Medical Emergency Mx

Question 1

What steps should you take to assess a patient’s airway during a medical emergency?

Answer 1

Check if the patient is vocalizing, which indicates a patent airway.
Feel for expired air.
Listen for sounds suggestive of obstruction (stridor, snoring, gurgling).
Look inside the mouth for loose objects or dentures.
Protect the cervical spine if an injury is possible, such as in trauma patients.

Question 2

What actions should be taken if secretions are present in a patient’s airway during a medical emergency?

Answer 2

Consider using wide-bore suction under direct vision to remove secretions.
If there are concerns about the airway, establish a patent airway using:
Manoeuvres like chin lift or jaw thrust.
Adjuncts such as an oropharyngeal airway (Guedel)

Question 3

What should you do if the airway remains impaired despite initial interventions in a medical emergency?

Answer 3

If the airway is still impaired, initiate an arrest call (2222).

Question 4

What steps should you take to assess a patient’s breathing during a medical emergency?

Answer 4

Look for chest expansion (is it equal? Is there fogging of the mask?), and check for cyanosis.
Listen for air entry (is it equal on both sides?).
Feel for chest expansion and percussion (are they equal?), and check for tracheal deviation.

Question 5

What investigations should be monitored to assess breathing in a medical emergency?

Answer 5

Monitor SaO2 (oxygen saturation) and respiratory rate (RR)

Question 6

What actions should be taken if there are concerns about a patient’s breathing during a medical emergency?

Answer 6

Start 15 L/min oxygen via a non-rebreather mask.
If there is poor or absent respiratory effort, use a bag valve mask.
If there is no respiratory effort, initiate an arrest call (2222).
Intubate and ventilate the patient.

Question 7

What steps should you take to assess a patient’s circulation during a medical emergency?

Answer 7

Look for signs of pallor, cyanosis, and distended neck veins (JVP).
Feel for the central pulse (carotid or femoral) to check the rate and rhythm.

Question 8

What investigations should be conducted to assess circulation in a medical emergency?

Answer 8

Monitor defibrillator ECG and blood pressure (BP).
Gain venous access and send blood samples if time permits.
Perform a 12-lead ECG.

Question 9

What actions should be taken if there are concerns about a patient’s circulation during a medical emergency?

Answer 9

Treat shock with 500 mL of 0.9% saline over 10-15 minutes.
If there is no cardiac output, initiate an arrest call (2222)

Question 10

What steps should you take to assess a patient’s disability during a medical emergency?

Answer 10

Assess the level of consciousness using AVPU (Alert, Voice, Pain, Unresponsive) and Glasgow Coma Scale (GCS).
Check pupil size to ensure they are equal and reactive to light.
Check the tone in all four limbs.
Check capillary glucose levels.

Question 11

What actions should be taken if a patient is unresponsive or has a GCS score less than 8 during a medical emergency?

Answer 11

Call an anaesthetist immediately.

Question 12

What steps should you take to assess a patient’s exposure during a medical emergency?

Answer 12

Undress the patient.
Check the patient’s temperature.
Look for rashes, bleeding, and the condition of any surgical site.
Cover the patient with a blanket after assessment.

Question 13

What additional information should be gathered when assessing a patient’s exposure during a medical emergency?

Answer 13

Events surrounding the illness.
Past medical history.
Current medication.
Known allergies.

Question 14

What are the A to E findings in a patient with acute asthma?

Answer 14

A (Airway): Tongue swelling, cough, cyanosis, inability to complete sentences.
B (Breathing): Wheeze, reduced chest expansion, tachypnoea, increased respiratory effort, silent chest.
C (Circulation): Tachycardia.
D (Disability): Drowsiness (due to carbon dioxide retention).
E (Exposure): Rashes (anaphylaxis as a differential).

Question 15

What work-up investigations should be performed for a patient with acute asthma?

Answer 15

Bedside: PEFR, ECG, ABG, SaO2.
Bloods: FBC, U&E.
Imaging: Chest X-ray (CXR).

Question 16

What are the management steps for a severe or life-threatening asthma attack?

