Management of medical emergencies

Question 1

What is the sequence for ALS?

Answer 1

Check for danger Airway Assess for signs of life Airway adjuncts Breathing Non re-breath mask 15L/min Chest compressions Shockable rhythms Drugs to consider Reversible causes

Question 2

What are some reversible causes for stopping breathing?

Answer 2

Question 3

What is the adult choking treatment?

Answer 3

Question 4

What is asthma?

Answer 4

A leading cause of death in young adults Cardiac arrest in the asthmatic is often a terminal event due to: Severe bronchospasm and mucous plugging Cardiac arrhythmias due to hypoxia Dynamic hyperinflation due to gas trapping and increased transthoracic pressure Tension pneumothorax – often bilateral.

Question 5

What are the signs someone’s having an asthma attack?

Answer 5

A – Noisy laboured breathing +/- wheeze May be unable to complete sentences Accessory muscles of respiration

B – RR , if slow may be terminal, PEF < 50%, SpO2

Wheeze on auscultation, ? Tracheal deviation, ? Hyper-resonance

C – Heart rate

D – Initially alert but may deteriorate rapidly

E – Cyanosis = late /terminal event

Question 6

How should you treat someone with an asthma attack?

Answer 6

O2,

Nebulised salbutamol 5mg

Oral prednisolone 40-50mg

ABG’s

Repeat nebulisers every 15 mins

Consider IV magnesium sulphate 1.2 – 2g over 20 mins

Correct fluid / electrolyte disturbances esp K+

Chest x-ray

Admit

Question 7

What is anaphylaxis?

Answer 7

Severe, life-threatening, systemic hypersensitivity reaction

Rapid changes in Airway +/- Breathing +/- Circulation

usually with skin and mucosal changes.

Question 8

What are the signs and symptoms of anaphylaxis?

Answer 8

Airway swelling

Lip and tongue swelling

Difficulty in breathing and swallowing

Globus Hoarse voice

Dysphagia

Stridor

Skin changes often the first feature and are present in over 80% of anaphylactic reactions:

• Erythema patchy, or generalised
• Urticaria (hives) anywhere on the body
• Angioedema swelling of mucosa
• Eyelids, throat, tongue, lips.

Question 9

What’s the management of anaphylaxis?

Answer 9

IM doses of 1:1000 adrenaline (repeat after 5 min if no better)

• Adult or child more than 12 years: 500 micrograms IM (0.5mL)
• Child 6 ‐12 years: 300 micrograms IM (0.3mL)
• Child 6 months ‐ ?6 years: 150 micrograms IM (0.15mL) •Child less than 6 months: 150 micrograms IM (0.15mL)

Steroids

Antihistamines

Oxygen

IV fluids

500 – 1000 ml IV bolus in adults

20 ml/Kg IV bolus in child

Monitor response – give further bolus as necessary crystalloid (0.9% sodium chloride or Hartmann’s)

Avoid Colloid, if colloid thought to have caused reaction

Question 10

What are some acute coronary syndromes?

Answer 10

• Unstable Angina
• Non ST elevation MI
• ST elevation MI

Question 11

How can you assess for acute coronary syndromes?

Answer 11

A – Short of Breath – O2

B – Shallow and fast

C – Tachycardia / BP /Cap refill variable

D – AVPU - A

E – Peripheral oedema

Question 12

How can you manage acute coronary syndromes?

Answer 12

Morphine – IV

Oxygen – High flow

Nitrates

Aspirin – 300mg orally crushed or chewed

Keep patient sitting up and consider an anti-emetic

Question 13

What is epilepsy?

Answer 13

Aura/Warning

Immediate loss of consciousness

Rigid (tonic phase)

Widespread jerking (clonic phase)

Incontinence

Flaccid after a few minutes

Consciousness is regained after a variable period

Patient may remain confused

Question 14

What triggers epliepsy?

