management Flashcards
status epilepticus
check BM and toxicology
open and secure airway 2222
lorazepam IV, buccal midazolam, PR diazepam
after 5 mins and then can repeat after 10 mins
ICU review and phenytoin infusion
treat cause eg alcohol, overdose, pregnancy
head injury
immobolise c spine.
check for csf leak > tetanus toxin and neurosurgeons
NICE guidelines for CT head criteria
addisonian crisis
Hydrocortisone IV
fluids
correct any U&E imbalance
long term steroid regimen
phaeochromocytoma
ICU
alpha blockade IV
once bp controlled > long acting alpha blockade anf can add beta1 blocker
elective surgery 4-6 weeks later
acute asthma attack
warn ICU if severe or life threatening
PEFR
Salbutamol nebs 5mg and high flow o2
ipratropium bromide nebs
IV magnesium sulphate
not responding > ICU, intubation, IV aminophyllline
give pred 40mg 7 days, gp follow up, check inhaler technique, 4 week resp follow up
sepsis
blood cultures
o2
VBG for lactate
catheter
broad spec ABX
IV fluids
PE
wells score, CTPA, D-Dimer
o2, morphine
DOAC (rivaroxiban)
VTE 3 months
massive PE
iv unfractionated heparin and thrombolysis (alteplase)
VTE 3-6 months
Acute COPD exacerbation
Sputum
Nebulised salbutamol, neb ipratropium bromide
o2 15L unless known co2 retainer > venturi 24-28% aim for 88-92% sats
IV hydrocortisone, abx trust guidelines,
ITU, IV aminopphylline
oral pred 40mg 7 days
acute HF
Troponin, BNP
15L o2
morphine
GTN
Furosemide
acute coronary syndrome
morphine, metoclopramide, o2, aspirin, clopidogrel
STEMI
NSTEMI
STEMI
ACS treatment plus
<12 hour symptoms and can have PCI<2 hours - PCI
<12hour symptoms cannot make PCI in 2 hours - Thrombolysis with PCI after if necessary
>12 hours since symptoms started angiography and possible PCI
NSTEMI
ACS treatment plus
Fondaparinux
Discharge MI drugs
aspirin, clopidogrel, ACEi, Statin, Beta blocker
pneumothorax
primary
<2cm discharge and review in OPD
>2cm or breathless aspirate then consider discharge and review in outpatients if not sucessful then chest drain and admit
secondary
<1cm admit high flow o2 observe 24hr
1-2cm aspirate sucess - admit high flow o2 and observe 24hr not sucess then chest drain and admit
>2cm chest drain and admit
if bilateral chest drain
tension pneumothorax
large bore cannula
2nd ics mcl
request CXR
insert chest drain
anaphylaxis
lie flat, secure airway 2222
adrenaline IM 1:1000 repeat after 5 mins every 5 mins
IV fluids
adrenaline infusion ITU
allergy clinic, Epipen, educate
stroke
o2, Ct scan, haemorrhagic ruled out>300mg aspirin.
thrombolysis <4.5hrs from start
physio, SALT
clopidogrel 75mg after 2 weeks aspirin. statin, antihypertensive abd abticoag if AF
HB<70g/l
give RBCS
do iron studies, b12, folate
signs of blood anywhere
CPR
give o2 compressions continuous
gain IV/IO access
give adrenaline every 3-5 mins
give amiodarone after 3 shocks
identify & treat reversible causes (hypoxia, hypovolaemia, hyper/hypokalaemia, hyper/hypothermia, thrombosis, tension pneumothorax, tamponade, toxins)
shockable rhythm - VT,pulseless VT
non-shockable rhythm - asystole, PEA
hypoglycaemia
glucose gel
10% dextrose IV
glucagon IM-must have reserve (not malnourished)
once recovered give long acting carb eg toast
HHS
LMWH (clot risk)
Rehydrate slowly over 48 hours (8-15L)
replace K+ when urine starts to flow
give insulin if glucose does not fall with rehydration
Acute upper GI bleed
peptic ulcer, varices, mallory weiss tear, malignancy
major haemorrhage and alert surgeons and endoscope
stop anticoag/platelets (reverse them)
IV hartmans and o- blood until crossmatched is available
catheter - monitor losses
endoscopy to treat
DKA
glucose >11 ketone >3 or ++ acidaemia<7.3 bicarb <15
NaCl bolus and continuous
insulin IV fixed rate (actrapid) 50 units in 50ml NaCl (0.1 unit) per hour increase to 1 unit/hour if fall in ketones not >0.5/hour
once glucose <14 start 10% dextrose 125ml/hour to prevent hypo
treat underlying cause eg infection, infarction, poor control
continue/initiate long acting insulin regime
check K+ may need to infuse
continue insulin until ketones <0.6mmol/L
AKI
treat the cause
urgent dialysis - AEIOU - Acidosis <7.3 electrolytes unresponsive hypokalaemia, intoxication (overdose), odema (unresponsive pulmonary oedema), uraemia symptoms (encephalitis, seizures)
hypernatraemia
oral fluids and IV dextrose 5%
hyponatreamia
hypovolaemic - IV NaCl
Euvolaemic - fluid restrict
hypervolaemic - fluid restrict and diuretics
do not correct faster than 10mmol/day. need expert advice for hypertonic saline
hyperkalaemia
> 6.5 or ECG changes
calcium gluconate 10ml 10% can repeat every 15 mins till K+ corrected
insulin 10 units in 50ml and 200 ml of 10% dextrose IV
salbutamol nebs
hypokalaemia
hold diuretics, insulin, salbutamol
give IV KCL 40mmol/L over 4 hours if need higher dose > ITU
hypercalaemia
IV NaCl
IV bisphosphonates if malignancy
hypocalcaemia
severe > 10% calcium gluconate and 50ml 5% dextrose 10 mins
followed by IV calcium gluconate infusion in NaCl 1L
