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MD3 > Management of Common Conditions > Flashcards

Management of Common Conditions Flashcards

1
Q

Management of pulmonary embolism (PE)

A
  • Oxygen therapy
  • Analgesia as needed
  • Assess bleeding risk:
    • Low: empiric anticoagulation (usually LMWH) or thrombolysis (alteplase)
    • High: temporary IVC filter or embolectomy
  • Long-term coagulation: DOAC or warfarin (review after 3 months)
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2
Q

Anticoagulation choice consideration for PE

A
  • First choice: LMWH (e.g. enoxaparin)
  • Renal failure patients: UFH
  • Long-term: DOAC or warfarin
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3
Q

Management for acute coronary syndrome

A
  • Adjunctive:
    • Morphine IV for pain relief
    • Oxygen if hypoxic
    • Nitrate (sublingual or IV) - symptomatic chest pain relief
    • Statins
  • Critical:
    • Revascularisation (if STEMI or high-risk NSTEMI)
      • PCI (e.g. balloon dilatation with stent implantation): if <2h since first medical contact
      • Fibrinolysis (e.g. alteplase): if PCI can’t be performed
    • Monitor: serial ECG (every 15-30min) and troponin (every 1-6h), continuous cardiac monitoring
    • Antiplatelets: aspirin + clopidogrel
    • Anticoagulation: UFH or LMWH
  • Consider beta-blockers, ACEi/ARBs, fluid management (e.g furosemide)
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4
Q

Management of ischemic stroke

A
  • Non-contrast CT: to rule out hemorrhagic stroke
  • Reperfusion therapy: IV thrombolysis (if <3h from onset) or mechanical thrombectomy (after doing CT angiography)
  • Supportive care:
    • Only treat severe hypertension (>220 SBP or >120 DBP)
    • Antiplatelet therapy (aspirin or clopidogrel): start within first 48h
    • Modifiable risk factors: statins, hypertension control, glycemic control
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5
Q

Indication for securing the airway

A
  1. Respiratory distress
  2. Airway obstruction
  3. Reduced level of consciousness
  4. Trauma or injury
  5. Anesthesia or sedation
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6
Q

Management of hemorrhagic stroke

A
  • Emergency non-contrast CT and/or lumbar puncture to conclusively rule out SAH
    • If still unsure, perform a CT angiography
  • Initial management:
    • Stabilization: ABDCE survey, secure airway if indicated
  • Prevention of rebleeding:
    • Anticoagulation reversal
    • BP control:
      • Target SBP<160mmHg
      • Control permissible hypertension (MAP>90mmHg) to maintain cerebral perfustion
  • Adjunctive measures:
    • ICP management: elevate head 30 degrees, IV mannitol
    • Nimodipine IV (within 96h): prevents vasospasm
    • Pain relief and antiemetics
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7
Q

Acute management of CHF

A
  • Loop diuretic (furosemide) + ACEi/ARB
  • Morphine
  • Nitrates: dilate blood vessels and reduce the workload of the heart
  • Oxygen: improve oxygenation and relieve SOB
  • Position (upright)

Consider inotropic support (e.g., dobutamine, norepinephrine)

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8
Q

Long-term management of CHF

A
  • Lifestyle
    • Fluid management: <1.5L if congested
    • Salt restriction:<2g/day
    • Dietary and exercise support
  • Medical treatment
    • ACEi/ARBs
    • Add beta-blockers once stable: reduces hospitalisation and mortality rate
    • Consider adding SGLT-2 inhibitors (cardioprotective factors)
  • Comorbidity treatment (e.g. hypertension, dyslipidemia, diabetes, OSA)
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9
Q

Management of DVT

A
  • Evaluate and treat concurrent PE
  • Analgesics
  • Anticoagulation:
    • Initial parenteral anticoagulation: LMWH or UFH for 5-10 days
    • Long-term oral anticoagulation: DOAC or warfarin for 3-6 months
    • Secondary prevention of DVT: Review with specialist on the need to extend use
    • Monitor bleeding risk annually
  • If anticoagulation is contraindicated: thrombectomy, catheter-directed thrombolysis
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10
Q

Management of PAD

A
  • For intermittent claudication: CV risk modification and structured exercise therapy
  • If persistent claudication
    • Pharmacological: cilostazol (vasodilator)
    • Revascularisation:
      • Endovascular: percutaneous angioplasty + stent placement
      • Surgical: peripheral artery bypass or endarterectomy
    • Amputation: if wet gangrene and/or septic
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11
Q

Management for unstable AF

A
  • Unstable AFib: emergency synchronized cardioversion
    • Cardiology consult and consider anticoagulation prior
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12
Q

Management for stable AF

A
  • Stable Afib
    • If <48h: rate or rhythm control
    • If >48h: rate control
    • Options:
      • Rate control (aim for <110bpm)
        • Beta-blockers (e.g. atenolol)
        • Nondihydropyridine CCBs (e.g. verapamil)
      • Rhythm control
        • Electrical cardioversion
        • Pharma cardioversion: flecainide or amiodarone
        • Note: assess for need of anticoagulation prior to cardioversion as it increases VTE risk
  • Anticoagulation therapy:
    • Valvular AF: warfarin
    • Non-valvular: DOAC or warfarin (based on CHADS-VASc)
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13
Q

Management of primary hypertension

A

First-line:
1. ACEi/ARBs
2. CCBs
3. Thiazide diuretics

Lifestyle: weight loss, diet, exercise

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14
Q

Management for hyperlipidemia

A
  • Lifestyle: weight loss, exercise, diet
  • Pharmacological treatment (based on age, LDL, and CVD risk)
    • Statins: first line
    • If LDL target not achieved, consider adding ezetimibe
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15
Q

General management for valvular heart disease

A
  • Medical treatment
    • Assess and manage for CVD risk factor
    • Consider endocarditis prophylaxis
    • Prevention of VTE if indicated (e.g. after anticoagulant therapy)
  • Intervention (if indicated)
    • Valve repair: reconstruction (e.g. annuloplasty) or valvuloplasty
    • Valve replacement
      • Mechanical: usually for younger patients
        • Lifelong anticoagulation: warfarin
      • Biological: for older patients or high bleeding risk
        • anticoagulation for 3 months
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16
Q

General management for infective endocarditis (IE)

