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Medical CPGs Flashcards

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USMLE® Step 1 flashcards
1
Q
  1. When is sepsis criteria relevant and what are the vital sign criteria?
A 
Relevant in the presence of an infection or severe clinical insult such as multi trauma leading to systemic inflammatory response syndrome
2 or more of:
- Temp > 38 or < 36
- HR > 90
- RR > 20
- BP < 90
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2
Q
  1. When can you give Ceftriaxone to inadequate perfusion?
A

If sepsis is suspected and prolonged transport times (>1 hour). Consult!

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3
Q
  1. What is the treatment for inadequate/extremely poor perfusion?
A

If sepsis is suspected and chest is clear and MICA is not immediately available:

  • Confirm MICA request
  • NS up to 20mL/kg over 30mins
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4
Q
  1. What are the key S/S of Meningococcal Septicaemia?
A
  • Typical purpuric rash
  • Septicaemia: fever, rigor, joint/muscle pain, cold hands and feet, tachycardia, hypotension, tachypnoea
  • Meningeal: headache, photophobia, neck stiffness, N/V, ACS
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5
Q
  1. What is the treatment for Meningococcal Septicaemia?
A
  • IV access: Ceftriaxone 1g IV, dilute with water to make 10mL and administer over 2mins, If inadequate perfusion Rx as per CPG
  • No IV access: Ceftriaxone 1g IM, dilute with 1% Lignocaine HCL to make 4mL, administer into upper lateral thigh or other large muscle mass
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6
Q
  1. What needs to be considered before giving opioids for headaches?
A

They are of limited benefit in treatment of migraine. Morphine may not be effective and may be associated with delayed recovery. Fentanyl should only be used to treat severe headache where other measures have failed and transport to the facility is prolonged.

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7
Q
  1. What are the key signs that are suggestive of intracranial event (headache CPG)?
A

Sudden onset headache - thunderclap

  • Abnormal neurological findings or atypical aura
  • new onset headache in older patients (>50) or those with a Hx of cancer
  • ACS or collapse
  • seizure activity
  • fever or neck stiffness
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8
Q
  1. What is important to note with cluster headaches Rx?
A

May not gain benefit from analgesia, high flow O2 may be beneficial if the patient can confirm their diagnosis.

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9
Q
  1. What is the treatment for headache of any severity?
A

Paracetamol 1000mg oral, or 500mg for weight < 60kg, frail/elderly, malnourished or liver disease
With/without Prochlorperazine 12.5mg IM
If after 15mins headache remains severe and hospital >15mins, treat with IV/IN Fentanyl, aim to reduce pain to < 7.

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10
Q
  1. What are the stroke mimics?
A
  1. Hypo/hyperglycaemia,
  2. seizures,
  3. sepsis,
  4. intoxication,
  5. brain tumour,
  6. inner ear disorder,
  7. subdural haematoma,
  8. syncope,
  9. migraine,
  10. electrolyte disturbance
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11
Q
  1. What are significant co-morbidities for stroke?
A
  • Dementia
  • Significant pre-existing physical disability
    They do not automatically exclude a pt from stroke interventions.
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12
Q
  1. When is ICH more likely?
A
  1. Rapid deterioration in conscious state and GCS < 8
  2. Complaint of severe headache
  3. N/V
  4. Bradycardia/hypertension
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13
Q
  1. What is thrombolysis eligibility timeframe? What is the endovascular clot retrieval timeframe?
A
  • Thrombolysis: 12 hours from symptom onset

- ECR: 24 hours from symptom onset - remove large vessel clots

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14
Q
  1. What are the Rx options for strokes?
A
  • MASS positive ≥ 12 hrs and ACT-FAST negative or suspected TIA - non-urgent Tx to closest thrombolysing stroke centre
  • MASS positive < 12 hours and ACT-FAST negative - non-ECR eligible stroke, IV access, Tx to nearest thrombo stroke centre, consider RV with MSU, notify hospital
  • MASS positive <24 hours and ACT-FAST positive at time of loading - possible ECR eligible stroke, IV access, Tx to ECR centre or RV with MSU
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15
Q
  1. What is the eligibility criteria for ECR with ACT-FAST?
A
  • Deficits are new or significantly worse
  • Known onset of symptoms < 24 hours
  • Living at home independently with at most minor assistance
  • No evidence of stroke mimics: pt not comatose/near comatose, no seizure preceding, BGL >2.8, no definitely known malignant brain cancer
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16
Q
  1. What are the main concerns with using Midazolam?
A

Pronounced effects on BP, conscious state, ventilations and airway tone.

