <36 weeks admit and observe closely for monitoring, delivery should be attempted as soon as foetus is able to be safely delivered or if mother is unstable. Give anti-D if rhesus -ve
Fibroids
Ix - FBC, U&Es, LFTs, CRP, pregnancy test, speculum examination, TVUSS
Mx - mirena/alternative hormonal contraceptive for menorrhagia. Short term GnRH can be used medically, alternatively myomectomy/endometrial ablation/hysterectomy would be surgical options.
Atrophic Vaginitis
Ix - speculum examination. FBC, TVUSS, bone profile (if concern of endometrial cancer)
Mx - Vaginal lubricants and moisturisers. Topical oestrogen.
Gestational diabetes
Ix - bedside BM, OGTT, USS (polyhydramnios), urinalysis, BP
Mx - self glucose monitoring. Dietary advice. If target glucose not met in 1-2 weeks, start metformin. If still not met, start insulin.
cholestasis
Ix - FBC, U&Es, LFTs, urinalysis, CTG, vital signs
Mx - ursodeoxycholic acid, vitamin K. Can induce labour from 37 weeks but not evidence-based.
Croup
Ix - clinical diagnosis based on resp exam findings. Can also do chest XR
Mx - Emergency: assess A-E, call senior. Give O2, steroids and adrenaline.
If stable: one-off dose of oral dexamethasone
Bronchitis
Ix - clinical diagnosis
Mx - analgesia, good fluid intake, abx if indicated
Epiglottitis
Ix - ABG if concerned about airway, chest XR, vital signs
Mx - Assess A-E, call senior. Visualise epiglottis, O2, abx
Intussusception
Ix - ultrasound is now the investigation of choice and may show a target-like mass
Mx - air insufflation
Neonatal sepsis
Ix - blood cultures, blood smears, FBC, CRP, LFTs, U&Es, VBG, urine culture and sensitivity, lumbar puncture
Mx - call senior help, assess A-E. O2, IV abx,
Meningitis (paediatric)
Ix - blood cultures, vital signs, FBC, U&Es, LFTs, lumbar puncture,
Mx - assess A-E, call senior help. Abx, steroids and fluid resuscitation.
Compartment syndrome
Ix - Largely clinical based on hx. Lactate, vital signs, FBC, CRP. Intracompartment pressures can be taken.
Mx - Urgent fasciotomy
NOF
Ix - XR, FBC, CRP
Mx - Refer ortho. Analgesia. intracapsular - hemiarthroplasty, extracapsular - DHS
Osteomyelitis
Ix - FBC, CRP, blood cultures, urine output, lactate, MRI, bone profile
Mx - IV abx
Osteoporosis
Ix - FRAX score, DEXA scan, bone profile, CRP, ESR, FBC, U&Es, LFTs
Mx - calcium and vitamin D supplements. Alendronate.
Cauda Equina
Ix - DRE, full neurological assessment, FBC, B12 and folate, CRP, bone profile, MRI spine
Mx - Analgesia, insertion of urinary catheter. Refer neurosurgeons. Laminectomy/tx of underlying cause
Ischaemic stroke
Ix - FBC, lipids, HbA1c, LFTs, U&Es, clotting, CT head,
Mx - immediate 300mg aspirin. Refer neurology/stroke team. thrombolysis/thrombectomy. Long-term clopidogrel + lifestyle management eg, smoking cessation
Guillain-Barre
Ix - lung function tests, b12 and folate, LP, FBC, CRP, ECG, LFTs, U&Es, CK, glucose,
Mx - IVIg, analgesia, refer neurology, physiotherapy, VTE prophylaxis
Bell’s palsy
Ix - clinical diagnosis
Mx - eye care, oral prednisolone
Carpel tunnel
Ix - clinical diagnosis supported by nerve conduction studies
Mx - splinting and rest. Surgical decompression can also be done
Parkinson’s
Ix - lying and standing BP, MOCA, FBC, U&Es, LFTs, TFTs, glucose, HbA1c, B12 and folate,
Mx - levodopa, MOA-inhibitors
Headache (Ix only)
Ix - vital signs, examination of the face, LFTs, CRP, U&Es, FBC. (LP and CT head if clinical suspicion)
MND
Ix - LFTs, CRP, U&Es, FBC, B12 and folate, MRI, nerve conduction studies
Mx - Riluzole, ventilatory support, PEG
MS
Ix - lying and standing BP, MOCA, FBC, U&Es, LFTs, TFTs, glucose, HbA1c, B12 and folate, HIV, MRI brain, LP
Mx - methylprednisolone to treat acute flair. DMARDs long-term
Status Epilepticus (Mx)
Mx - A-E approach, call for senior help. Observations. Oxygen, FBC, U&Es, lactate, toxicology screen, CRP, bone profile, magnesium, LFTs, blood cultures. Bedside BM and ketones.