A
  • Consult ID team to plan treatment and consider empirical therapy
  • Antibiotic therapy:
    • Obtain 2-3 sets of blood culture before commencing
    • Start empirical therapy
      • Native valve: benzylpenicillin + flucloxacillin + gentamicin
      • Prosthetic: vancomycin + flucloxacillin + gentamicin
    • Switch to targeted antibiotic therapy once results are available
  • Prophylaxis antibiotic: only for dental or cardiac procedures (usually amoxicillin or cefalexin prior to procedure)
  • Surgical therapy: valve replacement or valve repair
    • indicated if prosthetic valve or valve dysfunction leading to heart failure
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17
Q

General management for acute rheumatic fever

A
  • GAS eradication: IM benzathine benzylpenicillin
    • If hypersensitive to penicillin: cefalexin or azithromycin
  • Symptomatic treatment of arthritis/fever
    • NSAIDs: aspirin or naproxen
    • 2nd line: glucocorticoids
  • Secondary prevention:
    • IM benzathine benzylpenicillin every 3-4 weeks (could be for years)
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18
Q

General management of asthma

A
  • Assess severity
    • Mild: symptoms >2/week, minor limitation to activities (FEV>80%)
    • Moderate: daily symptoms, some limitation to activities (FEV 60-80%)
    • Severe: symptoms throughout the day, waking up due to symptoms every night (FEV<60%)
  • Stepwise pharmacological treatment
    • Step 1: SABA as needed
    • Step 2: low dose ICS+SABA
    • Step 3: low dose ICS+LABA
    • Step 4: medium dose ICS+LABA
    • Step 5: medium dose ICS+LABA+LAMA
    • Step 6: high dose ICS+LABA + oral corticosteroid
  • Adjunctive therapy
    • reduce exposure to allergens or trigger
    • lifestyle recommendations
    • reducing risk of infection-induced exacerbations (e.g. immunizations)
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19
Q

General management of COPD

A
  • Supportive measures
    • Lifestyle modification (e.g. cessation of tobacco use)
    • Immunization (pneumococcal, influenza, etc)
    • Management of comorbidities
    • Pulmonary rehabilitation
  • Severity
    • Mild (FEV>80%)
    • Moderate (FEV 60-80%)
    • Severe (FEV<60%)
  • Stepwise treatment
    • SABA
    • LAMA or LABA
    • LAMA+LABA
    • ICS+LAMA+LABA
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20
Q

General management of CAP

A
  • Collect blood and sputum samples before starting antibiotics
  • Assess need for hospitalization:
    • CURB-65 (≥2: inpatient)
      • Confusion
      • Urea>7mmol/L
      • RR>30
      • BP < 90/60mmHg
      • Age≥65
  • Empirical therapy:
    • Low-severity (0-1): oral amoxycillin + doxycycline for 5 days (treat as outpatient)
    • Medium-severity (2): IV benzylpenicillin + oral doxycycline
    • High-severity (3-5): IV ceftriaxone + azithromycin
    • Duration may vary, but lasts up to 5-7 days
      • Review antibiotics after 48h
  • Switch to targeted therapy after results of sputum sample MCS
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21
Q

General management of HAP

A
  • Collect blood and sputum samples before starting antibiotics
  • Severity assessment:
    • High severity: presence of septic shock, respiratory failure, rapid progression in X-rays
  • Empirical therapy:
    • Low-medium: IV or oral augmentin
    • High: IV pip-taz
  • Switch to targeted therapy after results of sputum sample MCS
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22
Q

Management of IPF

A
  • Lifestyle modification:
    • Smoking cessation
    • Vaccination recommended
    • Pulmonary rehab
  • Symptom approach
    • Supplementary oxygen therapy
    • Cough suppressant
  • Pharmacological therapy
    • Antifibrotic agentsmay reduce mortality and acute exacerbations
    • Immunosuppressive therapy is not indicated
  • Lung transplantation: the only curative therapy
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23
Q

Management for OSA

A
  • First-line treatment: CPAP machine
  • Risk factor management:
    • weight loss
    • sleep hygiene
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24
Q

Management for TB

A
  • Infection control:
    • Case notified to local health department and contact tracing
    • Airborne precautions
  • Pharmacological:
    • Intensive phase: 2-months of RIPE
      • Rifampin
      • Isoniazid
      • Pyrazinamide
      • Ethambutol
    • Followed by 4 months of:
      • Rifampin
      • Isoniazid
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25
Q

Management of PUD

A
  • General measures:
    • Avoid NSAIDs
    • Restrict alcohol, smoking, caffeine
  • Test for H. pylori infection (e.g. urea breath test)
    • Positive: H. pylori eradication therapy
      • 2 weeks course of azithromycin + amoxicillin + PPI
      • Confirm that H. pylori has been eradicated 4–6 weeks after completion of the treatment regimen
    • Negative: Trial of PPIs for 4-8 weeks and re-evaluate
  • Failure: elective surgery
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26
Q

Management of GORD

A
  • Lifestyle:
    • Diet: small portions, avoid eating before sleeping
    • Weight loss
    • Avoid caffeine, smoking, alcohol
  • Pharmacological:
    • PPI regimen for 8 weeks
      • Alternative: H2 antagonists
    • Review clinical response after 8 weeks
  • Surgical: when symptoms are refractory to medical therapy or presence of complications
    • Fundoplication: wrapping of the top part of the stomach around the lower part of the esophagus to prevent reflux
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27
Q

Management of achalasia

A
  • Low-surgical risk:
    • Pneumatic dilation
    • LES myotomy
  • High surgical risk:
    • Botulinum toxin injection in the LES
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28
Q

General management of acute pancreatitis

A
  • Initial management:
    • IV fluids: crystalloids (e.g. CSL)
    • Monitor vitals, O2 sat, urine output
    • Obtain lab studies (FBE, UEC) every 6-12h to assess adequacy of fluid resuscitation and tissue perfusion
    • Replete electrolytes as needed
  • Supportive therapy:
    • Analgesia: NSAIDs or opioids
    • Antiemetic: IV ondansetron
    • Antibiotic: only in patients with evidence of infected necrosis
  • Feeding:
    • Fasting is no longer recommended
    • Early oral feeding or via nasogastric tube
  • Management:
    • Biliary pancreatitis:
      • Therapeutic ERCP and stone removal
      • Cholecystectomy
    • Alcohol-induced:
      • Check Mg and PO4- levels and replete as needed
      • Vitamin supplementation (B1 and B6)
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29
Q