Answer 16

Warn ICU.
Administer bronchodilators: nebulised salbutamol 5 mg with high flow oxygen.
Administer steroids: IV hydrocortisone 100 mg or PO prednisolone 40-50 mg.
Provide oxygen: 15 L/min through a non-rebreathe mask if saturations < 92%.
For life-threatening cases: add nebulised ipratropium bromide 500 μg 6-hourly and administer IV magnesium sulphate 1.2-2 g over 20 mins.

Question 17

What should be done if a patient with acute asthma is responding to treatment? What if they are not responding?

Answer 17

If Responding:
Continue 4-hourly salbutamol nebulisers.
Give prednisolone 40-50 mg orally once daily for 5-7 days.
Monitor PEFR and SaO2.
If Not Responding:
Refer to ICU for intensified therapy (e.g., intubation, IV aminophylline).

Question 18

What are the A to E findings in a patient with acute exacerbation of COPD?

Answer 18

A (Airway): Cough (productive?).
B (Breathing): Wheeze, crepitations (infection?), bronchial breathing, increased respiratory effort.
C (Circulation): Tachycardia, raised JVP (right heart strain).
D (Disability): Not applicable.
E (Exposure): Fever.

Question 19

What work-up investigations should be performed for a patient with acute exacerbation of COPD?

Answer 19

Bedside: ECG, ABG.
Bloods: FBC, U&E, CRP, sputum culture.
Imaging: Chest X-ray (CXR).

Question 20

What are the management steps for a patient with acute exacerbation of COPD?

Answer 20

Bronchodilator: Nebulised salbutamol 5 mg every 4 hours and nebulised ipratropium bromide 500 μg every 6 hours.
Oxygen: If hypoxic, start high-flow oxygen via a non-rebreather mask. After ABG, titrate oxygen aiming for target saturations of 88-92% if the patient is a CO2 retainer.
Steroids: IV hydrocortisone 200 mg or oral prednisolone.
Antibiotics: Follow trust guidelines (e.g., amoxicillin, doxycycline).

Question 21

What should be done if a patient with acute exacerbation of COPD does not respond to initial treatment?

Answer 21

Refer to ICU.
Consider IV aminophylline.
Consider non-invasive ventilation (NIV).
Consider intubation and ventilation.
Consider respiratory stimulant (e.g., doxapram).

Question 22

What are the A to E findings in a patient with acute coronary syndrome?

Answer 22

A (Airway): Not applicable.
B (Breathing): Shortness of breath.
C (Circulation): Tachycardia, arrhythmia, cardiogenic shock.
D (Disability): Not applicable.
E (Exposure): Sweating, anxiety.

Question 23

What work-up investigations should be performed for a patient with acute coronary syndrome?

Answer 23

Bedside: 12-lead ECG, capillary glucose.
Bloods: Troponin, FBC, U&E, blood glucose, cholesterol.
Imaging: Chest X-ray (CXR).

Question 24

What immediate management steps should be taken for a patient with acute coronary syndrome?

Answer 24

IV Morphine 5-10 mg (repeat after 5 minutes if necessary).
IV Metoclopramide 10 mg.
15 L/min oxygen via a non-rebreathe mask if hypoxic.
PO Aspirin 300 mg AND PO Clopidogrel 300 mg OR PO Ticagrelor 180 mg.

Question 25

What is the management protocol for a patient with STEMI?

Answer 25

Percutaneous coronary intervention (PCI): If able to reach PCI center within 120 minutes of first medical contact.
Fibrinolysis (alteplase): Within 30 minutes of admission if PCI is unavailable.

Question 26

What medications should be prescribed upon discharge for a patient with acute coronary syndrome?

Answer 26

Dual antiplatelet therapy: Aspirin 75 mg OD for life AND clopidogrel 75 mg OD for 1 year OR ticagrelor 90 mg BD for 1 year.
ACE inhibitors: Ramipril 1.25-2.5 mg OD, increasing up to 10 mg.
Statin: Atorvastatin 80 mg OD.
Beta-Blocker: Bisoprolol 2.5 mg OD, increasing up to 10 mg.

