Medical Flashcards
Nausea and vomiting STOP POINT - Undifferentiated - Dehydrated - vestibular - Prophalaxis
STOP- Prochloperazine not to be given IV
Undifferentiated:
Ondansetron 4mg orally/IV or in combination
- repeat 4mg after 5/10 minutes if symptoms persist (max 8)
- If known allergy to ODT and >21 years, Prochlorperazine 12.5mg IM
Dehydrated-
Less than adequate perfusion
- consider Normal Saline IV (max 40ml/kg) titrated to patient response. Consult for further fluid. If consult unavailable repeat N/S 20ml/kg (total 60ml/kg)
- Adequate perfusion but significant dehydration, consider NS 20ml/kg IV over 30/60
Vestibular nausea:
- potential for motion sickness
- planned aeromedical evactuation
- vertigo
If pt >21 years Prochlorperazine 12.5mg IM
If <21 years ODT as per N+V
Prophalaxis
- awake pt with potential spinal
- penetrating eye injury
- Ondansetron
If known C/I to ODT Prochlorperazine
Hypoglycaemia
BGL <4- responding to commands.
Glucose 15g oral
If inadequate response after 15 minutes
Consider repeat Glucose 15g once or Dextrose IV or Glucagon 1 IU IM
BGL <4 not responding to commands IV cannula large bore, large vein Confirm patency - Dextrose 10% 15g (150ml) IV Normal saline 10ml flush
- if GCS or BGL not returned to normal after 5-10 minutes
- Dextrose 10% 10g (100ml) titrating to effect
- normal saline flush
If unable to insert IV
- Glucagon 1 IU IM
Hyperglycaemia
Clinical features DKA/HHS
- dehydration
- tachypnaea
- polydipsia
- polyohagia
- polyuria
- kussmauls breathing
- hx diabetes
BGL >11 AND clinical features of DKA/HHS AND less than adequate perfusion
- Normal saline 20ml/kg IV titrated to perfusion status
- consult for further if needed
Seizures
Stop point
Generalised convulsive status epilepticus
STOP
- Consider other causes - hypoglycaemia, hypoxia, head injury, stroke, ICH, meningitis
- Consider eclampsia in pregnant pt’s with no prior seizure history
- consult for midazolam for subtle SE
Generalised convulsive status epilepticus
- Mx airway and ventilate as required
- if patent o2
- Midazolam 10mg IM
- repeat Midazolam 10mg IM at 10/60 once only if seizure remains
- small <60kg, frail or elderly patients should be administered 5mg, rpt 5mg once only
Anaphalaxis
Criteria
Respiratory
Abdo- N,V,D, pain
Skin
Hypotension
Or isolated respiratory distress or hypotension with known exposure
Stop the trigger- remove if able.
Any patient under anaphalaxis must be transported to hospital
Require continuous monitoring as deterioration can occur
Do not sit or walk the patient
- Adrenaline 500mcg IM
- repeat 5/60 as required
MICA if risk factors or not responding
IV
o2 as per o2
Airway oedema
Adrenaline 5mg neb
Bronchospasm
- Salbutamol 5mg neb or pMDI 4-12 doses
- repeat 20 min intervals if required
- Ipatropium bromide 500mcg neb or pMDI 8 doses
- Dexamethesone 8mg IV/oral
Cardiovascular
Hypotensive <90 despite initial adrenaline
- NS max 40ml/kg titrated
Inadequate réponse to adrenaline or hx of heart failure or beta blocked
- Glucagon 1mg IV/IM
Repeat once @ 5 minutes if required
Overdose- Opioids
Safety points
Heroin
Other opioid OD
Possible opioid OD
- Paramedic safety
- Aware pt becoming aggressive
- sharps
- Consider poly pharmacy OD, prescription medications- fentanyl patches, morphine, codeine, methadone.
- Exclude other causes altered conscious state- BGL.
- clinical signs opioid OD
Heroin OD
- Assist and maintain airway/ventilation
- Nalaxone 1.6mg-2mg IM
Adequate response
- consider tx
- treat and refer
Inadequate response
- tx without delay
- Consider Igel
Other Opioid
- Assist and maintain airway/ventilation
- Naloxone 100mcg IV
- repeat Naloxone 100mcg every 2 minutes (max 2mg) until patient is adequately ventilating
- If unable to gain IV, 400mcg IM once only
- Consider iGel
- tx without delay