Management of coeliac disease

A
  • Investigate for nutrient deficiencies: iron, vitamin B12, folate, vit D
    • Supplementation as needed
    • Screen for osteopenia by BMD scan
  • Gluten-free diet
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30
Q

Management of ulcerative colitis

A
  • First-line treatment: 5-ASA (mesalamine)
    • Alternative: oral corticosteroids
  • For severe cases: consider adding biologics (e.g. anti-TNF therapy)
  • Supportive therapy:
    • Analgesics: paracetamol, sedatives
      • avoid opioids and NSAIDs
    • Identify and treat any micronutrient deficiency
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31
Q

Management of Crohn’s

A
  • Induction phase: to manage acute flares
    • Corticosteroids, biologics
  • Maintenance phase:
    • Biologics (e.g. anti-TNF - adalimumab
    • Immunomodulators (e.g. azathioprine, methotrexate)
  • Supportive therapy:
    • Pain management
    • Antidiarrheal therapy: loperamide
    • Identify and treat nutritional deficiency
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32
Q

Management of diverticulitis

A
  • Uncomplicated (w/o perforation, peritonitis, sepsis, etc)
    • Empirical antibiotic: oral Augmentin for 5 days
    • Supportive care:
      • Bowel rest: clear liquid diet until symptoms improve
      • Analgesics and antiemetics
  • Complicated
    • Empirical antibiotics: IV gentamicin + amoxicillin + metronidazole
      • Duration: no surgery (7-10 days); had surgery (5 days)
    • Surgical intervention:
      • Drainage of abscess
      • Potential colectomy or Hartmann
    • Supportive care:
      • NPO
      • IV fluids
      • Analgesics and antiemetics
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33
Q

Management of cholelithiasis

A
  • Initial support:
    • NPO
    • Analgesics and anti-emetics
  • Surgical management: Cholecystectomy
    • If evidence of choledocholithiasis, removal of CBD stone (via ERCP)
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34
Q

Management of acute cholecystitis

A
  • Initial management:
    • NPO
    • Analgesics
    • Antiemetics
  • Empirical antibiotics: IV gentamicin + amoxicillin
    • Alternative: IV Augmentin or ceftriaxone
    • Stop after cholecystectomy
  • Surgical management: laparoscopic cholecystectomy
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35
Q

Management of ascending cholangitis

A
  • Stabilize patient as needed
  • Initial management:
    • NPO
    • Analgesics
    • Antiemetics
  • Empirical antibiotics: IV gentamicin + amoxicillin
    • Alternative: IV ceftriaxone
  • Definitive management:
    • Biliary drainage (ERCP-guided)
  • Treatment of underlying cause:
    • Choledocholithiasis: ERCP-guided stone extraction and cholecystectomy
    • Biliary stricture: ERCP and CBD stenting
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36
Q

Management of appendicitis

A
  • Initial management:
    • NPO
    • IV fluids, analgesia, antiemetics
    • Electrolyte repletion as needed
    • Screen for peritoneal signs or sepsis
  • Empirical antibiotic: IV gentamicin + metronidazole + amoxicillin
    • For uncomplicated appendicitis, stop after appendicectomy.
  • Surgical management: emergency appendicectomy
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37
Q

Management of pericarditis

A
  • Usually self-limiting
  • Pharmacological therapy:
    • NSAIDs: aspirin
    • Consider colchicine in combination with NSAIDs
  • Supportive therapy:
    • Antibiotics for bacterial causes
    • Immunosuppressants in autoimmune disease
    • Dialysis (in case of uremia and CKD)
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38
Q

Management of acute liver failure

A
  • Stabilisation (ABCDE approach)
    • Immediate hemodynamic support (IV saline and/or vasopressors)
    • Respiratory support (consider early intubation)
    • Management of encephalopathy and increased ICP
      • refer early for liver transplant
      • consider lactulose + rifaximin
      • neuroprotective measures
  • Supportive therapy
    • Electrolyte repletion and optimize nutrition
    • Hemostasis: correct coagulopathy and consider stress ulcer prophylaxis (e.g. PPIs)
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39
Q

Management of esophageal variceal bleeds

A
  • Primary prevention: non-selective beta blocker (e.g. propranolol) and/or band ligation
  • Management
    • Terlipressin or octeotride
    • Emergency endoscopy:
      • Band ligation
    • Antibiotic prophylaxis: ceftriaxone
  • Secondary prevention:
    • Long-term
      beta-blocker therapy
    • Variceal band ligation
    • Regular endoscopy
    • Consider TIPS placement
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40
Q

Management of carotid artery stenosis

A
  • Medical management
    • Lifestyle modification
    • Long term:
      • statin therapy
      • antiplatelet therapy
  • Surgical management
    • Symptomatic: carotid revascularization if stenosis >70%
      • within 14 days of symptoms onset
      • Modalities:
        • Carotid endarterectomy
        • Carotid artery stenting
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41
Q

Management of otitis media

A
  • Conservative management (observe for 48-72h)
    • Rest, warm compresses, drinking fluids
    • Avoiding irritants (e.g. smoke)
    • Pain relief: paracetamol
  • Antibiotics: recommended to relieve symptoms if have not improved
    • Amoxicillin: first line
    • Cefuroxime: alternative for patients with penicillin allergy
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42
Q

Management of allergic rhinitis

A
  • Conservative management:
    • Avoiding allergens
    • Nasal saline irrigation
  • Medical/pharmacological management:
    • Antihistamines (e.g. loratadine)
    • Intranasal corticosteroids (e.g. fluticasone)
    • Immunotherapy (desensitization)
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43
Q

Management of acute viral hepatitis

A
  • Lifestyle management
    • Rest and adequate nutrition
    • Avoidance of alcohol and other hepatotoxic substances
  • Supportive therapy for acute viral hepatitis (e.g. antiemetics, IV fluids, and electrolyte replacement)
  • Medical management
    • Antiviral therapy for chronic viral hepatitis B and C infections
    • Vaccination against hepatitis A and B for prevention of infection
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44
Q