Question 27

What are the A to E findings in a patient with acute heart failure?

Answer 27

A (Airway): Cough, pink frothy sputum.
B (Breathing): Cardiac wheeze, tachypnoea, bibasal crepitations.
C (Circulation): Tachycardia, raised JVP, S3 gallop rhythm, displaced apex.
D (Disability): Anxious, sweaty.
E (Exposure): Pale, sitting up, ankle swelling.

Question 28

What work-up investigations should be performed for a patient with acute heart failure?

Answer 28

Bedside: ECG, ABG.
Bloods: Troponin, U&E, BNP.
Imaging: Chest X-ray (CXR), echocardiogram.

Question 29

What immediate management steps should be taken for a patient with acute heart failure?

Answer 29

Sit the patient upright.
Administer 15 L/min oxygen via non-rebreather mask.
Gain IV access.
Give Diamorphine 1.25-5 mg IV (use caution in liver failure and COPD).
Administer Furosemide 40-80 mg IV STAT.
Use GTN Spray 2 puffs sublingual.

Question 30

What should be done if there is no response to initial treatment in a patient with acute heart failure?

Answer 30

Repeat the dose of furosemide.
Consider CPAP.
Consider nitrate infusion.
Consider ITU admission.

Question 31

What management steps should be taken if a patient with acute heart failure is stable following initial treatment?

Answer 31

Monitor daily weight.
Repeat chest X-ray (CXR).
Switch to oral diuretics (furosemide or bumetanide).
Discharge medications should include:
ACE inhibitor.
Beta-blocker.
Consider spironolactone.

Question 32

What are the causes of acute kidney injury (AKI)?

Answer 32

Pre-Renal: Hypoperfusion (e.g., hypovolaemia, sepsis).
Renal: Drugs, glomerulonephritis, vasculitis.
Post-Renal: Obstruction (e.g., BPH).

Question 33

What are the A to E findings in a patient with acute kidney injury (AKI)?

Answer 33

A (Airway): Vomiting.
B (Breathing): Tachypnoea, cough (pulmonary oedema), bibasal crackles.
C (Circulation): Tachycardia, fluid overload.
D (Disability): Confusion (uraemia), oliguria.
E (Exposure): Abdominal pain (retention).

Question 34

What work-up investigations should be performed for a patient with acute kidney injury (AKI)?

Answer 34

Bedside: ECG (hyperkalaemia), urinalysis, urine sample (MC&S, ACR), ABG (acidosis).
Bloods: U&E, calcium, phosphate, FBC, CRP/ESR, LFTs, CK, renal screen.
Imaging: Ultrasound scan (USS), chest X-ray (CXR).

Question 35

What immediate management steps should be taken for hyperkalaemia in a patient with acute kidney injury (AKI)?

Answer 35

Administer 10-30 mL 10% Calcium Gluconate IV over 2-10 mins (can repeat every 15 mins up to 5 doses until K+ corrected). Note: IV calcium gluconate must be administered by a doctor due to the risk of arrhythmia.
Administer 10 U Actrapid with 100 mL 20% glucose IV over 10 mins.
Consider 5 mg Salbutamol nebuliser.
Monitor ECG and ensure quick access to a defibrillator.
Repeat U&E and perform ABG to check for acidosis.

Question 36

What are the indications for urgent dialysis in a patient with acute kidney injury (AKI)?

Answer 36

Refractory hyperkalaemia.
Refractory pulmonary oedema.
Uraemic complications (e.g., pericarditis, encephalopathy).
Severe metabolic acidosis (pH < 7.2).

Question 37

What are the A to E findings in a patient with anaphylaxis?

Answer 37

A (Airway): Stridor, angioedema.
B (Breathing): Cyanosis, wheeze, reduced breath sounds due to airway obstruction.
C (Circulation): Hypotension.
D (Disability): Low GCS.
E (Exposure): Rash (urticaria), allergy bracelet.

Question 38

What is the immediate management for a patient suspected of anaphylaxis?

