Planning management Flashcards
1
Q
What is the acute management of a STEMI
A
- ABC and O2 by non rebreather mask (if hypoxic, unless COPD)
- Hx, o/e, inv
- Aspirin 300mg oral
- Morphine 5-10mg IV with cyclizine 50mg IV
- GTN spray/tablet
- Primary PCI ot thrombolysis
- Beta blocker e.g. Bisoprolol 2.5mg oral (unless LVF/asthma)
- transfer to CCU
2
Q
What is the acute management of an NSTEMI
A
- ABC and O2 by non rebreather mask (if hypoxic, unless COPD)
- Hx, o/e, inv
- Aspirin 300mg oral
- Morphine 5-10mg IV with cyclizine 50mg IV
- GTN spray/tablet
- Clopidogrel 300mg and wither LMWH or Fondaparinux
- Beta blocker e.g. Bisoprolol 2.5mg oral (unless LVF/asthma)
- transfer to CCU
3
Q
What is the acute management of acute left ventricular failure
A
- ABC and O2 by non rebreather mask (if hypoxic, unless COPD)
- Hx, o/e, inv
- Sit patient up
- Morphine 5-10mg IV with cyclizine 50mg IV
- GTN spray/tablet
- Furosemide 40-80mg IV (repeat as required)
- If inadequate response, isosorbide dinitrate infusion +/- CPAP
- transfer to CCU
4
Q
How would you treat an adult with tachycardia and signs of shock
A
- synchronised DC shock (up to 3 attempts)
- Amiodarone 300mg IV over 10-20min and repeat shock
- followed by amiodarone 900mg over 24hrs
5
Q
How would you treat a stable patient with a regular rhythm narrow complex (QRS<0.12s) tachycardia?
A
- Vagal manoeuvres
- Adenosine 6mg rapid IV bolus if unsuccessful give 12mg
- Monitor ECG continuously
6
Q
What is the drug treatment of an adult in anaphylaxis?
A
Adrenaline 500 micrograms of 1:1000 IM
7
Q
Treatment of acute exacerbation of asthma in adults
A
- 100% O2 by non-rebreather mask
- Salbutamol 5mg neb
- Hydrocortisone 100mg IV (if severe) or prednisolone 40-50mg oral (if moderate)
- Ipratropium (500 micrograms neb)
- Aminophylline (only if life threatening)
8
Q
Acute treatment of pulmonary embolism
A
- High flow oxygen
- Morphine 5-10mg IV, cyclizine 50mg IV
- LMWH e.g. tinzaparin 175 units/kg SC daily
4, If low BP: IV fluid bolus -> contact ICU -> consider thrombolysis
9
Q
Management of acute GI bleed
A
- ABC + O2 (15L by non-rebreathe)
- x2 large bore cannulae
- catheter (and strict fluid monitoring)
- Crystalloid bolus
- Cross match 6 units blood
- Correct clotting abnormalities
- Camera (endoscopy)
- strop culprit drugs (NSAIDs, aspirin, warfarin, heparin)
- call surgeons if severe
10
Q
Acute management of seizures
A
- ABC
- Put patient in recovery position with oxygen
- Lorazepam 2-4mg IV or diazepam IV or midazolam (buccal) both 10mg
- If still fitting after 5min repeat benzodiazepine
- inform anaesthetist
- If still fitting after a further 5 min Phenytoin 15-20 mg/kg IV
- If still fitting after further 5min Propofol (intubate and ventilate)
11
Q
Hospital management of bacterial meningitis
A
- ABC, high flow oxygen, IV fluid
- 4-10mg Dexamethasone IV unless severely immunocompromised
- LP +/- CT head
- 2g cefotaxime IV (if immunocompromised or >55 add 2g ampicillin IV
- consider ITU
12
Q
Acute management of stroke
A
- ABC
- CT head to rule our haemorrhage
- if onset <4.5hrs consider thrombolysis
- consider thrombectomy if onset /,24hrs
- aspirin 300mg oral or rectal if unsafe swallow
- transfer to stroke unit
13
Q
Management of DKI
A
- ABC
- IV fluid 1L saline stat then 1L over 1hr then over 2 then over 4 then over 8
- Fixed rate insulin e.g. 50 units Actrapid in 50ml 0.9% saline at 0.1 units/kg/hour
- monitor capillary glucose + ketones hourly and repeat VBG 2hrly. if not decreasing, increase insulin rate by 1units/hour. Potassium monitoring
- Hunt for trigger
14
Q
Management of AKI
A
- ABC
- cannula and catheter, strict fluid monitoring
- IV fluid 500mL stat then 1L 4hrly
- hunt for cause, monitor U&E’s and fluid balance
15
Q
what is step 1 in management of hypertension for a black patient or a patient >55
A
CCB