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17
Q
  1. What is the treatment for GCSE?
A
  • Manage airway and ventilation as required
  • If airway patent, high flow O2
  • Midazolam 10mg IM; 5mg if < 60kg, frail/elderly, repeated once at a 5min interval if required
  • No response after 10mins, repeat 10mg IM once, consult for further doses
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18
Q
  1. What are the C/I and side effects of Prochlorperazine?
A

C/I: 1. Circulatory collapse, CNS depression, Hypersensitivity, <21 years and Pregnancy
Side effects: drowsiness, blurred vision, hypotension, sinus tachycardia, skin rash, extrapyramidal reactions

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19
Q
  1. What is the Rx for paediatric GCSE?
A
  • Mx airway and ventilation as required
  • If airway patent, high-flow O2
  • Midazolam IM: Medium child 2.5-5mg, Small child 2.5mg, Small/Large infant 1mg, Newborn 0.5mg
  • Seizure activity continues >10mins, repeat original dose once only, consult for further
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20
Q
  1. What is the Rx for paediatric Meningococcal Septicaemia?
A

Ceftriaxone 50mg/kg IM (max 1g) - dilute 1000mg with 3.5mL Lignocaine 1% and administer into upper lateral thigh

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21
Q
  1. What are the systemic illnesses in TCG?
A 
Poorly controlled hypertension
Ischaemic heart disease
Symptomatic COPD
Chronic renal or liver failure
Obesity
Controlled/uncontrolled CCF
- Pregnancy; Age<12 or >55
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22
Q
  1. What are the TCG vital signs?
A
  • HR <60 or >120
  • BP<90
  • RR<10 or >30
  • Sats <90%
  • GCS <13 or if ≤15yrs then GCS<15
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23
Q
  1. What does a yellow flag mean in clinical flags?
A

Transport not mandated, but pt with one or more yellow flag are advised to attend hospital or GP within 2 hours

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24
Q
  1. What does immunocompromised mean in yellow flags?
A
  • Chemo/radiotherapy for cancer
  • Organ transplant
  • HIV/AIDS
  • Rheumatoid arthritis therapies - other than NSAIDS
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25
Q
  1. What are the specific conditions for red flags?
A
  • Stridor
  • First presentation seizure
  • Anaphylaxis
  • Acute coronary syndrome
  • Ectopic pregnancy
  • Primary obstetric issue
  • Stroke/TIA
  • Sudden onset headache
  • Unable to walk
  • Post-tonsillectomy bleeding up to 14 days post operation
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26
Q
  1. What are the yellow flags? x7
A
  1. Ongoing pt or carer concern
  2. Infection not responding to community based care e..g antibiotics
  3. Immunocompromised with suspected infection
  4. Surgical procedure within past 14 days
  5. Significant unexplained pain (≥5)
  6. Syncope
  7. Abdominal pain
    Pt must have ability to attend hospital/GP, be read referral advice script
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27
Q
  1. In what situations is Fentanyl preferred over morphine?
A
  • Short duration of action
  • Hypersensitivity to morphine
  • Severe headache
  • N/V
  • Hypotension
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28
Q
  1. What are clinical signs of significant dehydration?
A
  1. postural perfusion changes including tachycardia, hypotension and dizziness
  2. decreased sweating and urination
  3. poor skin turgor, dry mouth, dry tongue
  4. fatigue and altered consciousness
  5. evidence of poor fluid intake compared to fluid loss
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29
Q
  1. Undifferentiated nausea and vomiting may include but is not limited to…
A
  • Secondary to cardiac chest pain
  • Secondary to opioid analgesia
  • Secondary to cytotoxic drugs or radiotherapy
  • Severe gastroenteritis
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30
Q
  1. What is the preferred treatment for N/V in the pregnant pt?
A

Fluid rehydration, consider Tx times and severity of nausea before treating with ondansetron. Prochlorperazine is C/I during pregnancy

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31
Q
  1. What needs to be considered when using ondansetron after tramadol administration?
A

Ondansetron is an antagonist at same receptor site where tramadol is active as an analgesic. If pt suffering N/V after taking tramadol, do not use ondansetron as it will reduce analgesic effect.

