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PSA > Prescribing in Medical Emergencies > Flashcards

Prescribing in Medical Emergencies Flashcards

1
Q

Cardiac Arrest

what is the ratio of chest compressions to breaths in CPR

A

30 chest compressions to 2 breaths

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2
Q

Cardiac Arrest

depth of chest compression

A

5-6cm

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3
Q

Cardiac Arrest

rate of chest compression

A

100-120/min

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4
Q

Cardiac Arrest

what 4 rhythms are identifiable in a cardiac arrest

A
  • ventricular fibrillation
  • pulseless ventricular tachycardia
  • asystole
  • pulseless electrical activity
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5
Q

Cardiac Arrest

which rhythms are shockable

A
  • ventricular fibrillation

- pulseless ventricular tachycardia

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6
Q

Cardiac Arrest

which rhythms are non-shockable

A
  • asystole

- pulseless electrical activity

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7
Q

Cardiac Arrest

mnx of shockable rhythms

A
  • administer shock with defib
  • continue chest compressions immediately after for 2min
  • check cardiac rhythm every 2 min
  • shock again (up to 3)
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8
Q

Cardiac Arrest

mnx of shockable rhythms after 3rd shock

A
  • IV adrenaline 1mg
  • single dose IV amiodarone 300mg
  • repeat dose of adrenaline every 3-5min (every other cycle of CPR)
  • do not interrupt chest compressions to administer drugs Cardiac Arrest
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9
Q

Cardiac Arrest

mnx of non-shockable rhythms

A
  • 2 min CPR before a further rhythm check
  • IV adrenaline 1mg ASAP after recognition of non-shockable rhythm
  • IV adrenaline 1mg every 3-5min thereafter
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10
Q

Cardiac Arrest

what are the reversible causes

A

4 H’s and 4 T’s

hypoxia
hypovolaemia
hypo/hyperkalaemia
hypothermia

tamponade (cardiac)
thromboembolism
toxins
tension pneumothorax

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11
Q

Cardiac Arrest

resus after water rescue mnx if temp <30

A
  • limit defib attempts to 3
  • withhold IV until temp >30
  • withhold adrenaline + amiodarone until temp >30
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12
Q

Cardiac Arrest

resus after water rescue mnx if temp 30-35

A

double the intervals between drug doses cmopared with normothermia intervals

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13
Q

Cardiac Arrest

name some specific drugs which can lead to cardiac arrest

A
  • opioids (morpine)
  • TCA
  • benzodiazepines
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14
Q

Cardiac Arrest

opioid reversal drug

A

naloxone

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15
Q

Cardiac Arrest

TCA reversal drug

A

sodium bicarb

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16
Q

Cardiac Arrest

benzodiazepine reversal drug

A

flumazenil but can cause cardiac arrest

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17
Q

Cardiac Arrest

mnx in woman in later stages of preganncy

A

manually displace uterus to left

consider emergency caesarean

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18
Q

Cardiac Arrest

what is post cardiac arrest syndrome

A

brain injury caused by the effects of hypoxia, myocardial dysfunction, systemic response to ischaemia + reperfusion and the potential ongoing effects of the initial cause of the cardiac arrest

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19
Q

Cardiac Arrest

mnx of post cardiac arrest syndrome

A
  • titrate inspired O2 to 94-98%
  • immediate temp mnx to achieve a core temp of no higher than 36
  • PCI if it was MI
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20
Q

Diabetic Emergencies

for hospital inpatients, what is hypoglycaemia defined as

A

blood glucose <4 mmol/litre

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21
Q

Diabetic Emergencies

what can lead to reduced awareness of hypoglycaemic symtoms

A

frequent episodes of hypoglycaemia

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22
Q

Diabetic Emergencies

how may hypoglycaemia during the night go unrecognised

A

the BG in the morning is misleadingly raised

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23
Q

Diabetic Emergencies

early sx of hypoglycaemia

A

adrenergic:

  • sweating
  • tachy
  • pallor
  • palpitations
  • hunger
  • restlessness
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24
Q

Diabetic Emergencies

late sx of hypoglycaemia

A

neuroglycopenic:

  • confusion
  • slurred speech
  • drowsiness
  • numbness of nose, lips and fingers`
  • anxiety
  • blurred vision
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25
Q

Diabetic Emergencies

which discontinuation of a drug may cause hypoglycaemia

A

long term corticosteroids

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26
Q

Diabetic Emergencies

mnx of conscious adult with BG <4mmol/litre

A
  1. 15-29g quick acting carb
  2. repeat BG 10-15min later
  3. repeat for up to 3 cycles if still <4
  4. IM glucagon 1mg or IV 10% glucose 150-200ml over 15min

when >4, 20g long acting carb or 40g id pt was administered glucagon

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27
Q

Diabetic Emergencies

symptomatic (hypoglycaemic) adults with BG >4 mnx

A
  • small carb snack: banana, bread, meal if due

- take BG conc at 10 min

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28
Q

Diabetic Emergencies

initial trx if person is conscious but confused and hypoglycaemic

A

1.5 - 2 tubes of glucogel or dextrogel

or

IM glucagon 1mg

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29
Q

Diabetic Emergencies

after initial trx mnx if person is conscious but confused and hypoglycaemic

A
  1. repeat BG 10-15min later
  2. repeat for up to 3 cycles if still <4
  3. IV 10% glucose 150-200ml over 15min

when >4, 20g long acting carb or 40g if pt was administered glucagon

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30
Q

Diabetic Emergencies

mnx of hypoglycaemia if pt is semi or unconscious
and IV access is available

A
  • 75 - 100ml glucose 20% over 15 min via a standard giving set

or

  • 150-200ml glucose 10% over 15 min
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31
Q

Diabetic Emergencies

mnx of hypoglycaemia if pt is semi or unconscious
and IV access is not available

A

IM glucagon 1 mg

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32
Q

Diabetic Emergencies

if you don’t find a convincing explanation for hypoglycaemic episodes, what do you do?

