Medical Presentations Flashcards
You are called to a 46 yo pt who has been vomiting all night and continues to feel nauseous, they are pale and sweaty. You decide to administer medication to the patient. What do you administer?
Ondansetron 4mg ODT via oral - can be repeated after 5-10 minutes if no relief.
You have a patient who has suffered a fall off a ladder onto their pruning shears, this has result in penetrating eye trauma. You are also suspicious they may have spinal concerns. Air ambulance will be required for transport. What medication may be considered for this patient aside from pain relief?
Ondansetron 8mg IV (+ 12.5 mg prochlorperazine IM)
You have a paediatric patient (7 year old female) who is c/o nausea. What medication and dosage would you consider for this patient?
Ondansetron 4mg oral dissolving tablet
Your patient has been vomiting for 12/24. You have given ondansetron 4mg odt and this has improved their condition. However, you suspect they may be suffering some dehydration but they do have an adequate perfusion status at this stage. What might you consider?
Normal saline 20mL/kg IV (30 mins)
You are called to a diabetic pt who is feeling weak and dizzy. You take their BGL and it is 3.8 mmol/L. The patient is able to reach up and squeeze your hands when asked. How do you proceed?
Administer glucose paste 15g orally, consider repeat if inadequate response 15/60, titrated to effects
You are dispatched to a diabetic patient found unconscious at her home. You take the patient’s blood sugar and it is 2.1 mmol/L. You are unable to get a response from the patient. Which medication should be considered and what is the dose?
IV cannula large vein: Dextrose 10% 15g (150 mL) IV + 10mL normal saline flush, repeat 10g (100mL) if GCS not improved by 5-10/60.
You suspect your patient may have suffered an opioid overdose, what signs and symptoms might indicate this?
Pin point pupils, respiratory depression, bradycardia, hypotension, hypothermia
On arrival your patient is unconscious. Their is drug paraphernalia around the scene and the patients girlfriend says he was shooting up when he became drowsy and lost consciousness. What medication is appropriate for this patient and what precautions should be taken alongside its use?
Naloxone 1.6/2mg IM, assist and maintain airway. Be aware of possible patient aggression.
Whilst treating a patient for severe pain using fentanyl IV, you notice their respiratory rate has begun to drop and their GCS drops, they are no longer responding to you. What should you do?
Administer naloxone 100 mcg IV, repeated every 2 mins until patient begins to adequately self-ventilate.
You are despatched to a pt with SOB, they appear anxious but can talk in full sentences, have normal skin, respiratory rate is 20, rhythm is regular and even, minor exp wheeze, pulse 80, alert. What is their respiratory status and how will you proceed? The pt is asthmatic but left their puffer at home.
Mild respiratory distress - give 4-12 doses salbutamol via pMDI and spacer every 20/60, pt takes 4 breaths per dose
You have given salbutamol via pMDI and spacer to an asthmatic patient in mild distress. After 20 minutes there has been no improvement and her work of breathing has increased. How will you escalate treatment?
Administer 10mg (5mL) salbutamol nebulised with 500 mcg (2mL) ipratropium bromide nebulised. Repeat salbutamol 5mg (2.5 mL) 5/60 as required. Administer dexamethasone 8mg IV/oral
You are called to an athletics carnival where you meet your pt who is an 8 yo F c/o difficulty breathing, she has asthma and has already tried using her puffer but it hasn’t helped. She can only speak in single words and is fighting for breath, she seems very distressed. Insp and exp wheezes present on auscultation, prolonged exp phase, RR 24, pulse 130, pale and sweaty skin, she seems confused as to why she is here. What level of respiratory distress is the pt in and how will you proceed?
Critical - salbutamol 10mg (5mL) nebulised, repeat 5/60. Ipratropium bromide 250 mcg nebulised. Adrenaline 10mcg/kg IM, repeat 5-10/60, Dexamethasone 600 mcg/kg oral
What is the objective of pain relief?
Reduce the suffering associated with the experience of pain to a degree that the patient is comfortable
What should be considered before utilising medication for pain relief?
Non-pharmacological interventions such as reassurance and splinting
What is first line management for moderate pain in adults?
Fentanyl IV (50 mcg /5mins) or morphine IV 5mg /5mins) and oral paracetamol
What is first line management of severe pain in an adult patient?
Morphine IV 5mg/5mins or fentanyl IV 50mcg/5mins and ketamine IN 75 mg, repeat 50 mg/20 mins
