Planning management Flashcards

1
Q

STEMI management

A
ABCDE
15l o2 via non rebreathing mask
Aspirin 300mg + clopidogrel 300mg /ticregolor
Morphine 5-10mg IV w/ metoclopramide 10mg IV
GTN spray/tablet 
Primary PCI or thrombolysis 
β-blocker unless LVF or asthma 
Transfer to CCU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

NSTEMI management

A
ABCDE
15l o2 via non rebreathing mask
Aspirin 300mg + clopidogrel 300mg /ticregolor
Morphine 5-10mg IV w/ metoclopramide 10mg IV
GTN spray/tablet 
LMWH e.g enoxaparin 1mg/kg BD SC
β-blocker unless LVF or asthma 
Transfer to CCU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute LV failure management

A
ABCDE
15l o2 via non rebreathing mask
Sit patient up 
Morphine 5-10mg IV w/ metoclopramide 10mg IV
GTN spray/tablet 
Frusomeide 40-80mg IV
If this is inadequate, isosorbide dinitrate infusion ± CPAP
transfer CCU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Unstable tacycardia management

A

Syncronised DC shock
AMiodarone 300mg IV over 10-20 mins
Repeate shock
amidoarone 900mg over 24hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Broad regular QRS tachycardia management (e.g VT) Rx

A

Amiodarone 300mg IV over 20-60 mins

then 900mg over 24hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Narrow QRS regular tachycardia (SVT) Rx

A

Vagal manouvers
Adenosine 6mg IV rapid bolus
If unsuccessful give 12mg
If still unsuccessful, give further 12mg
Record ECG whole time
If atrial flutter, control rate w/ βblocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Narrow complex irregular tacycardia (AF) Rx

A

Control rate w/ β blocker or dilitazem

Consider digoxin or amiodarone if HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anaphylaxis management

A
ABCDE
15L o2 via non rebreather mask
remove cause ASAP
Adrenaline 500 micrograms of 1:1000 IM 
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV 
If have wheeze - give ashthma treatment 
Amend drug chart and fill in allergy box
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute exacerbation of asthma management

A
ABCDE
100% O2 via non rebreather mask
Salbutamol Nebuliser 5mg 
Hydrocortisone 100mg IV if severe, or prednisolone 40-50mg oral if moderate
Ipratropium Neb - 500 micrograms 
Theophylline, only if life threatening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acute exacerbation of COPD management

A

ABCDE
28% O2 via non rebreather mask w/ ABG later
ABx if infective cause
Salbutamol Nebuliser 5mg
Hydrocortisone 100mg IV if severe, or prednisolone 40-50mg oral if moderate
Ipratropium Neb - 500 micrograms
Theophylline, only if life threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Curb65, what does it show?

A
Confusion (AMTS ≤8/10)
Urea >7.5
Reps rate > 30 
SBP <90
Age ≥ 65 
0-1 = home treatment 
2 - admit
3 - consider ITU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pneumonia treatment

A
ABCDE
High flow O2
Antibiotics (see below)
Paracetamol 
IV fluids if low BP or raised HR 

CAP ABx amoxicillin/clarithromycin if mild, co-amoxiclav w/ clarithro if severe
HAP - co-amoxiclav is mild, pipercillin w/ tazobactam if severe (+ Vanc if MRSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PE management

A

ABCDE
High flow O2
morphine 5-10mg IV w. metoclorpanide 10mg IV
LMWH e.g tinzaparin 175U/kg SC daily
if low BP - fluids, noradrenaline, thromolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GI bleeding management

A
ABCDE
15L o2 via non rebreather mask 
2 large bore cannula 
Catheter in 
Saline 
cross match 6 units 
correct clotting abnormality (PT more than 1.5x average, give FFP, if low platelets give platelets)
Endoscopy 
stop culprit - NSAID, aspirin, warfarin, heparin 
Call surgeons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bacterial meningitis management

A
ABCDE 
high flow O2
IV fluids
Dexamethasone IV
LP ± CT head
2g cefotaxime IV 
consider ITU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Seizures and status management