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32
Q
  1. What is the Rx for undifferentiated N/V?
A
  • Ondansetron 4mg ODT, repeat after 5-10mins if symptoms persist; if unable to tolerate oral or IV in situ, 8mg IV; if C/I to ondansetron and ≥21yrs, Prochlorperazine 12.5mg IM
  • If pt is dehydrated with
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33
Q
  1. What is the treatment for vestibular nausea?
A
  • potential for motion sickness, planned aeromedical evacuation or vertigo
    Rx: Prochlorperazine 12.5mg IM is pt ≥21yrs, if <21yrs Ondansetron
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34
Q
  1. What is the prophylactic treatment for awake pt with potential spinal injuries (immobilised) or eye trauma?
A
  • Ondansetron

OR if C/I and ≥21yrs - Prochlorperazine 12.5mg IM

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35
Q
  1. When should paramedics contact police regarding overdose?
A
  1. Family violence
  2. Sexual exploitation or abuse
    Or if:
  3. Supply of drugs appears to be from parent/caregiver
  4. Other evidence of child abuse or serious untreated injuries
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36
Q
  1. What information should be established about the OD?
A
  1. what substances are involved and collect any packets
  2. which route substances have been taken
  3. time substances taken
  4. amount taken
  5. what they were mixed with e.g. water, alcohol
  6. any treatment initiated prior to arrival e.g. induced vomiting
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37
Q
  1. What are ‘other opioid overdose’ drugs?
A
  1. prescription e.g. oxycodone, morphine, codeine, fentanyl patches, methadone
  2. Iatrogenic opioid - opioid analgesia
  3. polypharmacy involving opioids
  4. unknown cause - heroin not suspected
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38
Q
  1. What is the treatment for heroin OD?
A
  • Assist and maintain airway/ventilation
  • Naloxone 1.6-2mg IM
  • Inadequate response after 10mins - Tx without delay, consider SGA
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39
Q
  1. What is the treatment for other opioid OD?
A
  • Assist and maintain airway/ventilation
  • Naloxone 100mcg IV, repeat every 2mins, max 2mg, until pt is adequately self ventilating
  • If unable to insert IV - Naloxone 400mcg IM (single dose only)
    Consider SGA, Tx without delay
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40
Q
  1. What are some S/S of mild and severe TCA toxicity?
A
  • Mild-Moderate: drowsiness, tachycardia, slurred speech, hyperreflexia, ataxia
  • Severe: coma, respiratory depression, PVCs, SVT, VT, hypotension, seizures
41
Q
  1. What are the 3 signs of TCA toxicity that require intervention?
A
  1. QRS > 0.12secs
  2. Hypotension
  3. Ventricular arrhythmias
    MICA to administer Sodium Bicarbonate
42
Q
  1. Naloxone:
    - Presentation
    - Precautions
    - Side effects
    - Special notes
A
  • Presentation: 0.4mg in 1mL
  • Precautions: 1. If pt known to be physically dependent on opioids, expect combative pt after admin; 2. Neonates
  • Side effects: S/S of opioid withdrawal: sweating, tremor, N/V, agitation, dilation of pupils, excessive lacrimation, convulsions
  • Special notes: do not give naloxone for opioid associated cardiac arrest or head injury
    IV and IM effects: 1-3mins onset, 30-45mins duration
43
Q
  1. What is important to do when administering Dextrose?
A

Ensure IV is patent before administration - flush before and after with minimum 10mL NS

44
Q
  1. What is the median time for conscious state to be restored after Dextrose administration?
A

5-15mins, slow response greater than 15mins can occur occasionally.

45
Q
  1. What is the Rx for hypoglycaemia BGL<4 but responding to commands?
A

Glucose 15g oral

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

46
Q
  1. What is the Rx for BGL<4 and not responding to commands?
A

IV cannula in large vein - confirm patency - Dextrose 10% 15g (150mL), flush with 10mL NS

  • If GCS or BGL not returned to normal after 5-10mins, Dextrose 10% 10g (100mL) titrating to effect
  • If unable to insert IV - Glucagon 1 IU IM
47
Q
  1. What are the clinical features of DKA?
A

Confusion, signs of dehydration and Kussmaul’s breathing, polyuria, polydipsia (excessive thirst), tachypnoea

