Medical

Question 1

ICH CPG s/s in stroke guideline (SPANGS)

Answer 1

• GCS < 10 and the patient is not alert.
• The patient complained of severe headache.
• Nausea and vomiting is present.
• Slow pulse and hypertension is noted.
• Pupil abnormalities are noted.
• Abnormal patterns of respiration are noted.

Question 2

preferred method of N+V mx in the pregnant pt?

Answer 2

fluid admin if dehydrated
… be cautious with ondansetron
… do not give stemetil

Question 3

if IV or Oral routes are inaccessible; can ondansetron be given IM? if so, what dose?

Answer 3

yes; 4mg (2ml) repeat 4mg (2ml) if required - do not give the full 8mg (4ml) as a single dose.

Question 4

long QT interval in males?

Answer 4

> 440ms

Question 5

long QT interval in women?

Answer 5

> 460ms

Question 6

what is the QT interval?

Answer 6

from beginning of Q wave to end of T wave

Question 7

dehydrated guideline - < than adequate perfusion mx?

Answer 7

1. Consider Normal Saline IV (max. 40 mL/kg)
   titrated to patient response.
2. Consult for further fluid. If consult unavailable repeat Normal Saline 20 mL/kg IV (total 60 mL / kg)

Question 8

dehydrated guideline - adequate perfusion but significant dehydration mx?

Answer 8

Consider Normal Saline 20 mL/kg IV over 30

minutes

Question 9

other seizure causes listed in CPG?

Answer 9

hypoglycaemia, head injury, hypoxia, stroke / ICH, electrolyte disturbance, meningitis, eclampsia.

Question 10

Anaphylaxis < adequate perfusion fluid mx?

Answer 10

Less than adequate perfusion:
- Consider Normal Saline IV (max. 40 mL/kg) titrated to patient response

• Consult for further fluid. If consult unavailable repeat Normal Saline 20 mL / kg IV

Question 11

Sepsis: inadequate or extremely poor perfusion fluid mx?

Answer 11

If sepsis is suspected and chest is clear and MICA is
not immediately available:
- Confirm request for MICA support
- Normal Saline up to 20 mL/kg IV over 30 minutes

Question 12

what is the treatment goal for pt’s under ‘other opioid overdose’?

Answer 12

• target the return of adequate ventilation

- complete reversal of symptoms is not advised

Question 13

naloxone dose for -other opioid mx’

Answer 13

• Naloxone 100 mcg IV
- Repeat Naloxone 100 mcg IV every 2 minutes
(max. 2 mg) until patient is adequately self-ventilating
• If unable to insert IV – Naloxone 400 mcg IM (single dose
only)

Question 14

in what circumstances should you administer lower doses of Midazolam under the agitated pt guideline?

Answer 14

elderly, frail, weight < 60 kg, SBP < 100mmHg, or sedating drug / alcohol involvement

Question 15

under mild/mod agitation what is the dose regime and max?

Answer 15

Midazolam 5 - 10 mg IM
- Administer lower doses (2.5 – 5 mg IM) for elderly, frail, weight < 60 kg, SBP < 100mmHg, or sedating drug / alcohol involvement

• Repeat at 10 minute intervals if necessary, titrated to patient response
• Max. total dose 20 mg. Consult for further if required

Question 16

under the extreme agitation what is the dose regimen and max dose of midaz if ketamine is not able to be used?

Answer 16

If Ketamine not available: Midazolam up to 20 mg IM

• Repeat at 10 minute intervals if necessary, titrated to patient response
• Max. total dose 40 mg. Consult for further if required

Question 17

dose of IV glucagon and max in anaphylaxis pt with b-blocker unresponse to IMI adren?

Answer 17

For patients persistently unresponsive to Adrenaline
(especially if taking beta blocking medication) the
administration of Glucagon 20-30 mcg / kg (max 1 mg)
IV can be considered under consultation

Question 18

max dose for Paed opiod OD?

Answer 18

400mcg max single dose, with 1 repeat of original dose at 10/60