IV lorazepam, if no improvement after 10 mins can give 2nd dose. If still no improvement give phenytoin.
Steven-Johnson’s Syndrome
Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy
Mx - admit, urgent derm review and intensive care management. A-E approach. Supportive management, fluids etc, stop any potentially causative drugs
Eczema Herpeticum
Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy
Mx - IV aciclovir, careful monitoring and review under derm
Erythroderma
Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy, albumin
Mx - admit, urgent review. Assess A-E, cover in thick emollient creams head to toe, antihistamines for itch, fluids if dehydrated
Shingles
Ix - vital signs, routine bloods, otherwise clinical diagnosis
Mx - analgesia, advice to avoid vulnerable groups while infectious, antivirals if within first 72 hours
Acne (Mx)
Mx - 1st - topical retinoids/topical abx
2nd - combined topical retinoid + abx
3rd - oral abx + topical retinoid
4th - isotretinoin under specialist review
COCP can be trialled in females. Isotretinoin cannot be prescribed if risk of pregnancy and either LARC or 2 forms of contraception should be used.
Bullous Pemphigoid
Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy
Mx - refer derm. Oral steroids, topical abx can also be used
Pyoderma gangrenosum
Ix - vital signs, FBC, U&Es, CRP, LFTs, ?skin biopsy
Mx - oral steroids. Refer derm. Immunosuppressives. Postpone any surgery.
Septic arthritis
Ix - vital signs, FBC, U&Es, CRP, LFTs, joint aspiration, joint XR, blood cultures
Mx - Call senior. Assess A-E. Analgesia. IV abx, and aspirate joint to relieve swelling if needed
Osteoarthritis
Ix - FBC, U&Es, LFTs, bone profile, joint XR
Mx - lifestyle and activity advice. Simple analgesia initially. Intraarticular steroid injection can also be trialled. Refer ortho if worsening and for potential joint replacement.
Rheumatoid arthritis
Ix - FBC, U&Es, LFTs, bone profile, anti-CCP, rheumtoid factor, joint XR
Mx - analgesia. Refer rheumatology. Initial steroid dose and DMARD monotherapy (usually methotrexate) first line. Flairs treated with IM or oral pred.
Subarachnoid haemorrhage
Ix - obs, FBC, U&Es, clotting, CRP, LFTs, cultures, CT head (if normal within 6 hours consider alternative. If normal after 6 hours + LP)
Mx - Assess A-E. lie patient flat, analgesia, VTE prophylaxis, give nimodipine, refer neurosurgeons for clipping of aneurysm
Gout
Ix - obs, FBC, U&Es, CRP, ESR, LFTs, serum urate. Consider joint aspiration and joint XR if querying septic joint.
Mx - colchicine for 4 days. If renal impairment use NSAIDS, or 3rd line is steroids if not suitable for either. Allopurinol should be started 2 weeks after initial attack with colchicine cover. Also advise lifestyle changes: reduce alcohol and fatty food.
Ankylosing Spondylitis
Ix - physical examination. FBC, CRP, U&Es, ESR, HLA-B27, XR spine (inc sacroiliac joints), chest XR
Mx - encourage regular exercise. Refer rheumatology. NSAIDs, physiotherapy, sulfasalazine.
SLE
Ix - physical examination, FBC, CRP, U&Es, LFTs, ESR, ANA, anti-dsDNA, anti-Smith
Mx - NSAIDs, sunscreen, refer rheumatology, hydroxychloroquine,
Sjogrens
Ix - physical examination. Anti-Ro, Anti-La, ANA, Schirmers Test (tear test with filter paper at the eye)
Mx - refer rheumatology, artificial tears and saliva. Pilocarpine can also be given.
Polymyalgia rheumatica
Ix - physical examination. FBC, U&Es, ESR, CRP, LFTs, CK
Mx - prednisolone on a gradually reducing dosage
Neuroleptic malignant syndrome
Ix - obs, FBC, U&Es, CK, LFTs, CRP
Mx - stop antipsychotic. Admit to medical ward, likely ITU. Call senior. Assess A-E. Give IV fluids. Dopamine agonist.
Serotonin syndrome
Ix - obs, FBC, U&Es, CK, LFTs, CRP
Mx - supportive including IV fluids, benzodiazepines, refer seniors, admit, serotonin antagonists
Assess for suicide risk
- Employment status
- Relationship status and family
- Hx of self harm
- Drug/alcohol abuse
- previous attempts
- made efforts to avoid discovery
- planned suicide
- leaving a written note
- final acts such as sorting out finances
- violent method of suicide
First episode of psychosis (Mx)
- Refer psych. Atypical antipsychotics first-line. Can try alternative atypical or typical if 1st line ineffective. 3rd line clozapine. Optimise cardiovascular risk factors.
