Management of Acute Conditions Flashcards
Describe the general management of acute MI
Oxygen 15l via non-rebreathe mask, ECG, 300mg aspirin, 5-10mg IV morphine + 50mg IV cyclizine, GTN spray, beta blocker unless CI’d
Describe the MI management specific to a STEMI
Primary PCI or thrombolysis
Describe the MI management specific to an NSTEMI
300mg oral clopidogrel plus SC LMW heparin (e.g. dalteparin) or fondaparinux
Describe the management of anaphylaxis
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
Describe the management of acute LVF
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
State the components of a CURB-65 score
Confusion, urea >7.5mmol/l, resp rate >30, systolic BP <90mmHg, age over 65
Describe the management of unstable tachycardia
Synchronised DC shock up to 3x, 300mg IV amiodarone over 10-20 mins, repeat shock, 900mg IV amiodarone over 24h
Describe the signs of unstable tachycardia
Shocj, syncope, MI, HF
Describe the management of torsades des pointes
Expert help, magnesium sulphate 2mg IV over 10mins
Describe the management of AF with bundle branch block
Expert help, consider rate control with beta blocker or diltiazem
Describe the management of VT
Amiodarone 300mg IV over 20-60mins then 900mg over 24h
Describe the management of irregular narrow complex tachycardia (AF)
Rate control with beta blocker or diltiazem, consider digoxin or amiodarone if evidence of HF, CHADSVASC and anticoagulate
Describe the management of regular narrow complex tachycardia
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
Describe the management of acute asthma attack
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
Describe the management of an acute GI bleed
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
Describe the management of bacterial meningitis
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
Describe the management of a seizure
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
Describe the management of DKA
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
State the antidote to paracetamol
N-acetylcysteine
State the antidote to opiates
Naloxone
State the antidote to benzodiazepines
Flumazenil
State the antidote to antifreeze
Fomepezil
Describe the management of hyperkalaemia
Cardiac monitoring, IV calcium gluconate, combined insulin and dextrose IV infusion, nebulised salbutamol. AKI and persistent hyperkalaemia consider haemodialysis
Which drug is used to treat acute dystonia?
Procyclidine hydrochloride