A

ABC
Put in recovery position ± O2
check for provoking things - glucose, electrolytes, drugs sepsis
——————————————————————–
If seizure goes on for more than 5 mins
Lorazepam 2-4mg IV or diazepam IV/PR 10mg or midazolam buccal 10mg
If still fitting after 2 mins repeat diazepam
inform anaesthetist
Slow phenytoin infusion (20mg/kg, max 2g, over 20mins)
Rapid sequence induction e.g propofol and intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stroke Rx

A

ABCDE
CT head, check blood glucose
If aged <80, and <4.5 hours from onset, consider thrombolysis
Aspirin 300mg oral (not within first 24hours after thrombolysis)
Transfer to stroke unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DKA management

What about hyperglycaemic hyper osmotic coma

A

ABCDE
IV fluids - saline bolus of 500ml over 15mins, then maintinence
Fixed insulin 0.1units/kg/hr
look for trigger e.g MI, infection
give glucose 10% infusion once blood glucose is below 14

FOr HHOMC , same but rehydrate more slowly e/g give less fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

AKI management

A

ABCDE
Cannula, catheter, fluids monitoring
500ml fluids stat, then 1L hourly
check ABG, K+, make sure there’s no fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acute poisoning management

A

ABCDE
Cannula, Cather, strict fluid balance
supportive measures - IV fluids, analgesia
Correct electrolyte imbalance
Reduce absoprtion - gastric levage, whole bowel irrigation (if lithium or iron) or charcoal
Increase elimination (N-acetyl cysteine for paracetamol, naloxone for opiates, flumazenil for Benzos)
Psychiatric management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When to treat HTN

A

BP > 150/95
or BP >135/85 and existing or high risk vascular disease, or HTN organ damage (retinopathy, kidney disease, LVH)
Aim for below 140/85, 135/80 for diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment for chronic HTN

A
If <55 - ACEi or ARB
IF >55 or black - CCB 
Step 2 = ACEi + CCB
Step 3 = ACEi + CCB + Thiazide diuretic 
Step 4 = Step 3 + β blocker or Alpha blocker --> seek expert advice
23
Q

Treatment for chronic heart failure

A

ACEi e.g lisinopril 2.5mg day
β blockjer = bisoprolol 1.25mg day
increase doses if inadequate to max tolerated
Can add ARB if mild-mod
Can add hydralazine25mg 8hourly or isosorbide mononitrate 20mg 8 hourly if black and mod-severe
Can add spironalactome 25mg daily if mod-severe

24
Q

CHA2DS2-VASc

A
Congestive heart failure 
HTN 
AGE >75 = 2 points
DM
Stroke or TIA previously = 2 points
Vascular disease
Age 65-74
Sex - female 
score 0 = aspirin 75mg day 
score 1 = aspirin or warfarin 
score 2 or more = warfarin (INR 2.5)
Would probably use NOAC these days instead of warfarin tho
25
Q

Rate control in AF

A

Everyone w/ HR >90
β blocker (e.g propanolol 10mg 6 hourly)
or dilitazem 120mg daily
then add digoxin if required 62.5-125 micrograms daily

26
Q

Rhythm control in AF

A

For young/symptomatic/first episode or AF due to a treated precipitant
Cardiovert using electrical or amidoarone 5mg/kg IV over 20-120 mins
Will need anticoagulation first if AF >48 hours from onset

27
Q

Stable angina confirmation and management

A

No raised troponin, occurs with exertion and ceases within 15min, no ECG changes and responds to GTN spray
If first troponin isn’t positive, then check ECG –> may need 12hour troponin
GTN spray PRN for symptomatic relief
Beta blocker or CCB –> can increase dose if inadequate
+ 2º prevention - aspirin, statin
If inadequate, BB + CCB unless contraindicated, in which case add long acting nitrate (isosorbide mononitrate or nicorandil)
refer for revascularisation

28
Q

Chronic astmas management

A

Inhaled Salbutamol PRN
Add inhaled ICS 200-800µg/day (usually 400 to start) - can increase
Add leukotriene receptor agonist (montelukast) or add LABA
then can add other stuff e.g theophylline, steroid tablets

