Planning management

Question 1

management of STEMI/NSTEMI

Answer 1

ABC and O2 (15L) by non-rebreather mask
Hx, o/e, ECG
aspirin 300mg and ticagralor 180mg PO
morphine 5010mg IV with cyclizine 50mg IV
GTN spray
primary PCI
beta blocker 2.5mg PO
transfer to CCU
in NSTEMI - no PCI

Question 2

management of acute left ventricular failure

Answer 2

ABC and O2 (15L)
HX, o/e, Ix, LVF ±cause
sit patient up
morphine 5-10mg IV with cyclizine 50mg IV
GTN spray
furosemide 40-80mg IV
if inadequate response - isosorbide dinitrate infusion ±CPAP

Question 3

Management of a sinus tachycardia with adverse features

Answer 3

shock, syncope, MI, heart failure
synchronized DC shock (up to 3 attempts)
then try amiodarone 300mg IV over 10-20 mins and repeat shock, followed by 900mg amiodarone IV over 24hrs

Question 4

Management of narrow complex tachycardia

Answer 4

regular - vagal manoeuvres, adenosine 6mg rapid IV bolus, repeat 12mg IV then further 12mg IV, if sinus rhythm not restored, may be atrial flutter
irregular - rate control with beta-blocker or diltiazem

Question 5

Management of broad complex tachycardia

Answer 5

regular - amiodarone 300mg IV over 20-60mins

irregular - seek help

Question 6

Management of anaphylaxis

Answer 6

ABC and O2
Hx, o/e, Ix
remove cause
adrenaline 500micrograms or 1:1000IM
chlorphenamine 10mg IV
hydrocortisone 200mg IV

Question 7

Management of acute exacerbation of asthma

Answer 7

ABC
hx, o/e, Ix
100% O2
salbutamol nebs 5mg
hydrocortisone 100mg IV OR prednisolone 40-50mg oral
ipratropium bromide 500micrograms nebs
aminophylline (life threatening)

Question 8

Management of pneumothorax

Answer 8

primary - <2cm and not SOB, discharge and follow up in 4 weeks. If >2cm or feels SOB then aspirate
secondary (lung disease) - chest drain if >2cm or SOB or >50years
tension - emergency aspiration/chest drain

Question 9

Management of pneumonia

Answer 9

ABC, hx, ix, high-flow oxygen, antibiotics (amoxicillin/co-amox) paracetamol, ?fluids

Question 10

Management of PE

Answer 10

ABC, hx, ix, high-flow O2, morphine 5mg IV, cyclizine 50mg IV, LMWH, ?fluid, ?ITU

Question 11

Management of upper GI bleed

Answer 11

ABC, O2,, hx, ix (high urea), 2x large bore cannulae, crystalloid bolus, cross match 6 units of blood, correct clotting abnormalties, endoscopy, stop NSAIDs, aspirin, warfarin, heparin

Question 12

Management of bacterial meningitis

Answer 12

ABC, hx, ix, IV fluid, 4-10mg of dexamethasone, LP ±CT head, 2g cefotaxime IV ±2g ampicillin IV

Question 13

management of seizures/status epilepticus

Answer 13

1) ensure airway is patent
2) put in recovery position with O2
3) bedside tests - glucose, electrolytes, drugs and sepsis
4) drugs - lorazepam 2-4mg IV or diazepam 10mg IV or midazolam 10mg buccal
5) if still fitting repeat dose of benzo
6) if still fitting after a further 5mins - phenytoin 15-20mg/kg IV
7) intubate

Question 14

Management of stroke

Answer 14

1) ABC
2) hx, ix to exclude haemorrhagic stroke
3) if onset <4.5hrs then thrombolysis
4) thrombectomy if <24hrs
5) aspirin 300mg

Question 15

Management of DKA

Answer 15

1) ABC
2) Hx, Ix - blood glucose, urinary ketones, ABG
3) IV fluid 1L N. Saline then 1L over 1 hour then over 2 hours etc
3) fixed rate insulin e.g. 50 units Actrapid in 50ml 0.9% saline at 0.1 units/kg/hour
4) monitor capillary glucose and ketones
5) trigger - infection, MI, missed insulin

Question 16

Diagnosis of hyperosmolar hyperglycaemic state

Answer 16

diagnosis - hyperglycaemia, hyperosmolar, noketotic

Question 17

AKI management

Answer 17

1) ABC
2) Hx, Ix
3) cannula and catheter
4) IV fluid 500ml stat and then 1L 4hourly
5) ?cause
6) U+Es and fluid balance