Management of acute rhinosinusitis

A
  • Symptomatic treatment
    • Nasal irrigation with saline solution to help clear the sinuses
    • Steam inhalation or use of a humidifier to moisten nasal passages
    • Avoiding irritants (e.g. smoke)
  • Medical management
    • Antibiotics if bacterial infection is suspected or confirmed (e.g. amoxicillin, cefuroxime)
    • Consider:
      • Intranasal corticosteroids to reduce inflammation in the sinuses (e.g. fluticasone)
      • Decongestants to reduce nasal congestion (e.g. pseudoephedrine)
      • Pain relief: paracetamol or ibuprofen
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45
Q

Management of acute tonsillitis

A
  • Symptomatic management:
    • Saltwater gargles
    • Use of throat lozenges or sprays for symptomatic relief
    • Pain relief: paracetamol or ibuprofen
  • Medical management:
    • Antibiotics if bacterial infection is confirmed (e.g. penicillin V, amoxicillin)
      • Common etiology: GAS
    • Tonsillectomy may be considered for recurrent or severe cases
46
Q

Management of peripheral vertigo

A
  • Non-medical management:
    • Positional maneuvers such as the Epley maneuver to alleviate symptoms of benign paroxysmal positional vertigo (BPPV)
    • Avoiding sudden head movements and potential triggers such as alcohol or caffeine
    • Vestibular rehabilitation therapy, which involves exercises to improve balance and reduce symptoms of dizziness and vertigo
  • Medical management:
    • Vestibular suppressants (e.g. meclizine) or antiemetics to manage symptoms of vertigo and nausea
    • Steroids to reduce inflammation (e.g. prednisone) may be used in some cases (e.g. labyrinthitis)
47
Q

Management of lower UTI

A
  • Setting: if uncomplicated, management can be done in an outpatient setting
    • Complicating factors: risk factors for infection, treatment failure, serious outcomes
  • Supportive measures:
    • Increase fluid intake
    • Regular voiding
    • Proper hygiene practice
  • Medical management
    • Pain relief: paracetamol
    • Antibiotics: trimethoprim for 3 days (uncomplicated) or 7-14 days (complicated)
    • Refer to urology if complicated
48
Q

Management of acute pyelonephritis

A
  • If hemodynamically unstable, perform fluid resuscitation, admit to ICU and initiate sepsis workup
  • General management
    • IV fluids
    • Analgesia, antiemetics
    • Empirical antibiotics after collecting urine samples for MCS
      • Uncomplicated: oral Augmentin for 2 weeks or ciprofloxacin for 7 days
      • Complicated: IV gentamicin + amoxicillin up to 2 weeks
    • Antibiotic choice adjusted after MCS results
  • Assess for complications:
    • Septic screen
    • Blood culture
    • Percutaneous drainage for abscess
49
Q

Management of bulimia nervosa

A
  • Non-medical management:
    • Psychotherapy, such as cognitive behavioral therapy (CBT), to address underlying emotional issues that may contribute to the eating disorder
    • Nutritional counseling to promote healthy eating habits and meal planning
    • Support groups
  • Medical management:
    • SSRIs may be prescribed to help address underlying mood disorders
    • In some cases, hospitalization may be necessary for close monitoring of weight, nutritional status, and electrolyte balance, and to provide intensive treatment for the eating disorder
50
Q

Management of anorexia nervosa

A
  • Inpatient treatment if low BMI, failed outpatient treatment, medically or psychologically unstable
  • Non-medical management:
    • Psychotherapy, such as cognitive behavioral therapy (CBT), to address underlying emotional issues that may contribute to the eating disorder
    • Nutritional counseling to promote healthy eating habits and meal planning
    • Support groups
  • Medical management:
    • SSRIs may be prescribed to help address underlying mood disorders
    • In some cases, hospitalization may be necessary for close monitoring of refeeding syndrome
      • Monitoring and correction of electrolyte imbalances
      • Nutritional and micronutrient (e.g. thiamine) repletion
51
Q

General management for AKI

A
  • Depends on underlying cause:
    • Prerenal: correct adverse hemodynamic factors and replete fluid as needed
    • Postrenal: relieve urinary obstruction (temporarily using catheters)
    • Intrinsic: consider IV fluids and address specific causes
  • Supportive measures:
    • Avoid nephrotoxic medications
    • Consider medication dose adjustment based on renal function
    • Manage volume status and blood pressure to optimize kidney perfusion
    • Others: nutritional support, VTE prophylaxis
  • Renal replacement therapy (e.g. hemodialysis, peritoneal dialysis)
    • Consider if complications refractory to medical management or uremic symptoms
52
Q

General management of CKD

A
  • Control blood pressure (<130/80 mmHg)
    • Use ACE inhibitors or ARBs in patients with proteinuria
  • Manage blood glucose levels in patients with diabetes
    • Consider using or adding SGLT-2 or GLP-1 agonist
  • Address underlying causes of CKD (e.g. obstructive uropathy, glomerulonephritis, polycystic kidney disease)
  • Prevent and manage complications of CKD
    • Nutritional management: ensure adequate fluid intake, consider salt and protein restriction
    • Referral for specialist evaluation
    • Monitor electrolytes, bone mineral metabolism, anemia, and cardiovascular risk factors
  • Renal replacement therapy (RRT) planning
    • Discuss options for RRT, including dialysis and kidney transplantation
53
Q

General management of SVT

A
  • If pulseless, start CPR and defibrillate
  • If unstable with pulse, perform synchronized cardioversion
  • Stable patients:
    • If undifferentiated, start by performing vagal maneuvers (e.g. valsalva)
    • Reassess rhythm
      • Regular SVT: administer adenosine first-line (second-line: verapamil)
      • Irregular SVT: see management for AF - rhythm vs rate control
  • Consult cardiology for definitive management
54
Q

General management of VT

A
  • Attach defibrillator pads to patient
  • Assess 12-lead ECG to check for morphology
    • Monomorphic VT:
      • Stable: pharmacological cardioversion (e.g. amiodarone, procainamide)
      • Unstable: synchronized electrical cardioversion
    • Polymorphic (most commonly Torsades de pointes):
      • Stable: IV magnesium
      • Unstable: Defib + PCR
55
Q

Management of CAD

A
  • Pharmacotherapy for CAD
    • Antianginal: beta-blockers, CCBs, nitrates
    • Secondary prevention:
      • antiplatelets
      • statins
      • ACEi/ARBs: for hypertension
  • Consider revascularisation if high-risk lesions: CABG, PCI
56
Q

