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**CPGs 2020 > Medical > Flashcards

Medical Flashcards

1
Q
  1. What is Rx for undifferentiated N/V?
A
  • Ondansetron 4mg ODT, repeat after 5-10mins - if unable to tolerate ODT, or IV in situ, 8mg IV
  • C/I to Ondans and ≥21years, Prochlorperazine 12.5mg IM
  • If dehydrated:
    < adequate perfusion: NS max 40mL/kg, consult for further or additional 20mL/kg
    Adequate perfusion but significant dehydration: NS 20mL/kg over 30mins
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2
Q
  1. What is the Rx for Vestibular nausea (motion sickness, aeromedical evac, vertigo)?
A

If pt ≥21: Prochlorperazine 12.5mg IM, otherwise Ondansetron as per N/V
[Opposite for prophylaxis for immobilised spinal injury or eye trauma]

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3
Q
  1. What does undifferentiated N/V include:
A

Secondary to cardiac chest pain, opioid analgesia, cytotoxic drugs/radiotherapy, severe gastro

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4
Q
  1. What needs to be considered in regards to Ondansetron and Tramadol?
A

Ondans is antagonist at same site that tramadol is active as analgesic, therefore use prochlorperazine if possible.

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5
Q
  1. What is the Rx for BGL<4 and responding to commands?
A

Glucose 15g oral

Inadequate response after 15mins, consider repeat dose, max 30g, or Dextrose IV or Glucagon IM

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6
Q
  1. What is the Rx for BGL<4 and NOT responding to commands?
A

IV cannula in large vein and confirm patency

  • Dextrose 10% 15g (150mL) and 10mL flush - GCS or BGL not normal after 5-10mins, another 10g (100mL) titrating to effect
  • Unable to insert IV - Glucagon 1 IU IM
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7
Q
  1. What are the clinical features of DKA/HHS?
A

Dehydration, tachypnoea, polydipsia, polyphagia, polyuria, Kussmaul’s breathing, confusion

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8
Q
  1. What is the Rx for BGL>11?
A

Less than adeq perf and clinical features of DKA/HHS - NS 20mL/kg titrated to perfusion status

  • consult for further doses, consider reduced vol for elderly or impaired cardiac/renal
  • consider antiemetic
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9
Q
  1. What is the Rx for GCSE?
A
  • Mx airway and ventilation as required, if airway patent high flow O2
  • Midazolam 10 mg IM - No response after 10mins - repeat full dose, consult for further
  • 5mg for <60kg/elderly/frail (repeat at 5mins)
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10
Q
  1. What needs to be confirmed prior to Adrenaline administration for Anaphylaxis?
A

Sudden onset of symptoms (usually <30mins up to 4hrs) AND
≥2 of RASH with or without confirmed antigen exposure
- Respiratory distress (SOB, wheeze, cough, stridor)
- Abdominal symptoms (N/V/D, pain/cramps)
- Skin/mucosal symptoms (hives, welts, itch, flushing, angioedema, swollen lips/tongue)
- Hypotension (or ACS)

OR Isolated hypotension <90 following exposure to known antigen
OR isolated respiratory distress following exposure to known antigen

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11
Q
  1. What is the Rx for Anaphylaxis?
A
  • Do not allow pt to stand or walk
  • Adrenaline 500 mcg IM - repeat at 5mins until satisfactory result/side effects
  • Request MICA if risk factors or unresponsive to initial Adrenaline
  • Insert IV
  • O2
  • Stridor: Adrenaline 5mg neb, consult for repeat, notify hospital
  • Bronchospasm: Salbutamol 5mg neb or 4-12 doses pMDI (repeat at 20mins) + IB 500mcg neb or pMDI 8 doses + Dexa 8mg IV/Oral
  • BP<90 despite adrenaline: NS max 40mL/kg, consult for further or 20mL/kg
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12
Q
  1. Rx for pt who remain hypotensive after two doses of Adrenaline for anaphylaxis?
A

Glucagon 1mg IV/IM, repeat once at 5mins - in the setting of pt with phx of heart failure or taking beta blockers
Must not delay continued adrenaline administration

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13
Q
  1. What is the Rx for Inadequate/EP perfusion? non-cardiogenic or hypovolaemic
A

If sepsis suspected and chest clear and MICA not immediately available - Confirm MICA support
- NS up to 20mL/kg over 30mins

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14
Q
  1. What are the Sepsis criteria? When are they relevant?
A
  • Temp >38 or <36
  • HR >90
  • RR >20
  • BP <90
    Presence of infection or severe clinical insult such as multi trauma leading to systemic inflammatory response syndrome
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15
Q
  1. What are the typical s/s of meningococcal septicaemia?
A
  • Typical purpuric rash
  • Septicaemia signs: fever/rigor/joint muscle pain, cold hands and feet, tachy/hypotensive, tachypnoea
  • Meningeal signs: headache, photophobia, neck stiffness, n/v, ACS
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16
Q
  1. What is the Rx for meningococcal septicaemia?
A
  • IV access: Ceftriaxone 1g IV, dilute with water for injection to make 10mL, administer over 2mins - Rx as per inadeq perf
  • No IV access: Ceftriaxone 1g IM, dilute with 3.5mL 1% Lignocaine to make 4mL, administer into upper lateral thigh or other large muscle mass
17
Q
  1. What is the Rx for Opioid OD?
A
  • Heroin: Naloxone 1.6-2mg IM - assist and maintain airway/ventilation - inadequate response after 10mins, Tx w/o delay and consider SGA
  • Other opioid: Naloxone 100mcg IV, repeat every 2mins (max 2mg), assist and maintain airway/ventilation, if unable to insert IV - 400mcg IM (single dose)
18
Q
  1. What are the s/s of TCA OD?
A