Answer 38

If the airway is compromised: secure airway and give high flow oxygen.
Administer 0.5 mg adrenaline IM (i.e., 0.5 mL of 1:1000); repeat every 5 minutes if needed.
Secure IV access.

Question 39

What should be done if there is no improvement after two doses of IM adrenaline in a patient with anaphylaxis?

Answer 39

Administer a low-dose IV adrenaline infusion (starting at 0.5-1.0 mL/kg/hour and titrating according to clinical response).

Question 40

What additional treatments should be considered in the management of anaphylaxis?

Answer 40

Administer an IV fluid bolus if the patient is in shock.
Note that the administration of chlorphenamine and steroids is no longer part of the acute management of anaphylaxis.

Question 41

What ongoing management steps should be taken after an acute episode of anaphylaxis?

Answer 41

Refer the patient to an allergy clinic to identify the allergen (skin prick testing + specific IgE).
Discharge the patient with two adrenaline auto-injectors.
Teach the patient how to self-inject adrenaline.

Question 42

What are the A to E findings in a patient with atrial fibrillation?

Answer 42

A (Airway): Not applicable.
B (Breathing): Dyspnoea, basal crepitations.
C (Circulation): Tachycardia, hypotension.
D (Disability): Not applicable.
E (Exposure): Not applicable.

Question 43

What work-up investigations should be performed for a patient with atrial fibrillation?

Answer 43

Bedside: ECG.
Bloods: U&E, Bone Profile, Magnesium, TFT, Troponin.
Imaging: Not specified.
Scoring Systems: CHADS-Vasc (Stroke Risk), ORBIT, and HAS-BLED (Bleeding).

Question 44

What is the management approach for a patient with atrial fibrillation with adverse features?

Answer 44

Perform DC cardioversion if the patient has:
Chest pain (Myocardial Ischaemia).
Hypotension.
Pulmonary oedema.

Question 45

When should rhythm control be preferred over rate control in managing atrial fibrillation?

Answer 45

Rhythm control is preferred in patients with new-onset AF (< 48 hours) who have a clear precipitant that can be treated (e.g., pneumonia).
Rhythm control can be achieved either chemically (e.g., amiodarone) or electrically (DC cardioversion).

Question 46

What is the management approach for stroke risk in patients with atrial fibrillation?

Answer 46

Based on CHADS-Vasc Score vs ORBIT/HAS-BLED Score.
Stroke risk is usually managed with DOACs (e.g., apixaban)

Question 47

What are the A to E findings in a patient with diabetic ketoacidosis (DKA)?

Answer 47

A (Airway): Vomit, ketotic breath.
B (Breathing): Laboured breathing (Kussmaul).
C (Circulation): Tachycardia, dehydrated.
D (Disability): Drowsy, confused.
E (Exposure): Insulin injection sites, insulin pump

Question 48

What work-up investigations should be performed for a patient with diabetic ketoacidosis (DKA)?

Answer 48

Bedside: Capillary glucose and ketones, urine dipstick, ECG.
Bloods: Lab glucose and ketones, U&E, ABG/VBG, FBC, blood culture, amylase.
Imaging: Not specified.

Question 49

What is the initial management of insulin in a patient with diabetic ketoacidosis (DKA)?

Answer 49

Add 50 U Actrapid to 50 mL 0.9% NaCl.
Infuse continuously at 0.1 U/kg/hour.
Aim for a fall in ketones of 0.5 mmol/L/hour OR a rise in venous bicarbonate of 3 mmol/L/hour with a fall in glucose of 3 mmol/L/hour.
If not achieving these targets, increase insulin infusion by 1 U/hour until targets are achieved.

Question 50

What monitoring and adjustments should be made during insulin therapy for diabetic ketoacidosis (DKA)?

Answer 50

Check VBG at 1 hour, 2 hours, and every 2 hours thereafter, focusing on pH, bicarbonate, glucose, and potassium.
Consider low molecular weight heparin.
Once glucose < 14 mmol/L, start the patient on 10% glucose at 125 mL/hour alongside saline.
Continue fixed-rate insulin until ketones < 0.3 mmol/L, venous pH > 7.3, and venous bicarbonate > 18 mmol/L.