Management of T1D

A
  • Preventative:
    • Patient education
    • Lifestyle modification: weight reduction, diet and nutrition, exercise, smoking cessation
    • Evaluation for other comorbidities:
      • Autoimmune conditions (celiac, autoimmune thyroid)
      • Psychiatric disorders (depression, anxiety)
  • Routine screening: macro and microvascular complications
    • CVD risk assessment and prevention:
      • Hypertension
      • Lipid profile
      • HbA1C and fasting glucose
    • Other tests:
      • Diabetic neuropathy: monofilament test
      • Diabetic nephropathy: ACR (albumin-creatinine ratio), eGFR, UEC
      • Diabetic foot: pedal pulses
      • Diabetic retinopathy: visual acuity tests
    • Refer to specialist for further examination
  • Insulin therapy
    • Glycemic monitoring: assess hypoglycemia or impact of diet
    • Mode of therapy:
      • Basal-bolus insulin regimen
      • Insulin pump (commonly used)
57
Q

Management of T2D

A
  • Preventative:
    • Patient education
    • Lifestyle modification: weight reduction, diet and nutrition, exercise, smoking cessation
    • Evaluation for other comorbidities:
      • OSA, fatty liver disease
      • Psychiatric disorders (depression, anxiety)
  • Routine screening: macro and microvascular complications
    • CVD risk assessment and prevention:
      • Hypertension
      • Lipid profile
      • HbA1C and fasting glucose
    • Other tests:
      • Diabetic neuropathy: monofilament test
      • Diabetic nephropathy: ACR (albumin-creatinine ratio), eGFR, UEC
      • Diabetic foot: pedal pulses
      • Diabetic retinopathy: visual acuity tests
    • Refer to specialist for further examination
  • Pharmacology:
    • First-line: metformin
      • Review after 3 months, if glycaemic target <7% not reached consider adding second agent:
        • GLP-1 agonist: most reduction in HbA1c, cardioprotective, promotes weight loss
        • SGLT-2 inhibitor: renal and cardioprotective
58
Q

Management of hyperthyroidism

A
  • Symptomatic (hyperadrenergic symptoms): first-line beta blockers
  • Definitive therapy:
    • Antithyroid drugs (e.g. methimazole): first-line for Graves
    • Radioactive iodine ablation: preferred for toxic MNG or adenoma
    • Thyroid surgery (e.g. thyroidectomy or lobectomy): preferred for thyroid malignancy or large goitres
59
Q

Management of hypothyroidism

A
  • Hypothyroidism: treated with lifelong hormone substitution
    • Levothyroxine: first-line choice
  • Levothyroxine titrated with the goal of normal TSH levels
    • High TSH value (suggest low T4 activity): requires dose increase
    • Low TSH value (suggests high T4 activity): requires dose decrease
60
Q

Management of adrenal insufficiency

A
  • Hormone replacement therapy:
    • Primary AI: glucocorticoid +/- mineralocorticoids, androgens
    • Secondary AI: replacement for hypocortisolism and hypoandrogenism
  • Treatment of underlying causes:
    • Malignancy: tumour resection
    • Hypopituitarism: substitute other hormones
  • Stress-dose steroids:
    • dose should be increased to prevent adrenal crisis in at-risk patients (e,g, in acute illness, surgery, trauma)
61
Q

Management of hypercortisolism

A
  • Consult an endocrinologist
  • First-line treatment: tumour resection
    • Primary hypercortisolism: adrenalectomy
    • Cushing’s: resection of the pituitary (hypophysectomy)
  • Adjunctive therapy
    • Monitor for recurrence
    • Glucocorticoid replacement therapy often necessary
62
Q

Management of hyperaldosteronism

A
  • Surgical intervention
    • Adrenalectomy for unilateral adenoma, carcinoma, or adrenal hyperplasia
    • Correct hypokalemia prior to surgery
  • Pharmacological management:
    • Indication: bilateral hyperaldosteronism
    • Spironolactone (aldosterone receptor antagonist)
      • Reducing blood pressure
      • Limiting end-organ damage
63
Q

Management of adrenal crisis

A
  • Empiric glucocorticoid and mineralocorticoid replacement
  • Fluid resuscitation: IV saline
  • IV dextrose: if hypoglycemic
  • Identify and treat underlying cause
  • Consider higher-level monitoring: ICU
64
Q

Management of hyperglycemic crisis (DKA/HHS)

A
  • Fluid resuscitation:
    • IV 0.9% NaCl for first hour
    • Correct for sodium and glucose as needed
  • Potassium repletion: if K<5.3
  • Insulin therapy: short-acting insulin when K≥3.3
  • Identify and treat the precipitating cause (e.g. undiagnosed T1D, infection, surgery, trauma)
  • Admit to ICU and monitor for resolution of hyperglycemic crises
    • Monitor pH, glucose, osmolality, anion gap, ketones, and electrolytes (K+, Ca2+, Mg2+, PO43-)
65
Q

Management of cluster headaches

A
  • Avoid known triggers: e.g. tobacco, alcohol
  • Acute treatment:
    • 100% oxygen
    • Triptans (e.g. sumatriptan)
  • Prophylaxis: verapamil (first-line)
66
Q

Management of tension-type headache

A
  • Non-pharmacological:
    • Lifestyle and behavioural modification
    • Psychobehavioral treatments (e.g. CBT, relaxation training)
  • Pharmacological:
    • Episodic: NSAIDs, paracetamol
    • Chronic: amitriptyline (prophylaxis)
67
Q

Management of migraines

A
  • Supportive therapy
    • Limit stimuli and activity
    • Treat nausea and vomiting: fluids, antiemetics
  • Mild-moderate: NSAIDs or paracetamol (PO or IV)
  • Moderate-severe:
    • Migraine-specific agents: triptans
68
Q

Management of trigeminal neuralgia

A
  • Induction: high-dose glucocorticoid
  • Maintenance glucocorticoid therapy
69
Q

Management of GCA

A
  • Induction: high-dose glucocorticoid
  • Maintenance glucocorticoid therapy
70
Q

Management of facial nerve palsy

A
  • Symptomatic:
    • Incomplete eye closure: eye ointment, artificial tears
    • Incomplete mouth closure: proper lip and mouth care
  • Targeted treatment:
    • Oral glucocorticoids: start within 48-72h of onset
    • Consider adding antivirals (e.g. acyclovir)
    • For secondary palsy: treat based on cause (e.g. herpes zoster, stroke, MS)
71
Q