48
Q
  1. What portion of DKA patients will present with low to moderate hyperglycaemia?
A

Half will present with 11-29 mmol/L

49
Q
  1. What are the features of Hyperosmolar Hyperglycaemic State (HHS)?
A
  • Typically older
  • Higher BGL readings >30
  • Usually do not present with clinical features of DKA
50
Q
  1. What is the Rx for adequately perfused DKA/HHS pts?
A

If transport time >1hr consider maintenance dose of NS IV 500mL/hr

51
Q
  1. What is the Rx for hyperglycaemia BGL>11?
A

< adequate perfusion and clinical features of DKA/HHS

  • NS 20mL/kg titrated to perfusion status, consult for further doses, consider reduced fluid volumes for elderly or impaired renal/cardiac function
  • Consider antiemetic
52
Q
  1. When is IV adrenaline used for anaphylaxis?
A

Pt who is extremely poorly perfused or facing impending cardiac arrest, should be subsequent to IM adrenaline in all cases - IV ideally administered via syringe pump infusion

53
Q
  1. When can glucagon be considered for anaphylaxis?
A

Pt persistently unresponsive to adrenaline (beta blocking meds), administer Glucagon 1-2 IU IM or IV under medical consultation.
Must not delay further adrenaline administration.

54
Q
  1. What inhaled therapy can be considered for anaphylaxis?
A

Salbutamol for persistent bronchospasm and nebulised adrenaline for persistent upper airway oedema and stridor
Always secondary therapy

55
Q
  1. What are the clinical features to confirm anaphylaxis?
A

2 or more RASH, with or without antigen exposure
- Respiratory distress (SOB, wheeze, cough, stridor)
- Abdominal symptoms (nausea, vomiting, diarrhoea, abdominal pain/cramps)
- Skin/mucosal symptoms (hives, welts, itch, flushing, angioedema, swollen lips/tongue)
- Hypotension (or altered conscious state)
Or isolated hypotension <90 following exposure to known antigen

56
Q
  1. What is the Rx for anaphylaxis?
A
  • Monitor cardiac rhythm
  • Adrenaline 500mcg IM, repeat at 5min intervals until satisfactory results or side effects occur; ≤60kg/frail/elderly administer 300mcg
  • Provide O2 therapy
  • Manage resp distress - salbutamol for bronchospasm, neb adrenaline for upper airway oedema
  • Less than adequate perfusion - NS 40mL/kg titrated to response, consult or further 20mL/kg
  • Do not allow pt to stand or walk
57
Q
  1. How do you prepare Ceftriaxone?
A
  • IV Dilute 1g with 9.5mL of Water for injection and administer 1g over 2mins
  • Or IM 1g with 3.5mL 1% Lignocaine HCL, administer into upper lateral thigh or other large muscle mass
58
Q
  1. What are the key general notes for organophosphate poisoning?
A
  • Notify hospital to prepare for isolation and decontamination
  • Look for anticholinesterase on label
  • Consider calling for extra MICA as atropine can run out quickly
59
Q
  1. What are the general care principles for organophosphate poisoning?
A
  • Remove contaminated clothing and wash skin thoroughly with soap and water
  • If possible minimise the number of staff exposed
  • Attempt to minimise transfers between vehicles
60
Q
  1. What are the key cholinergic effects?
A

Salivation, bronchospasm, sweating, nausea and bradycardia

61
Q
  1. What are some considerations for suspected ICH?
A
  • Primary transport to a neurosurgical centre including AAV rural areas
  • Opioid analgesia should be used with caution due to risk of a deterioration in conscious state
  • Prochlorperazine unlikely to have a beneficial effect, it should only be given if N/V and ondansetron cannot be given
62
Q
  1. What are the pharmacological actions of adrenaline?
A
  • Increase HR by increasing SA node firing rate
  • Increase conduction velocity through AV node
  • Increase myocardial contractility
  • Increases irritability of ventricles
  • Causes bronchodilation
  • Causes peripheral vasoconstriction
63
Q
  1. What’s the onset times for adrenaline?
A
  • IV onset 30 secs, peak 3-5mins, duration 5-10mins

