Medical Emergencies Flashcards
Angina: unstable
Aspirin dispersible tablets (75 mg, 300 mg)
By mouth (dispersed in water or chewed)
ADULT 300 mg
Plus
either glyceryl trinitrate aerosol spray (400 micrograms/metered dose)
Sublingually
ADULT 1–2 sprays, repeated as required
or glyceryl trinitrate tablets (300 micrograms, 500 micrograms, 600 micrograms)
Sublingually
ADULT 0.3–1 mg, repeated as required
Myocardial infarction: non-ST-segment elevation
Treat as for Angina: unstable
Myocardial infarction: ST-segment elevation
-Aspirin dispersible tablets (75 mg, 300 mg)
By mouth (dispersed in water or chewed)
ADULT 300 mg
-Glyceryl trinitrate aerosol spray (400 micrograms/metered dose)
Sublingually
ADULT 1–2 sprays, repeated as required
or
-glyceryl trinitrate tablets (300 micrograms, 500 micrograms, 600 micrograms)
Sublingually
ADULT 0.3–1 mg, repeated as required
-Metoclopramide hydrochloride injection (5 mg/mL)
By intravenous injection
ADULT 18–19 YEARS (BODY-WEIGHT UP TO 60 KG): 5 mg
ADULT 18–19 YEARS (BODY-WEIGHT 60 KG AND OVER): 10 mg
ADULT OVER 19 YEARS 10 mg
-Diamorphine hydrochloride injection (5 mg powder for reconstitution)
By slow intravenous injection (1–2 mg/minute)
ADULT 5 mg followed by a further 2.5–5 mg if necessary
ELDERLY or FRAIL patients, reduce dose by half
or -morphine sulfate injection (10 mg/mL)
By slow intravenous injection (1–2 mg/minute)
ADULT 5–10 mg followed by a further 5–10 mg if necessary
ELDERLY or FRAIL patients, reduce dose by half
Oxygen, if appropriate
Asthma: acute
Emergency asthma consultations should be regarded as being for severe acute asthma until shown otherwise. Patients with features of severe or life-threatening acute asthma, and patients who fail to respond adequately at any time should be referred to hospital immediately. Acute asthma in children aged under 2 years should be managed in hospital.
High-flow oxygen should be given if available (via tight-fitting face mask in children) to achieve and maintain an SpO2 level of 94‑98%.
acute asthma tx
Salbutamol aerosol inhaler (100 micrograms/dose inhaler)
or
salbutamol dry powder inhaler (100 micrograms/dose inhaler, 200 micrograms/dose inhaler)
or
or salbutamol nebuliser solution (1 mg/mL, 2 mg/mL)
or
or terbutaline sulfate nebuliser solution (2.5 mg/mL)
Plus (in all cases)
either prednisolone tablets (or prednisolone soluble tablets) (5 mg)
or hydrocortisone (preferably as sodium succinate)
Monitor response 15 to 30 minutes after nebulisation; if any signs of acute asthma persist, arrange hospital admission. While awaiting ambulance, repeat nebulised beta2 agonist (as above) and give with
Ipratropium bromide nebuliser solution (250 micrograms/mL)
Croup
Dexamethasone oral solution (2 mg/5 mL)
Anaphylaxis
Adrenaline/epinephrine injection (1 mg/mL (1 in 1000)) 1 GRAM OF ADRENALINE IN 1000 ML OF SOLUTION
If life-threatening features persist, further doses of intramuscular adrenaline/epinephrine can be given every 5 minutes until specialist critical care available.
High-flow oxygen should be given as soon as available.
Meningococcal disease
Benzylpenicillin sodium injection (600 mg, 1.2 g)
By intravenous injection (or by intramuscular injection if venous access not available)
NEONATE 300 mg
CHILD 1 MONTH–11 MONTHS 300 mg
CHILD 1–9 YEARS 600 mg
CHILD 10–17 YEARS 1.2 g
ADULT 1.2 g
Note A single dose should be given before urgent transfer to hospital, so long as this does not delay the transfer.
or if history of allergy to penicillin
Cefotaxime injection (500 mg, 1 g, 2 g)
By intravenous injection (or by intramuscular injection if venous access not available)
NEONATE 50 mg/kg
CHILD 1 MONTH–15 YEARS 50 mg/kg (max. 2 g)
CHILD 16–17 YEARS 2 g
ADULT 2 g
Note A single dose can be given before urgent transfer to hospital, so long as this does not delay the transfer.
or if history of immediate hypersensitivity reaction (including anaphylaxis, angioedema, urticaria, or rash immediately after administration) to penicillin or to cephalosporins
Chloramphenicol injection (1 g)
By intravenous injection
CHILD 12.5–25 mg/kg
ADULT 12.5–25 mg/kg
Note A single dose can be given before urgent transfer to hospital, so long as this does not delay the transfer.
