Planning management Flashcards
STEMI management
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
NSTEMI management
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
Acute LV failure management
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
Unstable tacycardia management
Syncronised DC shock
AMiodarone 300mg IV over 10-20 mins
Repeate shock
amidoarone 900mg over 24hr
Broad regular QRS tachycardia management (e.g VT) Rx
Amiodarone 300mg IV over 20-60 mins
then 900mg over 24hours
Narrow QRS regular tachycardia (SVT) Rx
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
Narrow complex irregular tacycardia (AF) Rx
Control rate w/ β blocker or dilitazem
Consider digoxin or amiodarone if HF
Anaphylaxis management
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
Acute exacerbation of asthma management
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
Acute exacerbation of COPD management
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
What is Curb65, what does it show?
Confusion (AMTS ≤8/10) Urea >7.5 Reps rate > 30 SBP <90 Age ≥ 65 0-1 = home treatment 2 - admit 3 - consider ITU
Pneumonia treatment
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)
PE management
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
GI bleeding management
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
Bacterial meningitis management
ABCDE high flow O2 IV fluids Dexamethasone IV LP ± CT head 2g cefotaxime IV consider ITU
Seizures and status management
ABC
Put in recovery position ± O2
check for provoking things - glucose, electrolytes, drugs sepsis
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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
Stroke Rx
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
DKA management
What about hyperglycaemic hyper osmotic coma
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
AKI management
ABCDE
Cannula, catheter, fluids monitoring
500ml fluids stat, then 1L hourly
check ABG, K+, make sure there’s no fluid overload
Acute poisoning management
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
When to treat HTN
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
Treatment for chronic HTN
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
Treatment for chronic heart failure
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
CHA2DS2-VASc
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