- IM onset 30-90secs, peak 4-10mins, duration 5-10mins

64
Q
  1. Ceftriaxone side effects?
A

N/V and skin rash

65
Q
  1. Dextrose:
    - Presentation
    - Pharmacology
    - Metabolism
A
  • Presentation: 25g in 250mL infusion pack
  • Pharmacology: slightly hypertonic crystalloid solution; composed of sugar (10% dextrose) and water; provides a source of energy and supplies body with water
  • Metabolism: dextrose is broken down in most tissues and stored in liver and muscle as glycogen
66
Q
  1. What needs to be considered for patients post thrombolysis?
A

1% of patients may develop orolingual angioedema - managed initially with nebulised adrenaline 5mg in 5mL, if patient deteriorates IV adrenaline can be given (ALS consult)

67
Q
  1. What are the steps in the ACT-FAST assessment?
A
  1. Position arms at 45deg and encourage to hold up - can they hold or does it drop within 10 secs?
  2. Right arm drifts/not moving - CHAT - severe language deficit
  3. Left arm - TAP - shoulder on left side and call name - look for both eyes moving to right side or abnormal response
68
Q
  1. What are the abnormal vital signs for paediatric clinical flags?
A
  • Newborn/small infant: HR <110 or >170, RR <25 or >60, SBP <60
  • Large infant: HR <105 or >165, RR <25 or >55, SBP<65
  • Small child: HR <85 or >150, RR <20 or >40, SBP<70
  • Large child: HR <70 or >135, RR <16 or >34, SBP<80
  • GCS<15 or not alert
  • SPO2<96%
  • Unexplained pain
  • Second presentation within 48hrs to AV or medical practitioner for related complaint
69
Q
  1. What are the specific red flag conditions for paediatric clinical flags?
A
  1. Febrile >38deg (<3months old)
  2. Stridor
  3. First presentation seizure
  4. Anaphylaxis
  5. Unable to walk
  6. Post-tonsillectomy bleeding up to 14 days post-op
  7. Testicular pain
  8. Ingestion/inhalation of toxic substance
  9. Inhalation of foreign body
  10. Non-blanching rash
70
Q
  1. What is the Rx for Mild and Moderate pain for paeds?
A
  • Mild: Paracetamol 15mg/kg
  • Moderate: Fentanyl IN
    Small child (10-17kg) 25mcg
    Medium child (18-39kg) 25-50mcg
    Repeat initial dose at 5-10mins (consult after 3 doses), consult with RCH for children <10kg
    Unable to administer Fentanyl IN or moderate/severe procedural pain: Methoxyflurane 3mL, repeat 3mL
71
Q
  1. What is the main focus in paediatric n/v?
A

Oral rehydration, if n/v is being tolerated than basic care and Tx is only required Rx, IV fluid replacement intended for pt in shock

72
Q
  1. What is the Rx for paed n/v?
A

Ondansetron ODT: small child 2mg, medium child 4mg

- Same for prophylaxis for SCI or eye trauma

73
Q
  1. What is the Rx for paed hypoglycaemia?
A
  • Responding: Glucose 15g oral, inadequate response after 15min repeat or glucagon IM
  • Not responding: <25kg Glucagon 0.5 IU (0.5mL) IM, ≥25kg 1 IU (1mL) IM
74
Q
  1. What is the treatment for paed hyperglycaemia BGL>11?
A

Less than adequate perfusion and clinical features of DKA/HHS - consider antiemetic as per n/v - MICA can give NS

75
Q
  1. What is the Rx for paed anaphylaxis?
A
  • Monitor cardiac rhythm
  • Adrenaline 10 mcg/kg IM - repeat at 5/60
  • Provide high flow O2
  • Mx respiratory distress: bronchospasm with salbutamol and nebulised adrenaline for upper airway oedema.
  • Do not allow pt to stand or walk
76
Q
  1. What is the Rx for paed meningococcal septicaemia?
A

Ceftriaxone 50mg/kg IM (max 1000mg at 6yrs) - dilute 1000mg with 3.5mL Lignocaine 1% and administer into upper lateral thigh

77
Q
  1. What is the Rx for paed opioid OD?
A
  • Assist and maintain airway/ventilation

- Naloxone 10 mcg/kg (max 400mcg) IM, inadequate response after 10mins, Tx without delay and repeat dose

78
Q
  1. What needs to be confirmed in order for MICA to administer Atropine to organophosphate poisoning?
A

Excessive cholinergic effects

- Salivation compromising the airway or bronchospasm and/or bradycardia with inadequate perfusion