QRS>0.12, Hypotension, Ventricular arrhythmias

Severe: coma, resp depression, conduction delays, PVC, SVT, VT, Hypotension, Seizures, ECG changes

19
Q
  1. What are the common TCAs?
A
  • Amitriptyline (most common) - Endep/Entrip
  • Clomipramine
  • Dosulepin
  • Doxepin
  • Imipramine
  • Nortriptyline
20
Q
  1. What is the Rx for Agitation?
    - Mild
    - Moderate
    - Severe
A
  • Mild: Olanzapine 10mg oral - 5mg for elderly/frail, <60kg or significant effect from sedating drug/alcohol - repeat dose at 20mins if pt remains mildly agitated
  • Moderate: Midazolam 5-10mg IM - 2.5-5mg for elderly/frail, <60kg, SBP<100 or significant effect from sedating drug/alcohol - repeat dose at 10mins if necessary, max 20mg, consult for further - consider Olanzapine if pt remains agitated but becomes cooperative
- Severe: Ketamine IM
<60kg 200mg
60-90kg 300mg
>90kg 400mg
Consult for further if required, if pt hyperthermic or increased muscle tone consult for midazolam IV or IM
21
Q
  1. What is required in post sedation care?
A 
Airway mx
supplemental O2 - route if ketamine used
use of capnography where available
perfusion mx - inadequate perf
temp mx
reassessment and mx of clinical causes of agitation
insert IV
22
Q
  1. SAT scores:
A

+3: violent + continual loud outbursts
+2: very anxious/agitated and loud outbursts
+1: restless and talkative
-1: rouses to name called
-2: response to physical stimulation, few recognisable words
-3: no response to stimulation

23
Q
  1. Key considerations and s/s of organophosphate poisoning:
A

Look out for anticholinesterase on label - remove contaminated clothing and wash skin with soap and water, while minimising staff involved and transfers between vehicles
S/S: excessive cholinergic effects - salivation, bronchospasm, bradycardia - also sweating and nausea

24
Q
  1. Rx for autonomic dysreflexia:
A
  • Confirm previous SCI at T6 or above with severe headache and/or SBP>160
  • Identify and Rx possible causes: distended bladder, ensure IDC not kinked, Mx pain
  • If SBP still >160, GTN 300mcg (no prev admin) or 600mcg, repeat 10/60 until symptoms resolve, side effects or BP<160
25
Q
  1. What are the steps for assessment and mx of a suspected stroke?
A

Determine onset time, consider mimics, consider co-morbidities, perform MASS (if +ve <24hrs perform ACT-FAST), assess ECG for possible AF:
- #1 MASS +ve ≥12hrs and ACT-FAST -ve or suspected TIA: Tx to closest thrombolysing stroke centre

  • # 2 MASS +ve <12hrs and ACT-FAST -ve: IV 18G in large vein, Tx to nearest thrombo centre, consider R/V with MSU, notify hospital with details/name/DOB
  • # 3 MASS +ve <24hrs and ACT-FAST +ve: ECR eligible, IV 18G large vein, consider R/V with MSU, pre-notify
26
Q
  1. What is the eligibility criteria for ACT-FAST? 4
A
  1. Deficits are new or significantly worse
  2. Known onset of symptoms <24hrs
  3. Living at home independently with at most minor assistance
  4. No evidence of mimics: not comatose, no seizure, BGL>2.8, no definitely known malignant brain cancer
27
Q
  1. Stroke mimics: SMITH MISSES
A 
Seizures
Migraine
Intoxication
Tumour - Brain
Hypo/Hyperglycaemia
Multiple sclerosis
Inner ear disorder (vertigo)
Sepsis
Syncope
Electrolyte disturbance
Subdural Haematoma
28
Q
  1. When is an ischaemic stroke or ICH more likely? And Tx options?
A
  • Rapid deterioration in conscious state and GCS<8
  • Severe headache
  • N/V
  • Bradycardia/hypertension

Tx: awake - nearest stroke hospital
comatose - neurosurgical centre - RMH, SVH, Austin, Alfred or MMC

29
Q
  1. What is the Rx for Palliative care pts?
A

Community palliative care service unavailable - cross check calculations with partner/clinician
- Rx N/V as per CPG
- Rx pain, agitation caused by pain or dyspnoea with Morphine max (20mg) subcutaneously
- Treat mild agitation not caused by pain with Midazolam 2.5 mg S/C
Morphine and Midazolam should not be administered to same pt unless under direction of community palliative care service to due risk of resp depression

30
Q
  1. What needs to be considered for TBI when using Agitation CPG?
A
  • Agitation in traumatic/hypoxic brain injury must be managed with judicious analgesia
  • Hypotensive effects of midaz can be detrimental to pt outcomes
  • Mild-moderate acute TBI (GCS 10-14) - sedation can only be given after consultation with clinician
31
Q
  1. Considerations for paed and adolescent pt for Agitation CPGs:
A
  • <16yrs: RCH (or MCH) must be consulted prior to any sedation
  • 16 + 17yrs: consult with clinician for most appropriate hospital

**CPGs 2020 (19 decks)

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