Management of Acute Conditions

Question 1

Describe the general management of acute MI

Answer 1

Oxygen 15l via non-rebreathe mask, ECG, 300mg aspirin, 5-10mg IV morphine + 50mg IV cyclizine, GTN spray, beta blocker unless CI’d

Question 2

Describe the MI management specific to a STEMI

Answer 2

Primary PCI or thrombolysis

Question 3

Describe the MI management specific to an NSTEMI

Answer 3

300mg oral clopidogrel plus SC LMW heparin (e.g. dalteparin) or fondaparinux

Question 4

Describe the management of anaphylaxis

Answer 4

Oxygen 15l via non-rebreathe mask, remove cause, adrenaline 500mch of 1:1,000 IM, chlorphenamine 10mg IV, hydrocortisone 200mg IV, if wheeze asthma management

Question 5

Describe the management of acute LVF

Answer 5

Oxygen 15l via non-rebreathe mask, sit patient up, look for cause, morphine 5-10mg IV plus cyclizine 50mg IV, GTN spray, furosemide 40-80mg IV repeated as required, consider isosorbide dinitrate infusion and CPAP

Question 6

State the components of a CURB-65 score

Answer 6

Confusion, urea >7.5mmol/l, resp rate >30, systolic BP <90mmHg, age over 65

Question 7

Describe the management of unstable tachycardia

Answer 7

Synchronised DC shock up to 3x, 300mg IV amiodarone over 10-20 mins, repeat shock, 900mg IV amiodarone over 24h

Question 8

Describe the signs of unstable tachycardia

Answer 8

Shocj, syncope, MI, HF

Question 9

Describe the management of torsades des pointes

Answer 9

Expert help, magnesium sulphate 2mg IV over 10mins

Question 10

Describe the management of AF with bundle branch block

Answer 10

Expert help, consider rate control with beta blocker or diltiazem

Question 11

Describe the management of VT

Answer 11

Amiodarone 300mg IV over 20-60mins then 900mg over 24h

Question 12

Describe the management of irregular narrow complex tachycardia (AF)

Answer 12

Rate control with beta blocker or diltiazem, consider digoxin or amiodarone if evidence of HF, CHADSVASC and anticoagulate

Question 13

Describe the management of regular narrow complex tachycardia

Answer 13

Continuous ECG monitoring, vagal manoevres, adenosine 6mg rapid IV bolus, then 12mg, then 12mg, if sinus rhythm not restored consider atrial flutter and rate control

Question 14

Describe the management of acute asthma attack

Answer 14

ABCDE approach, 15l oxygen via non-rebreathe mask, 5mg nebulised salbutamol, 40-50mg oral prednisolone, if needed 500mcg nebulised ipratropium, if needed 100mg IV hydrocortisone, if still life-threatening ICU referral and IV aminophylline

Question 15

Describe the management of an acute GI bleed

Answer 15

ABCDE approach, 15l oxygen via non-rebreathe mask, 2 large bore cannulae, catheterise with strict fluid monitoring, crystalloid bolus, cross-match 6 units blood, correct clotting abnormalities, endoscopy, stop anticoagulants and antiplatelets

Question 16

Describe the management of bacterial meningitis

Answer 16

ABCDE approach, high-flow oxygen, IV fluids, 4-10mg dexamethasone IV unless immunocompromised, LP (consider CT head first if worries about raised ICP), 2g IV ceftriaxone, if immunocompromised or over 55 add 2g IV ampicillin, ICU referral

Question 17

Describe the management of a seizure

Answer 17

ABCDE approach, consider airway adjunct, put patient in recovery position with oxygen, if still seizing after 5min lorazepam 2-4mg IV or midazolam 10mg buccal or diazepam 10mg rectal, if still seizing at 10mins repeat, inform anaesthetist, if still seizing at 20mins phenytoin 15-20mg/kg IV, if still seizing after 35mins consider RSI with propofol and intubation

Question 18

Describe the management of DKA

Answer 18

ABCDE approach, IV fluid (0.9% NaCl 1l stat then 1l over 1h, 1l over 2h, 1l over 4h, 1l over 8h), fixed rate insulin at 0.1units/kg/h, hourly capillary glucose and ketone monitoring, 2hourly VBGs for potassium (>5.5mmol/l add none, 4-5.5 add 20mmol, <4 add 40mmol), when glucose <14mmol/l add 10% dextrose at 125ml/h, investigate trigger

Question 19

State the antidote to paracetamol

Answer 19

N-acetylcysteine

Question 20

State the antidote to opiates

Answer 20

Naloxone

Question 21

State the antidote to benzodiazepines

Answer 21

Flumazenil

Question 22

State the antidote to antifreeze

Answer 22

Fomepezil

Question 23

Describe the management of hyperkalaemia

Answer 23

Cardiac monitoring, IV calcium gluconate, combined insulin and dextrose IV infusion, nebulised salbutamol. AKI and persistent hyperkalaemia consider haemodialysis

Question 24

Which drug is used to treat acute dystonia?

Answer 24

Procyclidine hydrochloride

Question 25

Give an example of a continuous transdermal HRT preparation

Answer 25

Levonorgestrel 7mcg/ oestradiol 50mcg/24h transdermal weekly patch