79
Q
  1. What are some of the modifying factors in paed hypovolaema?
A
  • Pt with isolated neurogenic shock can be given up to 5mL/kg NS bolus to correct hypotension
  • Penetrating trunk injury or uncontrolled haemorrhage - accept palpable carotid pulse and Tx immediately
  • Excessive fluid should not be given if SCI is an isolated injury
80
Q
  1. When are antibiotics indicated for gastroenteritis?
A

Bacterial or parasitic infection suspected - pt generally present with high fever >40, severe abdo cramping and bloody diarrhoea

81
Q
  1. When must you Tx a gastro pt?
A
  • Pt requires timely hospital mx: significant dehydration requiring IV, potential GIT bleed (haematemesis, melaena, PR bleeding), severe/constant abdo pain, BGL>17
  • Symptoms due to diff dx: absence of diarrhoea, past hx of IBD
  • Pt high risk of complications: pregnancy, co-morbidities (diabetes, immunocompromised)
82
Q
  1. When is it good to refer a gastro pt to a GP?
A
  1. symptoms do not improve after 48 hrs
  2. pt has recently returned from overseas
  3. Temp>40
83
Q
  1. When must you Tx a heroin OD pt (treat and refer)?
A
  1. Incomplete recovery - GCS<15 or RR<10
  2. 2nd dose of naloxone required
  3. Confirmation of drug other than heroin
  4. Polypharmacy OD - special concern for alcohol, benzos, or sedating agents
  5. Other contributing factors to ACS e.g. hypoglycaemia, infection, trauma
  6. Any seizure
  7. Suspected aspiration or APO
  8. Pregnancy
  9. Pt risk to self or others
84
Q
  1. What else do you need to consider before treat and refer for heroin OD?
A
  • Pt chest clear on auscultation?
  • SpO2 >94% on room air?
  • Pt fully recovered, deemed low risk and can be supervised by competent adult for 4 hours?
85
Q
  1. What needs to be advised to heroin OD pt when leaving on scene?
A
  • Advise risks of relapse if opioid taken within next 6 hrs
  • Advise pt to avoid all sedating agents whilst still drug-affected
  • Advise of local social/drug support resources
  • Provide with self-care advice and health info sheet
  • Confirm pt understands advice prior to departing
86
Q
  1. What are the longer-acting carbohydrate options to prevent hypoglycaemia and appropriate sources of glucose to consume for future episodes of hypoglycaemia?
A
  • Longer-lasting: sandwich, dried fruit or yoghurt

- Future episodes: 6-7 jelly beans, 1 tbs honey, 200mL fruit juice, 150-200mL soft drink, 20g glucose tablets

87
Q
  1. When must you Tx hypoglycaemia pt (TnR)?
A
  • Incomplete recovery to normal conscious state
  • Risk of prolonged/recurrent hypoglycaemia: unwitnessed onset/prolonged episode, pt on oral hypoglycaemic medication, OD on meds, unable/unwilling to consume further carbs, unable to be monitored by adult for at least 4 hrs
  • No diagnosis of diabetes
  • Suspected cause of episode requires further investigation e.g. infection
  • Injury or seizure sustained
  • Pregnant
88
Q
  1. What needs to be confirmed before leaving a hypoglycaemic pt at home?
A
  • Confirm BGL>4 and pt remains in normal conscious state at least 10mins after last Rx
  • If cannulation required, IV has been removed
  • Pt and carer understand advice given
89
Q
  1. When should a pt carer call an ambulance according to seizure TnR?
A
  • Seizure recurs before pt is reviewed by doctor
  • Future seizures do not stop after 5mins or are different to usual
  • Seizure continues despite following Mx plan
  • Injury sustained, vomiting, immersed in water
  • Pt not regained consciousness or taking longer to wake up than usual
  • Carer has any other concerns and requires advice
90
Q
  1. When must a seizure pt be transported?
A
  • Further assessment in hospital required: incomplete recovery to normal CS, suspected non-epileptic seizure (hypoglcaemic, stroke, hypoxia, OD), no Dx of epilepsy, different to usual presentation, concurrent illness (infection), injury/aspiration/submersion sustained, pt administered Midazolam
  • Seizure was unwitnessed
  • Risk of recurrent seizure: Hx of multiple seizures per episode, pt has feeling of impending seizure, pt unable to be monitored by responsible adult
  • Pregnancy
  • Pt request Tx for further investigation
91
Q
  1. Fentanyl:
    - Pharmacology
    - Precautions
    - Side effects
    - Special notes
A
  • Pharmacology: synthetic opioid analgesic - CNS: depression, respiratory depression, dependence; CVS: decrease conduction velocity through AV node
  • Precautions: 1. Elderly/frail 2. Impaired hepatic function 3. Respiratory depression 4. Current asthma 5. MAO inhibitors 6. Addiction to opioids 7. Rhinitis, rhinorrhea or facial trauma (IN)
  • Side effects: 1. respiratory depression 2. apnoea 3. rigidity of diaphragm + IC muscles 4. Bradycardia
  • Special notes: IV onset immediate, peak <5mins, duration 30-60mins
    IN peak 2mins
92
Q
  1. What are the glucagon special notes?
A