Answer 14

Hunger

Some drugs

TCA’s

Alcohol

External stimuli, flashing lights etc

Non compliance with medications

Question 15

What is the management of epilepsy?

Answer 15

A-Maintain patent airway.

B- Give Oxygen

C

D-U on AVPU scale

E-Convulsions

Prevent patient form damaging themselves

Recovery position after fits have ceased

No medications, await recovery

Question 16

What should you do if someone is in status epilepticus?

Answer 16

Epileptic seizure or repeated seizures lasting 30 mins + Mortality of 20%

Maintain airway & give oxygen

Call an ambulance, transfer to hospital

Check blood glucose

If seizures persist for 5 mins give 10mg midazolam (buccal/intranasal/IV/IM/PR)

Repeat if no recovery within 10 minutes

Transient convulsions can occur during fainting due to cerebral anoxia

Question 17

What is hypoglycaemia?

Answer 17

Rapid onset

Irritability

Sweating

Rapid/full pulse

Shaking/fitting

Blood glucose <3mmol/l

Unconsciousness

Question 18

What is hyperglycaemia?

Answer 18

Slow onset

Drowsy

Dry mouth/skin

SOB

Slow/weak pulse

Ketoacidosis (pear drops)

Blood glucose >10mmol/l

Question 19

What is the management of hypoglycaemia?

Answer 19

Glucose tablets/powder

“Hypostop” gel

If unconscious give 50ml 50% glucose IV

SC glucagon 1mg

Question 20

What is choking?

Answer 20

Airway Obstruction (partial/complete)

Coughing and spluttering

Difficulty breathing

Breathing noisy, wheeze or stridor

“Paradoxical “ chest or abdominal movements

Cyanosed

Loss of consciousness

Question 21

What is the management of choking?

Answer 21

Allow patient to cough vigorously

Removal of any obvious FB’s from mouth/pharynx

5 back slaps followed by 5 abdominal thrusts

If unconscious start CPR

Question 22

What causes syncope? (fainting)

Answer 22

Pain

Anxiety

Fatigue

Fasting

High temperature and humidity

Question 23

What happens in syncope?

Answer 23

Caused by a lack of oxygen reaching the brain e.g. overstimulation of IX, hypotension

Premonitory dizziness, weakness & nausea

Pallor and sweating

Cold moist skin

Pulse initially slow & weak, becoming full & bounding

Low blood pressure

Loss of consciousness

Question 24

What is the management of syncope?

Answer 24

Lay flat & lift legs (the patient’s)

Loosen tight clothing around neck

Monitor pulse

Give sweetened drink on regaining consciousness

Exclude other causes

Question 25

What is adrenal insufficiency?

Answer 25

Acute deficiency of cortisol and aldosterone when the demand exceeds adrenal glands production. Happens if there’s an abrupt withdrawal of steroids or in periods of physiological stress.

May also be brought about by:

• Infection
• Trauma
• Surgery
• Pregnancy
• General anaesthesia
• Hypermetabolic states

Question 26

What are the signs and symptoms of adrenal insuffiency?

Answer 26

Hypotension, especially postural Weak/confused

Circulatory collapse may be severe with feeble rapid pulse and soft heart sounds

Pyrexia is common and may be due to underlying infection. Anorexia, nausea, vomiting, acute abdo pain

The patient may show increased motor activity progressing to delirium or seizures

Question 27

What’s the management of adrenal insufficiency?

Answer 27

Lay flat and raise legs

Give oxygen

Hydrocortisone 200mg IV Fluids ++ IV

Treat the underlying precipitating disorder, e.g. infection, with antibiotics

Ambulance & transfer to hospital

Question 28

What’s SBAR?

Answer 28

Written/verbal communication of events:

Situation

Background

Assessment/Actions

Response/Recommendations

Question 29

What is the AVPU scale?

Answer 29

(an acronym from “alert, voice, pain, unresponsive”) is a system by which a first aider, ambulance crew or health care professional can measure and record a patient’s responsiveness, indicating their level of consciousness.