Medical Flashcards
- What is Rx for undifferentiated N/V?
- 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
- What is the Rx for Vestibular nausea (motion sickness, aeromedical evac, vertigo)?
If pt ≥21: Prochlorperazine 12.5mg IM, otherwise Ondansetron as per N/V
[Opposite for prophylaxis for immobilised spinal injury or eye trauma]
- What does undifferentiated N/V include:
Secondary to cardiac chest pain, opioid analgesia, cytotoxic drugs/radiotherapy, severe gastro
- What needs to be considered in regards to Ondansetron and Tramadol?
Ondans is antagonist at same site that tramadol is active as analgesic, therefore use prochlorperazine if possible.
- What is the Rx for BGL<4 and responding to commands?
Glucose 15g oral
Inadequate response after 15mins, consider repeat dose, max 30g, or Dextrose IV or Glucagon IM
- What is the Rx for BGL<4 and NOT responding to commands?
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
- What are the clinical features of DKA/HHS?
Dehydration, tachypnoea, polydipsia, polyphagia, polyuria, Kussmaul’s breathing, confusion
- What is the Rx for BGL>11?
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
- What is the Rx for GCSE?
- 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)
- What needs to be confirmed prior to Adrenaline administration for Anaphylaxis?
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
- What is the Rx for Anaphylaxis?
- 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
- Rx for pt who remain hypotensive after two doses of Adrenaline for anaphylaxis?
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
- What is the Rx for Inadequate/EP perfusion? non-cardiogenic or hypovolaemic
If sepsis suspected and chest clear and MICA not immediately available - Confirm MICA support
- NS up to 20mL/kg over 30mins
- What are the Sepsis criteria? When are they relevant?
- 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
- What are the typical s/s of meningococcal septicaemia?
- 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
- What is the Rx for meningococcal septicaemia?
- 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
- What is the Rx for Opioid OD?
- 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)
- What are the s/s of TCA OD?
QRS>0.12, Hypotension, Ventricular arrhythmias
Severe: coma, resp depression, conduction delays, PVC, SVT, VT, Hypotension, Seizures, ECG changes
- What are the common TCAs?
- Amitriptyline (most common) - Endep/Entrip
- Clomipramine
- Dosulepin
- Doxepin
- Imipramine
- Nortriptyline
- What is the Rx for Agitation?
- Mild
- Moderate
- Severe
- 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
- What is required in post sedation care?
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
- SAT scores:
+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
- Key considerations and s/s of organophosphate poisoning:
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
- Rx for autonomic dysreflexia:
- 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
- What are the steps for assessment and mx of a suspected stroke?
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
- What is the eligibility criteria for ACT-FAST? 4
- Deficits are new or significantly worse
- Known onset of symptoms <24hrs
- Living at home independently with at most minor assistance
- No evidence of mimics: not comatose, no seizure, BGL>2.8, no definitely known malignant brain cancer
- Stroke mimics: SMITH MISSES
Seizures Migraine Intoxication Tumour - Brain Hypo/Hyperglycaemia
Multiple sclerosis Inner ear disorder (vertigo) Sepsis Syncope Electrolyte disturbance Subdural Haematoma
- When is an ischaemic stroke or ICH more likely? And Tx options?
- 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
- What is the Rx for Palliative care pts?
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
- What needs to be considered for TBI when using Agitation CPG?
- 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
- Considerations for paed and adolescent pt for Agitation CPGs:
- <16yrs: RCH (or MCH) must be consulted prior to any sedation
- 16 + 17yrs: consult with clinician for most appropriate hospital