Depression (mx)
Mild: guided self-help, CBT, SSRIs
Severe: Refer CMHT. SSRIs/SNRIs + CBT. In cases of catatonia or treatment resistant depression, ECT can be used.
Anxiety Mx
Psychoeducation. SSRIs and self-guided CBT.
Conjunctivitis
Ix - can swab the eye if ?bacterial infection but likely viral
Mx - warm compresses and simple analgesia. If bacterial can give chloramphenicol eye drops. If allergic can give antihistamines.
Idiopathic Intracranial Hypertension
Ix - fundoscopy, LP, CT head, FBC, U&Es, LFTs, CRP, HbA1c
Mx - weight loss, acetazolamide, therapeutic lumbar puncture
Acute angle glaucoma
Ix - fundoscopy, tonometry
Mx - Pilocarpine, timolol, and apraclonidine eye drops. IV acetazolamide. Laser iridotomy.
Orbital Cellulitis
Ix - obs. FBC, cultures, eye examination including acuity and movements, CT head and orbits
Mx - Admit. Refer ophthalmology. IV abx
Primary open-angle Glaucoma
Ix - slit lamp examination, fundoscopy, tonometry and corneal thickness measurement
Mx - Prostaglandin analogue eye drops. Beta blocker eye drops.
Macular degeneration
Ix - Fundoscopy. Slit lamp examination.
Mx - VEGF. Laser photocoagulation.
Anterior uveitis
Ix - HLA-B27, fundoscopy, spine XR (look for Ank Spond.)
Mx - Urgent ophthalmology r/v. Atropine eye drops, steroid eye drops.
Optic neuritis
Ix - FBC, U&Es, CRP, MRI brain and orbits
Mx - IV methylprednisolone. Consider referral to neurology if 2nd presentation or other sx as ?MS
Ramsay Hunt
Ix - examination of ears and mouth. Assess hearing and consider stroke sx.
Mx - oral aciclovir and prednisolone. Eye care.
Menierres
Ix - examination of ears and mouth. Assess hearing and consider stroke sx.
Mx - Inform DVLA. IM prochlorperazine for acute attacks. Betahistine is given to prevent.
BPPV
Ix - examination of ears and mouth. Assess hearing and consider stroke sx.
Mx - Epley manoeuvre. Offer betahistine if struggling but limited evidence for improvement.
Otitis media
Ix - examination of ears and mouth. Assess hearing and palpate for mastoid tenderness.
Mx - At home supportive management in majority of cases. Abx only to be given if: sx longer than 4 days, systemically unwell, immunocompromised, <2 years and bilateral, if perforated
Otitis externa
Ix - examination of ears and mouth. Assess hearing and palpate for mastoid tenderness.
Mx - topical abx and steroids. If not successful consider ear swab and oral abx.
Acoustic neuroma/Vestibular schwannoma
Ix - examination of ears and mouth. Assess hearing and consider stroke sx. MRI cerebellopontine angle. Audiometry
Mx - urgent referral to ENT. Observation, surgery, radiotherapy are all options.
Diabetic ketoacidosis
Ix - bedside BM, obs, ketones, ABG, FBC, HbA1c, U&Es, LFTs
Mx - Assess A-E. Call senior help. IV fluids. Stop short-acting insulin but continue long-acting. Start insulin infusion and potassium replacement.
Addisonian Crisis
Ix - obs, U&Es, LFTs, FBC, CRP,
Mx - Assess A-E. Call senior help. IV fluids, steroid replacement
Thyrotoxicosis
Ix - Obs, TFTs, thyroid antibodies, FBC, CRP, U&Es, LFTs
Mx - emergency admission. Call senior and assess A-E. Beta blockers. ‘Block and replace’ (carbimazole + levothyroxine) to control T4.
Myxoedemic coma
Ix - Obs. TFTs, thyroid antibodies, FBC, CRP, U&Es, LFTs
Mx - Emergency admission, assess A-E and call senior. IV thyroid replacement, IV fluids and steroids, correct electrolyte imbalances. Rewarming might be necessary.
Diabetes Mellitus Type 2
Ix - HbA1c, lipids, FBC, random and fasting glucose, LFTs, TFTs, U&Es
Mx - lifestyle and diet. Metformin unless renal impairment. If CVD risk factors add SGLT-2 inhibitors or consider monotherapy if metformin contraindicated. Add DPP-4 if still not under control. Consider insulin therapy.