Not all pt will respond to glucagon, e.g. those with inadequate glycogen stores in liver (alcoholics, malnourished)
Onset 5mins, Duration 25mins

93
Q
  1. Methoxyflurane:
    - C/I
    - Precautions
    - Side effects
    - Special notes
A
  • C/I: 1. pre-existing renal disease/impairment 2. tetracyline antibiotics 3. >6mL in 24hrs 4. Hx of malignant hyperthermia 5. muscular dystrophy
  • Precautions: 1. must be hand-held 2. pre-eclampsia 3. concurrent use with oxytocin may cause hypotension
  • Side effects: drowsiness, decrease in BP and bradycardia (rare), exceeding 6mL in 24hr may lead to renal toxicity
  • Special notes: 3mL provides about 25mins of analgesia, commences after 8-10 breaths and last for approx 3-5mins once discontinued
94
Q
  1. Midazolam
    - Presentation
    - Pharmacology
    - Precautions
    - Side effects
    - Special notes
A
  • Presentation: 5mg in 1mL or 15mg in 3mL
  • Pharmacology: short acting CNS depressant - anxiolytic, sedative, anti-convulsant
  • Precautions: 1. reduced doses for elderly/frail, chronic renal failure, CCF or shock 2. CNS depressant effects enhanced with narcotics/other tranquillisers 3. can cause severe respiratory depression in pt with COPD 4. pt with myasthenia gravis
  • Side effects: depressed LOC, resp depression, loss of airway control, hypotension
  • Special notes: IM onset 3-5mins, peak 15mins, duration 30mins
    IV onset 1-3mins, peak 10mins, duration 20mins
95
Q
  1. Morphine:
    - Pharmacology
    - Precautions
    - Side effects
    - Special notes
A
  • Pharmacology: CNS - depression, resp depression, depression of cough reflex, stimulation, dependence; CVS - vasodilation, decreases conduction velocity through AV node
  • Precautions: 1. elderly/frail 2. hypotension 3. resp depression 4. current asthma 5. resp tract burns 6. addiction 7. acute alcoholism 8. MAO inhibitors
  • Side effects: CNS - drowsy, resp depression, euphoria, n/v, addiction, pin-point pupils; CVS - hypotension, bradycardia
  • Special notes: IV onset 2-5mins, peak 10mins, duration 1-2hrs
    IM onset 10-30mins, peak 30-60mins, duration 1-2hrs
96
Q
  1. Normal saline
    - Pharmacology
    - Special notes
A
  • Pharmacology: isotonic crystalloid solution; composition - electrolytes (Na and Cl); action - increase volume of intravascular compartment
  • Special notes: approximately 30-60min half life
97
Q
  1. Paracetamol
    - Precautions
    - Side effects
A
  • Precautions: 1. impaired hepatic function/liver disease 2. elderly/frail 3. malnourished
  • Side effects: hypersensitivity reactions and haematological reactions (both rare)
98
Q
  1. Prochlorperazine:
    - PEI
    - Precautions
    - Side effects
    - Special notes
A
  • PEI: Prophylaxis of n/v: motion sickness, planned aeromedical evacuation, known allergy to ondansetron, headache irrespective of n/v, vertigo
  • Precautions: 1. hypotension 2. epilepsy 3. pt affected by alcohol or anti-depressants
  • Side effects: drowsy, blurred vision, hypotension, sinus tach, skin rash, extrapyramidal reactions (dystonic)
  • Special notes: onset 20mins, peak 40mins, duration 6hrs

*Medical Conditions (12 decks)

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