Management of meningitis

A
  • Patient stabilization
    • Airway management: consider intubation if low GCS or signs of cerebral herniation
    • Hemodynamic support: fluids and/or vasopressors
    • Reverse any coagulopathy
    • Treat any elevated ICP
  • Empirical therapy
    • Antibiotics (suspected bacterial cause)
      • Depends on age group and individual patient risk factors and comorbidities
      • Common regimen for adults: IV ceftriaxone + dexamethasone
        • Add benzylpenicillin to cover >50y, immunocompromised to treat Listeria
        • Add vancomycin if S. pneumoniae indicated
    • Antivirals (suspected HSV, VZV, EBV): acyclovir
  • Change to target therapy after results of CSF MCS
72
Q

Management of aortic dissection

A
  • Approach:
    • Stanford A dissection: immediate surgery
    • Stanford B dissection: treat conservatively unless complications occur
  • Supportive therapy:
    • Analgesia as needed (e.g. morphine)
    • Control blood pressure:
      • Hypotensive patients: IV fluids, vasopressors
      • Hypertension: control tachycardia, start with IV beta blocker/CCBs before adding vasodilator (e.g. esmolol + sodium nitroprusside)
  • Surgical procedure: aortic stent or graft implantation
73
Q

Management of AAA

A
  • Medical therapy:
    • BP control with beta blockers
    • Appropriate medical management of other CVD risk factor (diabetes, hyperlipidemia)
    • Lifestyle changes: smoking cessation
  • Asymptomatic:
    • Aneurysm surveillance: repeat US based on aortic diameter size
    • Consider elective aneurysm repair
  • Symptomatic:
    • Urgent vascular team consult
    • Signs of rupture (hypotension, severe pain, pulsatile mass): emergency aneurysm repair within 90min
      • Large-bore IV access, IV hemodynamic support, fluid resuscitation
    • No signs of rupture: Urgent aneurysm repair and consult anesthesia
74
Q

Management of pneumothorax

A
  • Supportive therapy:
    • Respiratory support: upright position, high-flow oxygen
    • Analgesics for pain relief
  • Depends on patient condition
    • Stable:
      • Repeat CXR and monitor for improvement
      • If enlarging appearance, consider chest tube placement
    • Unstable and/or traumatic
      • Emergency needle thoracostomy, followed by chest tube placement
    • Note: always check CXR to assess chest tube placement
75
Q

Management of seizures

A
  • Acute management of seizures:
    • Stabilisation:
      • Call for help and remove or control hazards
      • Perform ACBDE assessment
      • Assess and manage rapidly reversible causes of seizures (hypoglycaemia, hyponatremia, hypocalcemia, hyperthermia, alcohol withdrawal)
    • Pharmacological management:
      • Early seizure (<5min): usually self-limiting
      • Status epilepticus (>5min)
        • IV benzo or IV valproate
        • If refractory: consider induction of coma
  • Long-term management:
    • Remove cause or provoking factors (e.g. recreational drugs, treatment of underlying disorders)
    • Assess for risk of recurrence: brain imaging for CNS lesion, EEG
    • Consider starting long-term antiepileptic drugs (e.g. lamotrigine)
76
Q

Management of TBI

A
  • Primary survey and stabilisations
    • Prehospital trauma care (e.g. spine immobilization, analgesics)
    • Maintain BP and respiratory control
    • Measure GCS and pupillary response
  • Secondary survey
    • Continuous monitoring - vitals, SpO2, serial neuro exams
    • Emergency neurosurgery consult if GCS<12 or deteriorating
      • Intubate if GCS<8
      • Consider surgical procedures (e.g. craniotomy and hematoma evacuation)
    • Neuroimaging (e.g. CT-non contrast, MRI, etc)
  • Supportive care:
    • DVT prophylaxis
    • Antibiotic prophylaxis: consider in patients with open head injuries
    • Seizure prophylaxis: indicated for severe TBI
77
Q

Management of degenerative disk disease

A
  • Identify and treat compressive spinal emergencies immediately (e.g. cauda equina, conus medullaris)
  • Otherwise, start with conservative management:
    • Physiotherapy, continuation of daily activities, analgesics (e.g. NSAIDs)
    • Consider injection of local anaesthetics and glucocorticoids to affected region for severe pain
  • Surgical therapy:
    • Indications;
      • Urgent: signs of neuro deficits, bowel or bladder incontinence, compressive emergencies
      • Elective: failed conversative management
    • Procedure: discectomy - removal of herniated portion of disc
78
Q

Management of osteoarthritis

A
  • Lifestyle management:
    • Exercise and weight loss
    • Referral to physiotherapist and/or occupational therapist
  • Pharmacotherapy:
    • topical or oral NSAIDs, opioids
    • Intraarticular glucocorticoid injections
  • Surgical management: partial or total arthroplasty
79
Q

Management of RA

A
  • Acute treatment:
    • Glucocorticoids: oral prednisone
    • Intraarticular glucocorticoid injections
    • Symptomatic management: NSAIDs, celecoxib
  • Long-term management:
    • Monotherapy with DMARD (e.g. methotrexate)
      • Consider short-term use of steroids for acute flare-ups and symptom control
  • Supportive therapy
    • physical and occupational therapist
    • heat or cold packs
  • Surgical therapy: arthroplasty, synovectomy, etc
80
Q

Management of RA

A
  • Lifestyle management:
    • Avoid or reduce known triggers: alcohol, seafood, etc
    • Rest and ice affected joints
  • Acute management: NSAIDs, steroids, colchicine
  • Long-term management: ULTs (e.g. allopurinol)
    • Administer anti-inflammatory prophylaxis before initiating ULT
81
Q

Management for osteoporosis

A
  • Lifestyle management:
    • optimize calcium and Vit D intake
    • Encourage physical activity
    • Avoid or minimize use of tobacco, steroids, alcohol
  • Fall prevention
    • Identify and manage any risk factors for falls (e.g. dementia, medication etc)
    • Refer to physiotherapist and occupational therapist
  • Pharmacological therapy:
    • Bisphosphonates: consider risk of esophagitis
    • Denosumab injections
82
Q

Management of carpal tunnel syndrome

A
  • Conservative management:
    • Rest and activity modification
    • Wrist splinting - reduce pressure on nerve
    • Analgesics: corticosteroid injections
  • Surgical intervention: Carpal tunnel release surgery
83
Q