Diabetic hypoglycaemia
Fast-acting carbohydrate (glucose is preferred)
CHILD UP TO 5 YEARS
By mouth
5 g (20 mL Lift® (previously Glucojuice®) oral glucose liquid or 1.5 glucose tablets or half a tube of glucose 40% oral gel or 1 teaspoonful of sugar dissolved in an appropriate volume of water), repeated after 15 minutes if necessary
Or by buccal administration [in conscious but uncooperative children]
5 g (half a tube of glucose 40% oral gel), repeated after 15 minutes if necessary
CHILD 5–11 YEARS
By mouth
10 g (40 mL Lift® (previously Glucojuice®) oral glucose liquid or 3 glucose tablets or 1 tube of glucose 40% oral gel or 2 teaspoonfuls of sugar dissolved in an appropriate volume of water), repeated after 15 minutes if necessary
Or by buccal administration [in conscious but uncooperative children]
10 g (1 tube of glucose 40% oral gel), repeated after 15 minutes if necessary
CHILD 12–17 YEARS
By mouth
15 g (60 mL Lift® (previously Glucojuice®) oral glucose liquid or 4 glucose tablets or 1.5 tubes of glucose 40% oral gel or 3 teaspoonfuls of sugar dissolved in an appropriate volume of water), repeated after 15 minutes if necessary
Or by buccal administration [in conscious but uncooperative children]
15 g (1.5 tubes of glucose 40% oral gel), repeated after 15 minutes if necessary
ADULT
By mouth
15–20 g (60–80 mL Lift® (previously Glucojuice®) oral glucose liquid or 4–5 glucose tablets or 1.5–2 tubes of glucose 40% oral gel or 150–200 mL pure fruit juice or 3–4 heaped teaspoonfuls of sugar dissolved in an appropriate volume of water), repeated after 15 minutes if necessary
Or by buccal administration [in conscious but uncooperative patients]
15–20 g (1.5–2 tubes of glucose 40% oral gel), repeated after 15 minutes if necessary
Note Examples of glucose preparations which can be used to give oral doses are based on the use of oral liquid containing glucose 250 mg/mL and tablets containing glucose 4 g per tablet. Buccal dosing is based on tubes of 40% oral gel containing glucose 10 g per tube.
or if hypoglycaemia unresponsive or if oral route cannot be used
Glucagon injection (GlucaGen® 1 mg/mL)
By intramuscular injection
CHILD 8 YEARS AND BELOW OR BODY-WEIGHT UP TO 25 kg 500 micrograms (0.5 mL)
CHILD 9–17 YEARS OR BODY-WEIGHT 25 kg AND OVER 1 mg (1 mL)
ADULT 1 mg (1 mL)
or if hypoglycaemia prolonged or unresponsive to glucagon after 10 minutes
Glucose 10% intravenous infusion
By intravenous injection into large vein
CHILD 5 mL/kg (glucose 500 mg/kg)
ADULT 150–200 mL infused over 15 minutes
or glucose 20% intravenous infusion
By intravenous injection into large vein
ADULT 75–100 mL infused over 15 minutes
Convulsive (including febrile) seizures lasting longer than 5 minutes
Either diazepam rectal solution (2 mg/mL, 4 mg/mL)
By rectum
NEONATE 1.25–2.5 mg, repeated once after 5–10 minutes if necessary
CHILD 1 MONTH–1 YEAR 5 mg, repeated once after 5–10 minutes if necessary
CHILD 2–11 YEARS 5–10 mg, repeated once after 5–10 minutes if necessary
CHILD 12–17 YEARS 10–20 mg, repeated once after 5–10 minutes if necessary
ADULT 10–20 mg, repeated once after 5–10 minutes if necessary
ELDERLY 10 mg, repeated once after 5–10 minutes if necessary
or midazolam oromucosal solution
By buccal administration
NEONATE 300 micrograms/kg, repeated once after 5–10 minutes if necessary [unlicensed]
CHILD 1–2 MONTHS 300 micrograms/kg (max. 2.5 mg), repeated once after 5–10 minutes if necessary [unlicensed]
CHILD 3 MONTHS–11 MONTHS 2.5 mg, repeated once after 5–10 minutes if necessary
CHILD 1–4 YEARS 5 mg, repeated once after 5–10 minutes if necessary
CHILD 5–9 YEARS 7.5 mg, repeated once after 5–10 minutes if necessary
CHILD 10–17 YEARS 10 mg, repeated once after 5–10 minutes if necessary
ADULT 10 mg, repeated once after 5–10 minutes if necessary [unlicensed]