Question 51

What are the steps for fluid and potassium replacement in a patient with diabetic ketoacidosis (DKA)?

Answer 51

Fluid Replacement:
Use 0.9% NaCl.
Usual fluid deficit: 100 mL/kg.
Replace fluid deficit over 48 hours.
Potassium Replacement:
Usual deficit: 3-5 mmol/kg.
Do NOT add K+ to the first bag.
Monitor urine output and only add K+ once urine output > 30 mL/hour.
Check U&E hourly and replace as necessary.
If serum K+ is 3.5-5.5 mmol/L, add 40 mmol of K+ to 1 L of fluid.

Question 52

What are the A to E findings in a patient with pulmonary embolism?

Answer 52

A (Airway): Not applicable.
B (Breathing): Shortness of breath, haemoptysis, normal breath sounds, cyanosis.
C (Circulation): Hypotension, tachycardia, raised JVP (right heart strain).
D (Disability): Not applicable.
E (Exposure): Swollen, tender calf.

Question 53

What work-up investigations should be performed for a patient with pulmonary embolism?

Answer 53

Bedside: ECG, ABG.
Bloods: FBC, U&E, clotting, D-Dimer, troponin, BNP.
Imaging: CXR, CTPA.

Question 54

What is the initial management for a patient with pulmonary embolism?

Answer 54

Administer 15 L/min oxygen via non-rebreathe mask if hypoxic.
Morphine 5-10 mg IV (with metoclopramide 10 mg IV).
Treatment-dose anticoagulation (LMWH, UFH, or DOAC).

Question 55

What should be done if a patient with pulmonary embolism is critically ill with massive PE?

Answer 55

Immediate thrombolysis.

Question 56

What is the ongoing management for a patient with pulmonary embolism after initial treatment?

Answer 56

Use compression stockings.
Continue LMWH alongside warfarin until INR > 2 for 24 hours.
Duration of Warfarin Treatment:
3 months if there is an obvious cause for VTE.
3-6 months if there is no obvious cause for VTE

Question 57

What are the A to E findings in a patient experiencing a seizure?

Answer 57

A (Airway): Blood in mouth, airway compromise.
B (Breathing): Crackles (aspiration).
C (Circulation): Tachycardia.
D (Disability): Reduced GCS.
E (Exposure): Head injury

Question 58

What work-up investigations should be performed for a patient experiencing a seizure?

Answer 58

Bedside: ECG, BM (blood glucose monitoring).
Bloods: FBC, U&E, Bone Profile, Magnesium, VBG (Lactate), Anticonvulsant Levels.
Imaging: CT Head.

Question 59

What are the initial management steps during a seizure?

Answer 59

Ensure that the space surrounding the patient is clear of anything that could cause damage.
Gain IV access and take blood (including VBG).
If Status Epilepticus and IV Access available:
IV Lorazepam 4 mg; repeat after 5-10 mins if necessary.
If no response, administer Levetiracetam, Phenytoin, or Sodium Valproate.
If still no response, try an alternative second-line agent.
If no response, consider Phenobarbital or general anesthesia (intubation and ventilation).
If IV Access is difficult, consider intraosseous access.

Question 60

What should be done if there is no IV access during a seizure?

Answer 60

Administer Buccal Midazolam or Rectal Diazepam

Question 61

What steps should be taken after a seizure?

Answer 61

Reassess the patient using an A to E approach.
Correct any potential precipitants (e.g., hypoglycemia, electrolyte imbalance)

Question 62

What are the A to E findings in a patient with sepsis?

Answer 62

A (Airway): Not applicable.
B (Breathing): Tachypnoea, cough.
C (Circulation): Hypotension, slow capillary refill, tachycardia.
D (Disability): Low GCS.
E (Exposure): Rash, cellulitis (potential source of infection)

Question 63

What work-up investigations should be performed for a patient with sepsis?

Answer 63

Bedside: ECG.
Bloods: FBC, U&E, VBG (lactate), glucose, blood culture.
Imaging: Depending on the suspected cause (e.g., CXR).