Management of fibromyalgia

A
  • Optimize patient education and supportive therapy for all patients.
  • Consider adding pharmacotherapy for severe pain
  • Engage a multidisciplinary teamfor patients who do not achieve adequate relief.
84
Q

Management of PMR

A
  • Low-dose oral glucocorticoids
    • Usually rapid relief (2-4 weeks)
85
Q

Management of septic arthritis

A
  • Acute management:
    • Native joints:
      • Therapeutic arthrocentesis, repeat as often as needed
      • Synovial fluid analysis after each aspiration - to monitor improvement
    • Prosthetic joints: surgery to remove pus and infected tissue
  • Empirical antibiotics
    • Choice depends on suspected etiology:
      • Staphylococcal (gram-positive in clusters): IV flucloxacillin or vancomycin (if MRSA)
      • Streptococcal (gram-positive in chains) or gram-negative: IV ceftriaxone
    • Change into targeted therapy after MCS
86
Q

Management of osteomyelitis

A
  • Approach:
    • Assess for signs of sepsis and manage accordingly
    • If imaging and blood cultures are inconclusive - consider bone biopsy
    • Consider referral to ID specialist
  • Antibiotic:
    • Empiric antibiotic rarely required
    • Pathogen-directed antibiotics based on culture results for 4-8 weeks
  • Surgical intervention: debridement, amputation in severe cases
87
Q

Management of conjunctivitis

A
  • Supportive therapy
    • Eyelid hygiene - saline irrigation, avoid touching eyes, hand hygiene
    • Warm or cold compresses
    • Stop using contact lenses
  • If bacterial: topical antibiotics (e.g. azithromycin, ciprofloxacin)
88
Q

Management of cataracts

A
  • Referral to ophthalmologist
  • Definitive management: surgery
    • replacing old lens with an intraocular lens implant
89
Q

Management of angle-closure glaucoma

A
  • Emergency ophthalmology consultation
  • Supportive therapy: analgesics, antiemetics
  • Pharmacotherapy: administer the following in succession, 1min apart
    • Direct sympathomimetic: pilocarpine
    • Alpha-2 agonist: apraclonidine
    • Beta blocker: timolol
    • PLUS a systemic carbonic anhydrase inhibitor (e.g. acetazolamide)
  • Interventional therapy:
    • Anterior chamber paracentesis - drainage of aqueous humor
    • Laser peripheral iridotomy
90
Q

Management of open-angle galucoma

A
  • Pharmacotherapy:
    • First-line: topical latanoprost (prostaglandin analogs)
    • Alternative: topical beta blockers
  • Interventional therapy:
    • Laser trabeculoplasty
    • Surgical trabeculectomy
91
Q

Management of atopic dermatitis

A
  • Lifestyle management:
    • Avoid triggers of flares
    • Maintain skin hydration
    • Stress management - supportive psychotherapy
  • Based on severity:
    • Very mild: Non-pharmacological therapy (e.g. moisturizers)
    • Mild-moderate: Consider adding topical steroids
    • Moderate-severe:
      • Escalate non-pharmacological therapy (e.g. wet wrap therapy)
      • Increase potency of topical steroids
      • Consider adding systemic therapy:
        • Phototherapy (UV light)
        • Systemic steroids
  • Treatment of acute flare: topical or oral (for severe) corticosteroids
92
Q

Management of psoriasis

A
  • Based on severity:
    • Mild (3-5% BSA): topical steroids/retinoids or targeted phototherapy
    • Moderate-severe (>5% BSA):
      • Systemic pharmacotherapy - e.g. biologics, such as adalimumab
      • And/or phototherapy (e.g., narrow UVB)
  • Supportive therapy:
    • Skin hydration with moisturizers
    • Reduce alcohol consumption and smoking cessation
  • Complications
    • Psoriatic arthritis: DMARDs (e.g. methotrexate), NSAIDs, intraarticular corticosteroids
93
Q

Management of shingles

A
  • <72h onset: start oral antiviral therapy (e.g. acyclovir)
  • > 72h onset:
    • If new vesicles still appear: oral antiviral therapy
    • No new vesicles: supportive care (analgesia and proper wound care)
94
Q

Management of melanoma

A
  • Surgical excision: full-thickness with appropriate safety margins
    • 0.5-1cm for melanoma in situ
95
Q

Management of cSCC and BCC

A
  • Surgical excisionof the lesion along with a rim of normal skin
    • Cryotherapy may be used in cases of carcinoma in situ
  • Radiotherapy or chemotherapy: for high-risk features or metastasis
96
Q

Management of MDD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-medical
    • Psychotherapy: CBT or interpersonal therapy to address negative thoughts and develop coping skills
    • Lifestyle changes and social support
  • Medical
    • Antidepressants (SSRIs or SNRIs)
    • Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment
97
Q

Management of BPD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-Medical Management:
    • Psychoeducation: Dialectical behavior therapy (DBT)
    • Mood Tracking: Monitor mood, energy, and sleep patterns to identify patterns.
    • Lifestyle Routines: Establish stable daily routines for stability and balance.
    • Consider using a case manager to assist patients with accessing care and support services
  • Medical Management:
    • Medications: usually not indicated
      • May consider mood stabilizers and/or atypical antipsychotics for symptom management
    • Referral to a psychiatrist for ongoing medication and plan management
98
Q

Management of BPAD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Pharmacological:
    • Acute mania: atypical antipsychotics (e.g. quetiapine, aripiprazole)
      • Atypical antipsychotics are frequently used for management of acute mania due to its rapid onset of action.
      • Stop once acute mania symptoms remit and patient is euthymic
    • Bipolar I: mood stabilizers (e.g. lithium, valproate) for 6-12m
      • After starting, recheck lithium/valproate serum levels to ensure it is within therapeutic range.
  • Non-pharmacological: CBT or psychoeducation by GP or psychologist
  • Follow-up: medication control can be managed by GP or referred to a psychiatrist
99
Q

Management of general drug use

A
  • Biological
    • Offer medical detoxification services for severe withdrawal syndrome (e.g. Turning Point, DirectLine)
    • GP to monitor for any physical health complications resulting from substance use
  • Psychological
    • Psychotherapy and counselling to provide for relapse prevention strategies, coping skills, and stress management
    • Screening and treatment of concurrent psychiatric symptoms (e.g. psychosis, mood issues, etc)
  • Social
    • Lifestyle modification - regular exercise and sleep hygiene
    • Social support groups and peer networks
    • Access to community and social resources (e.g. job, housing)
100
Q