29
Q

Chronic COPD management

A

SABA or SAMA as required
in exacerbations where FEV1 >50 - can add LABA or LAMA (istead of SAMA), adding ICS to LABA (combined inhaler) if required
If FEV1 <50, LABA + ICS or LAMA

30
Q

CV risk management e.g in diabetes

A

aspirin 75 OD
Simvastatin/atorvostatin 20-40mg OD
ACEi if evidence of diabetic nephorpathy

31
Q

Blood glucose lowering in T2DM (if HbA1c > 48)

A

Metformin 500mg w/ breakfast - can increase to 1g
Add sulphonylurea next e.g gliclazide 40mg OD

can use sulphonyureas instead if kidney problems –> add gliptin (DPP4 inhibitor) next

32
Q

Parkinson’s dissuade management

A

Usually co-careldopa (levodopa w/ carbidopa)

Cause use dopamine agonist (ropinirole) or MAO inhibitor (rasagiline) if mild or concerned about finite effect of LDOPA

33
Q

Generalised tonic colonic/myoclonic/tonic seizure management

A

Sodium valproate

34
Q

Absence seizure management

A

Sodium valproate or ethosuzimide

35
Q

Focal seizure management

A

Carbamazepine or lamotrigine

36
Q

Lamotrigine side effects

A

Rash, rarely SJS

37
Q

Carbamazepine s/e

A
Rash
dysarthria
ataxia 
nystagmus
SIADH - hyponatraemia
38
Q

Phenytoin S/E

A

Ataxia
peripheral neuropathy
gum hyperplasia
hepatotoxicity

39
Q

Sodium valproate

A

Tremor
teratogenicity
Weight gain

40
Q

Alzheimer’s management

A

Donepezil, started by specialist

if severe, can use memantine

41
Q

Insomnia in hospital management

A

Zopiclone

  1. 5mg oral nightly in a adult
  2. 75mg oral in the elderly
42
Q

Diarrhoea - what to give and when

A

Don’t give loperamide for infective diarrhoea

For non infective diarrhoea, can give loperamide 2mg oral up to 3 hourly

43
Q

Fever management

A

Paracetamol, max 4g in 24hr

44
Q

Inducing remission in Crohn’s

A

mild flare - pred 30mg daily PO
Severe flaire - hydrocortisone 100mg 6hourly IV + supportive care
Can use rectal hydrocortisone for rectal disease

45
Q

Maintaining remission in Crohn;’s

A

Azathioprine –> is converted to 6 mercaptopurine, which is metabolised by TPMT
Check TPMT levels before starting as 10% have low, which cause bone marrow and liver toxicity
If low use methotrexate instead

46
Q

Rheumatoid arteritis management

A

Methotrexate monotherapy
can add other DMARDS in dual therapy if failure e.g hydrochloroquinine or sulfazalazine

During flare, can use IM methylprednisolone 80mg + short actin NSAID (e.g ibuprofen 400mg 8 hourly) w/ gastroprotection (lansoprazole)

If failure to control use TNFa inhibitor e.g infliximab

47
Q

Name a stool softener, what is it good for

A

Docusate sodium
Arachis oil (rectal) - don’t use in nut allergy
good for foecal impaction

48
Q

Name a bulking agent laxative

A

Isphagula husk
DOn’t use in faecal impaction or colonic atony
Takes days to work

49
Q

Name a stimulant laxative

A

Senna
Bisacodyl - don’t use in acute abdomen
Can exacerbate abdo cramps

50
Q

Name an osmotic laxitive

A

Lactulose
Phosphate enema - don’t use in acute abdomen
Max exacerbate bloating

51
Q

what is the best time to give ACEi

A

at night - can cause postural HTN

52
Q

what do you need to monitor with statins

A

CK if at risk from myopathy - PMHx, Fox, high ETOH, renal impairment, hypothyroidism, elderly
+ Serum ALT (in the exam pick this if no risk for myopathy )

53
Q

does serum sodium effect lithium levels

A

Yes, reduce sodium increases the risk of lithium toxicity

54
Q

what should you measure when starting olanzapine

A

Fasting blood glucose - can cause diabetes