Question 64

What is the initial management for a patient with sepsis (Sepsis 6)?

Answer 64

Administer high flow oxygen.
IV fluids (e.g., bolus 0.9% NaCl 500 mL over 10-15 mins).
Take blood cultures.
Measure lactate (ABG).
Monitor urine output (consider inserting a catheter).
Administer broad-spectrum antibiotics according to trust guidelines.

Question 65

What are the critical time considerations in managing a patient with sepsis?

Answer 65

All initial management steps (Sepsis 6) should be completed within 1 hour.

Question 66

What are common sources of infection in sepsis as indicated by physical findings?

Answer 66

Rash and cellulitis are common indicators of potential sources of infection in sepsis.

Question 67

What are the A to E findings in a patient with a stroke?

Answer 67

A (Airway): Not applicable.
B (Breathing): Laboured, abnormal (e.g., depressed, Cheyne-Stokes).
C (Circulation): Irregularly irregular (AF).
D (Disability): Unequal pupils (space-occupying lesion?), low GCS, low BM (hypoglycaemia), unilaterally increased or decreased tone, weakness.
E (Exposure): Not applicable.

Question 68

What work-up investigations should be performed for a patient with a stroke

Answer 68

Bedside: ECG, capillary glucose.
Bloods: FBC, U&E, lipids, clotting, cardiac enzymes, G&S.
Imaging: CT head, carotid doppler.

Question 69

What is the immediate management for a patient with a suspected stroke?

Answer 69

Provide oxygen if SaO2 < 94%.
Keep the patient nil by mouth.
Treat any present arrhythmia and low glucose.
Request an urgent CT head scan.

Question 70

What is the management protocol once a haemorrhagic stroke has been ruled out?

Answer 70

Administer Aspirin 300 mg PO STAT (or PR if concerns about swallowing).
Consider thrombolysis with tPA if:
Age < 80 years and < 4.5 hours from start of symptoms.
Age > 80 years and < 3 hours from start of symptoms.
Ensure the patient receives physiotherapy and SALT input.

Question 71

What medications should be prescribed upon discharge for a patient who has had a stroke?

Answer 71

After 2 weeks, switch from 300 mg Aspirin to 75 mg Clopidogrel OD PO.
Statin (e.g., atorvastatin 80 mg).
Blood pressure medication.
Anticoagulants (e.g., apixaban or warfarin) if there is co-existing AF.

Question 72

What are the A to E findings in a patient with an upper GI bleed?

Answer 72

A (Airway): Blood in mouth.
B (Breathing): Coughing (aspirated blood).
C (Circulation): Hypotension, tachycardia, peripherally shut down, prolonged capillary refill.
D (Disability): Dizziness.
E (Exposure): Abdominal pain, chronic liver disease (jaundice, spider naevi, etc.)

Question 73

What work-up investigations should be performed for a patient with an upper GI bleed?

Answer 73

Bedside: Blood pressure (BP).
Bloods: Group and save, cross-match 6-10 units of blood, clotting screen, LFT, FBC, U&E.
Imaging: Endoscopy.
Scoring System: Rockall.

Question 74

What are the immediate management steps for a patient with an upper GI bleed?

Answer 74

Protect airway and keep the patient nil by mouth (NBM).
Insert two large-bore cannulas.
Rapid IV crystalloid infusion up to 1 L.
Use O-negative blood until cross-match is complete if the patient is in grade 3-4 shock.
Correct clotting abnormalities (e.g., vitamin K, FFP, PCC).
Consider referral to ICU for central venous line.
Insert catheter to monitor urine output.
Urgent endoscopy.

Question 75

What additional measures should be taken if there is a massive bleed in a patient with an upper GI bleed?

Answer 75

May require tamponade with Sengstaken-Blakemore tube.

Question 76

What is the medical management for major ulcer bleeding and variceal bleeding in a patient with an upper GI bleed?

Answer 76

Major Ulcer Bleeding: Omeprazole 80 mg IV STAT over 40-60 minutes.
Variceal Bleeding: Terlipressin 2 mg SC/IV QDS.