Management of GAD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-medical
    • Psychotherapy: CBT or interpersonal therapy to teach coping strategies and challenge negative thought patterns
    • Lifestyle changes and social support
  • Medical
    • Antidepressants (SSRIs or SNRIs)
      • Inform patients clinical response might occur after 4 weeks
    • Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment
101
Q

Management of GAD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-medical
    • Psychotherapy: CBT or interpersonal therapy to teach coping strategies and challenge negative thought patterns
    • Lifestyle changes and social support
  • Medical
    • Antidepressants (SSRIs or SNRIs)
      • Inform patients clinical response might occur after 4 weeks
    • Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment
102
Q

Management of OCD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-medical
    • Psychotherapy: CBT or ERP (Exposure and Ritual Prevention) - exposed to situations that trigger obsessions, and are taught strategies to prevent the compulsive response
    • Lifestyle changes and social support
  • Medical
    • Antidepressants (SSRIs or SNRIs)
      • Inform patients clinical response might occur after 4 weeks
    • Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment
103
Q

Management of PTSD

A
  • Inpatient treatment if failed outpatient treatment, medically or psychologically unstable, risk to self or others
  • Non-medical
    • Psychotherapy: trauma-focused CBT
    • Lifestyle changes and social support
  • Medical
    • Antidepressants (SSRIs or SNRIs)
      • Inform patients clinical response might occur after 4 weeks
      • If there is poor response or tolerability, the patient should be switched to another first- or second-line agent.
    • For individuals with PTSD-associated nightmares:
      • Prazosincan reduce trauma nightmares and improve sleep quality.
    • Follow-up with GP or psychiatrist for assessment of clinical response and dose adjustment
104
Q

Management of alcohol withdrawal syndromes

A
  • Identify and manage any complications:
    • Seizures: IV benzodiazepines (e.g. lorazepam, oxazepam, temazepam)
    • Psychosis: low-dose antipsychotics (e.g. haloperidol)
    • Delirium: High-dose IV benzo
  • Supportive care:
    • Hydration: IV fluid therapy and fluid balance assessment
    • Metabolic and nutritional support:
      • Folate and thiamine supplementation
      • Electrolyte repletion
    • Assess and manage comorbidities (e.g. GI bleeding, sepsis, alcoholic hepatitis, etc.)
  • Follow-up and treatment of alcohol use disorder
    • Therapy and counselling (see drug use mx)
    • Pharmacotherapy: Naltrexone, Acamprosate
    • Management of comorbidity and micronutrient levels
105
Q

Management of cellulitis

A
  • Empirical antibiotics (against GAS and S. aureus)
    • E.g. oral cephalexin, IV ceftriaxone
  • Supportive therapy: elevation of affected limb, analgesics
106
Q

Management of dementia

A
  • Pharmacological: antidementia medications:
    • Cholinesterase inhibitors: donepezil, galantamine
    • NMDA-receptor antagonist: memantine 9for moderate-to-severe AD)
  • Supportive therapy
    • Maintain predictable schedule, familiar home environment
    • Assess need for home care package and liaise with social care worker - ACAS assessment
    • Assess need for move to RCAF for more involved level of care
  • Management of BPSD
    • First-line: non-pharmacological interventions
      • Assess and address any possible causes of agitation (e.g. incontinence, pain, etc)
      • Diversional therapy - physical, cognitive, sensory activities
      • Sleep hygiene
      • Medication review
107
Q

Management of delirium

A
  • Pharmacological: antidementia medications:
    • Cholinesterase inhibitors: donepezil, galantamine
    • NMDA-receptor antagonist: memantine 9for moderate-to-severe AD)
  • Supportive therapy
    • Maintain predictable schedule, familiar home environment
    • Assess need for home care package and liaise with social care worker - ACAS assessment
    • Assess need for move to RCAF for more involved level of care
  • Management of BPSD
    • First-line: non-pharmacological interventions
      • Assess and address any possible causes of agitation (e.g. incontinence, pain, etc)
      • Diversional therapy - physical, cognitive, sensory activities
      • Sleep hygiene
      • Medication review
108
Q

Management of NOF fracture

A
  • Acute management:
    • Primary assessment
    • Analgesia (oral, parenteral, and especially region, such as fascia iliaca block)
    • Pre-op assessment:
      • Basic pre-op work up (FBE, UEC, coagulation profile, group and hold, ECG)
      • Fitness for surgery: identify and treat any comorbidities (e.g. diabetes, anticoagulation)
      • Capacity to consent
      • Consider fasting time and fluid management
  • Operative management: type of surgery depends of fracture type, displacement, etc
    • Fixation using a dynamic hip screw, partial hip replacement, THR
  • Peri-operative management
    • Prevention of complications (e.g. VTE, pressure ulcers, delirium)
    • Weight-bearing status and urge early mobilisation
    • Minimize interventions (IV, IDC, etc)
  • Long-term management:
    • Falls and fracture prevention (OT referral and home modification, Vit D supplement, etc)
    • Physiotherapy - strengthening muscle and mobility rehabilitation
    • Patient and family support and education
109
Q

Management of Parkinson’s

A
  • Supportive care:
    • Rehabilitation: involve physiotherapy for gait and balance training
    • Falls prevention and education
    • Advanced care planning:
      • prognosis and end-of-life choices should be discussed early
      • consider referral to palliative care for symptom management
  • Pharmacological treatment
    • First-line: Levodopa, a dopamine agonist
    • Inform patient of potential side effects (e.g. dyskinesia) and to avoid sudden discontinuation
  • Treatment of associated symptoms:
    • MDD: treat with antidepressants (SSRIs, SNRIs)
    • Dementia: rivastigmine (cholinesterase inhibitor)
    • Autonomic dysfunction: based on presentation
    • Sleep disorders: improve sleep hygiene, consider melatonin
110
Q

Management of sepsis

A

Oxygen: Maintain oxygen saturation above 94%.
Intravenous fluids: Administer fluids to restore and maintain adequate circulating volume.
Blood cultures: Collect blood samples for culture.
Intravenous antibiotics: Administer broad-spectrum antibiotics promptly.
Urine output measurement: Monitor and document urine output.
Serum lactate: Measure lactate levels to assess tissue perfusion.

MD3 (9 decks)

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