Medical Emergencies Flashcards
What signs define a ‘severe’ asthma attack?
Peak Expiratory flow rate of 33-50% of predicted
RR 25 or more
HR 110 or more
Inability to complete sentences in one breath
Severe asthma becomes life threatening if any one what signs are present?
Peak Exp flow rate less that 33% of predicted O2 sats < 92% on air Pa02 less than 8.0 kPa PaCO2 rising Silent chest Cyanosis Bradycardia Dysarrythmia Hypotension Feeble respiratory effort Exhaustion Confusion Coma
What defines a near fatal asthma?
PaCO2 greater than 6.0 kPa (Normal Range 4.5 – 6kPa)
What is the immediate management of Acute Asthma?
Oxygen - 15L/min non rebreath mask - maintain sats >92%
Salbutamol 5mg nebulisers driven by oxygen, repeat at 15-20mins
If no response then seek senior help
Ipratropium bromide 500mcg nebulised (4-6 hourly)
Steroids - Hydrocortisone 100mg IV 6 hourly or Prednisolone 40mg PO once per day
What are the Acute Coronary Syndromes?
Unstable Angina - Negative Troponin at 12 hours
NSTEMI - +ve Troponin at 12 hours
STEMI - ST Elevation, +ve Troponin at 12 hours
Definition of Unstable Angina:
Ischaemic chest pain - worsening severity or duration greater than 20mins
Possible ECG changes - T wave inversion, ST depression
Negative Troponin at 12 hours
Definition of NSTEMI:
Ischaemic chest pain
Possible ECG changes - T wave inversion, ST depression
Cardiac failure
Positive Troponin at 12 hours
Definition of STEMI:
Ischaemic chest pain
ECG changes - ST elevation or new Left Bundle Branch block
Positive Troponin at 12 hours
Requires reperfusion therapy ASAP
Initial management of Acute Coronary Syndrome:
ABCDE assessment + ECG + IV access and bloods
Morphine 2.5-10mg IV slow bolus + Antiemetic
Oxygen
Nitrates - Glyceryl trinitrate 2 sprays
Aspirin 300mg PO
Specific further management of STEMI after MONA:
Definitive management = Primary percutaneous coronary intervention (PCI)
Must be within 12 hours of onset
If PCI not available - Thrombolysis within 24 hours of onset
Low Molecular Weight Heparin as DVT prophylaxis
Ticagrelor 180mg PO (only after discussion with cardiologist)
Specific further management of NSTEMI or Unstable Angina after MONA:
Beta-blocker (contraindicated in asthma, LVF, Bradycardia or Coronary artery spasm)
Ticagrelor 180mg PO loading dose
Low Molecular Weight Heparin (only after discussion with cardiologist)
What are the signs of heart failure on a chest x-ray?
Alveolar oedema (bat’s wings) kerley B lines (interstitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Effusion (pleural)
What flow and % oxygen will a Blue venturi mask deliver?
2 - 4 L/min delivering 24% Oxygen
What flow and % oxygen will a White venturi mask deliver?
4 - 6 L/min delivering 28% Oxygen
What flow and % oxygen will a Yellow venturi mask deliver?
8 -10 L/mina delivering 35% Oxygen
What flow and % oxygen will a Red venturi mask deliver?
10 - 12 L/min delivering 40% Oxygen
What flow and % oxygen will a Blue venturi mask deliver?
12 - 15 L/min delivering 60% Oxygen
What is the immediate management of anaphylaxis:
Stop the transfusion
0.5mg of adrenaline 1:1000
ABCDE
10mg Chlorphenamine slow IV
200mg Hydrocortisone slow IV
What risk score would you do for a patient with pneumonia?
CURB 65
Confusion of new onset (AMTS of 8 or less)
Urea > 7 mmol/l
RR > 30
BP < 90 mmHg systolic or diastolic BP < 60 mmHg
Age 65 or older
What risk scores would you do for a patient with an upper GI bleed?
Glasgow Blachford score
- to asses urgency of endoscopy
- Score of 0 can be managed as outpatient
Rockall score
- to assess risk of adverse outcome after endoscopy
- score < 3 = good prognosis
- score > 8 = poor outcomes
