OSCE DOC - Medical emergency Flashcards
Medical Emergency
Hypoglycaemia and seizure (12 mins)
Explain hypoglycaemia and seizure / epilepsy drugs to a nurse.
Correct drug, detailed action, description of emergency (signs / symptoms)
Medication
* Glucagon- increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis to convert glycogen to glucose
* Releases glucose from the liver
Signs
* Type 1 diabetic hypoglycaemic coma- normal 5-7mmol
* unconscious <3mmol
* Signs- pale, shaky, sweaty, clammy, dizzy, hungry, aggression and confusion, blurred vision, loss of consciousness, increased heart (>110bpm) and breathing rate, vagueness, slurring speech, headache
* *they must mention loss of consciousness as it defines treatment
Treatment
* Assess ABCDE
* 100% oxygen 15L/min
* If conscious and cooperative- administer oral glucose 10-20g or sugary drink (repeated in 10-15 mins if needed)
* If unconscious / uncooperative- 1milligram IM glucagon injection and oral glucose when regain consciousness
* After they regain consciousness (15 mins – 2nd dose if not) supply oral glucose / sugary drink as they would have depleted their glycogen stores- they will be unwilling to drink this…
* Transfer to hospital if treatment ineffective or contraindicated
* If treatment effective, patient may go home, but must be accompanied and shouldn’t drive
IM injection and technique
* Twist to open
* Inject diluting solution in vial with glucagon powder (inject fluid into powder without shaking)
* Roll to mix- don’t shake as will foam up (takes a while)
* Draw solution back into syringe
* Use Z-track technique to inject into thigh or bicep
* - spread skin, advance needle into skin 90 degrees, aspirate, inject 30s, pull out, release tension (thigh, hip, deltoid, buttock)
* - say ‘I would normally prepare needle / change needle, remove clothing, alcohol wipe skin, but not going to as life threatening and saves time’
* Reassess ABCDE- assess effect of medication, more oral glucose required
*
Medical emergency epilepsy.
Epilepsy
Medication
* Midazolam- a short acting benzodiazepine- enhances the effect of the neurotransmitter GABA on the GABA receptors resulting in neural inhibition
Signs
* Unresponsive, loss of consciousness, uncontrollable muscle spasms, drooling, tonic (falls rigid), clonic (sharp jerky movements), hypotension, hypoxia, loss of airway tone, frothing from mouth
Treatment
* Assess ABCDE
* Ensure safe environment
* Do not try to restrain convulsive movements- ensure the patient is not at risk from injury
* Secure airway
Administration
* Administer 100% oxygen, 15L/min flow rate- call for help
* If the fit is repeated or prolonged (>5 min), give midazolam 2ml oromucosal solution, 5mg/ml topically into buccal cavity (10mg)- repeat after 5 mins if not worked
* - check expiry date and the form of midazolam is compatible with buccal administration, choose appropriate dosage of midazolam by age (different tubes of midazolam with different dosage available)
* If subsided- provide reassurance, put in recovery position and check airway
* Refer to hospital if- first seizure, seizure is atypical (prolonged / repeated), injury was caused or difficult to monitor patient
Asthma and Anaphylaxis (12 mins)
New nurse asks what they do if a patient has an asthma attack and how you can identify it.
How do they treat it and use a spacer?
They ask what they do if it turns to anaphylaxis and how they will know it is anaphylaxis.
What do you know about adrenaline and how do I use it?
Correct drug- detailed action. Description of emergency (signs and symptoms)
Asthma
Medication
* Salbutamol
* Short acting selective beta-2 agonist, relaxes smooth muscles in the bronchi causing bronchodilation
Signs
What is asthma
* Airway constriction / bronchoconstriction
* Fast breathing, wheeze, gasping, clutching chest, tripods, blushing, tachycardia- probably regular
Treatment
* Assess ABCDE
* 100% oxygen 15L/min
* Call ambulance- location, number, describe patient condition
Administration
* 2 puffs of patient’s own beta 2 agonist inhaler (inhale, hold breath for 10s, and further puffs if they don’t respond rapidly)
* If own inhaler not available- salbutamol inhaler- 100ug per actuation, 4 puffs in large volume spacer 20 secs inhalation and then put on oxygen- repeat as required
* Transfer to hospital if they do not respond to treatment within 5 mins of administration (give oxygen with salbutamol 5mg or terbutaline sulfate 10mg by nebuliser whilst awaiting transfer)
* Reassess ABCDE
* Administer 100% oxygen, 15L/min flow rate
Asthma and Anaphylaxis (12 mins)
They ask what they do if it turns to anaphylaxis and how they will know it is anaphylaxis.
What do you know about adrenaline and how do I use it?
Correct drug- detailed action. Description of emergency (signs and symptoms)
Anaphylaxis
Medication
* Adrenaline
* Powerful vasoconstrictor, bronchodilator and increases contractility of myocardium
Signs
* Airway constriction / bronchoconstriction- upper airway oedema and bronchospasm- causing stridor and wheezing
* Fast irregular breathing, stridor, blushing, tachycardia but weak pulse, urticaria, angioedema
* Anaphylactic shock- inability to perfuse organs
* Abdominal pain, vomiting, diarrhoea, flushing
Treatment
* Assess ABCDE
* Secure airway, lie flat, raise feet 45 degrees
* Remove source of anaphylaxis if known
* Put in recovery position if unconscious or at risk of vomiting
* 100% oxygen, 15L/min
* Call ambulance- location, number, describe patient condition
Administration
* Adrenaline ½ of a 1ml ampule 1:1000, 500ug IM injection 0.5ml)
* Aspirate as can generate arrhythmias
* Use Z-track technique to inject into thigh or bicep
* Spread skin, advance needle in skin 90 degrees, aspirate, inject 30s, pull out, release tension- thigh, hip, deltoid, buttock
* (Go through skin quickly, put traction on muscle, advance through muscle, advance further, pull back, aspirate, inject, pull halfway out, let go of traction (this traps the drug in the muscle instead of pulling it up to sit underneath the skin due to capillary action- would lose 50-75% of drug if you pulled it straight out)
* Say ‘I would normally prepare needle / change needle, remove clothing, alcohol wipe the skin, but not going to as life threatening and saves time’
* Repeat at 5 min intervals if needed
* Reassess ABCDE
* Administer 100% oxygen, 15L/min flow rate
* Transfer to hospital immediately
Can be hard to differentiate between asthma attack and anaphylaxis. How would you know which one is which?
- Check medical history or series of events leading to the episode
- Asthma only has respiratory symptoms and those caused by the hypoxia (e.g., tachycardia)
- Anaphylaxis is systemic presenting with a weaker pulse, urticaria (hives on skin) and angioedema (swollen face)
Treatment for a choking adult?
- ABCDE
- Are you choking?
- 5 back slaps between shoulder blades
- 5 abdominal thrusts between belly button and sternum
- Continually check for object dislodging
- Re-evaluate ABCDE
- BLS if still not resolved
- Call 999 to check for rib fracture
