PLANNING MANAGEMENT

Question 1

STEMI Mx

Answer 1

ABCDE and O2 via non rebreather

Aspirin 300mg

Morphine 5-10mg IV

Cyclizine 50mg IV

GTN spray/tablets

Primary PCI or thrombolysis

B-blocker e.g. bisoprolol 2.5mg oral unless LVF/asthma

Transfer CCU

Question 2

NSTEMI Mx

Answer 2

ABCDE and O2 via non rebreather

Aspirin 300mg

Morphine 5-10mg IV

Cyclizine 50mg IV

GTN spray/tablets

Clopidogrel 300mg oral or LMWH or fondaparinux 2.5mg SC

B-blocker e.g. bisoprolol 2.5mg oral unless LVF/asthma

Transfer CCU

Question 3

Acute LVF

Answer 3

ABCDE and O2 via non rebreather

Sit patient up

Morphine 5-10mg IV

Cyclizine 50mg IV

GTN spray/tablets

Furosemide 40-80mg IV (repeat as required)

If inadequate response, isoboride dinitrate infusion +/- CPAP

Transfer to CCS

Question 4

Anaphylaxis Mx

Answer 4

ABCDE and O2 via non rebreather

Remove the cause

Adrenaline 500mcg of 1:1000 IM

Chlorphenamine 10mg IV

Hydrocortisone 200mg IV

Asthma Mx if wheeze

Amend drug chart allergies box

Question 5

Acute asthma Mx adults

Answer 5

ABCDE and O2 via non rebreather

Salbutamol 5mg NEB

Hydrocortisone 100mg IV (if severe/life threatening) or prednisolone 40-50mg oral (if mod)

Ipratropium (500mcg NEB)

Aminophylline (only if life-threatening)

Question 6

Pneumonia Mx

Answer 6

ABC

High flow O2

ABX e.g. amoxicillin or co-amoxiclav

Paracetamol

If low BP or raised HR: IV fluids as normal

Question 7

PE Mx

Answer 7

ABC

High-flow O2

Morphine 5-10mg IV

Cyclizine 50mg IV

LMWH e.g. tinzaparin 175 units/kg SC daily

If low BP > fluid bolus > contact ITU > consider thrombolysis

Question 8

8 Cs of GI bleeding

Answer 8

Cannulae (2 large bore)

Crystalloid bolus

Cross-match 6 units of blood

Correct clotting
- if PT/aPTT >1.5 x normal range give FPP
- if platelets <50x10^9/L give platelet transfusion

Camera (endoscopy)

Stop culprit drugs (NSAIDs, aspirin, warfarin, heparin)

Call surgeons if severe

Question 9

Bacterial meningitis Mx

Answer 9

High flow O2

IV fluid

4-10mg dexamethasone IV unless immunocompromised

LP (+/- CT head)

2g Cefotaxime IV
if immunocomp or >55 add 2g ampicillin (give ABX pre-LP if having CT head or prolonged LP)

Consider ITU

Question 10

Seizure Mx

Answer 10

Recovery position + O2

Lorazepam 2-4mg IV or diazepam IV or buccal midazolam both 10mg

If fitting after 5 mins repeat benzo

Inform anaesthetist

If still fitting after further 5 min phenytoin 15-20mg/kg IV

If still fitting after further 5 minutes propofol (intubate & ventilate)

Question 11

Mx ischaemic stroke

Answer 11

Blood glucose and CT head

<4.5h since onset: thrombolysis

If <24h thrombectomy can be offered

Aspirin 300mg oral or rectal

Transfer to stroke unit

Question 12

Mx of DKA

Answer 12

IV fluid:
1L of saline stat
then 1L over 1 hour, then 2 then 4 then 8

fixed-rate insulin e.g. 50 units ActRapid in 50ml 0.9% saline at 0.1units/kg/hr

Monitor cap glucose & ketones

Aim to decrease ketones by >0.5mmol/L/h

Question 13

Acute renal failure Mx

Answer 13

Cannula and catheter, strict fluid monitoring

IV fluid: 500ml stat then 1L 4 hourly

Hunt for cause

Question 14

Mx of acute gout flares if there is CKD

Answer 14

You cannot give NSAIDs such as ibuprofen

1st line - colchicine
2nd line - intra-articular steroid injection such as IM Depo-Medrone