A
  1. Bloods: insulin, C-peptide, insulin growth factor, 3-beta-hydroxybutyrate
  2. give PO glucose or IV 20% glucose
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33
Q

Diabetic Emergencies

hypoglycaemia: inform DVLA if?

A
  • lorry/bus driver and treated with any PO antidiabetic
  • treated with insulin
  • > 1 episodes of severe hypoglycaemia within the last 12m
  • any severe episode if driving a bus/lorry
  • impaired awareness of hypoglycaemia
  • suffered a hypoglycaemic episode whilst driving
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34
Q

Diabetic Emergencies

1st hour of mnx of DKA

A
  1. 500ml NaCl 0.9% over 15min
  2. additional 500ml over 45min
  3. fixed rate IV insulin infusion. 50U made up to 50ml with 0.9% NaCl . rate: 0.1U/kg/hr
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35
Q

Diabetic Emergencies

how often should ketones be monitored in DKA

A

every hour

conc should fall by 0.5 mmol/litre/hr

36
Q

Diabetic Emergencies

how often should capillary glucose me monitored in DKA

A

every hour

conc shold fall by 3 mmol/litres/hr

37
Q

Diabetic Emergencies

what may insulin do to potassium levels

A

it may decrease K levels

give 40mmol/litre of replacement fluids if K 3.5 - 5.5

38
Q

Diabetic Emergencies

how come DKA may present in someone with T2

A

SGLT2 inhibitors may cause DKA

39
Q

Diabetic Emergencies

how long do you continue the insulin infusion for in DKA

A

until the
- ketone <0.6 mmol/litre
- venous pH > 7.3
or bicarb >18 mmol/litre

40
Q

Diabetic Emergencies

characteristic features of hyperosmolar hyperglycaemic state

A
  • hypovolaemia
  • hyperglycaemia >30 mmol/litres
  • raised osmolarity >320 mosmol/kg
41
Q

Diabetic Emergencies

difference between DKA and HHS

A

in pure HHS:

  • ketones <3
  • pH>7.3, bicarb>15
42
Q

Diabetic Emergencies

trx of HHS

A
  1. decrease osmolarity: glucose, sodium
  2. 1L NaCl 0.9%
  3. monitor + replace electrolytes
  4. aim for a reduction of 5mmol/hour in BG. Insulin should only be initiated when the BG is no longer falling with IV alone
43
Q

Diabetic Emergencies

in the case of unexplained hypoglycaemia, which blood tests and results would indicate insulinoma

A
  • raised insulin
  • raised C-peptide
  • low 3-beta-hydroxybutyrate conc
44
Q

Drug Allergy and Anaphylaxis

which drug may cause pure angioedema

A

ACEi

45
Q

Drug Allergy and Anaphylaxis

what are fixed drug eruptions

A

erythematous plaques which recur in the same [;ace each time the causative drug is taken

46
Q

Drug Allergy and Anaphylaxis

what are the most common cross reacting drug classes

A

penicillins and cephalosporins

47
Q

Drug Allergy and Anaphylaxis

pt has true allergic reaction to penicillin. Should you prescribe a carbapenem?

A

no but assess risk

48
Q

Drug Allergy and Anaphylaxis

how long should pt be observed for in hospital after anaphylaxis

A

6-12h

49
Q

Drug Allergy and Anaphylaxis

which drugs may aggravate pre-existing urticaria

A

NSAIDs and opioids

50
Q

Drug Allergy and Anaphylaxis

mild moderate reaction presentation

A

no evidence of a systemic reaction

51
Q

Drug Allergy and Anaphylaxis

mnx of a mild and moderate reaction

A

PO chlorphenamine

52
Q

Drug Allergy and Anaphylaxis

initial trx for anaphylactic reaction

A

IM adrenaline 500micrograms

IV chlorphenamine 10mg

IM/IV hydrocortisone 200mg

53
Q

Drug Allergy and Anaphylaxis

patient follow up care after anyphylactic reaction

A
  • prednisolone for up to 3d
  • non-sedating anti-histamine for up to 3d
  • report to Yellow Card scheme
  • issue medical alert band
  • refer if appropriate
54
Q

Drug Allergy and Anaphylaxis

when is taking mast cell tryptase useful

A

in suspected reactions during anaesthesia

55
Q

Drug Allergy and Anaphylaxis

what should be reported to the Yellow Card Scheme

A

adverse drug reactions (inc anapkylactic shock) or which have resulted in hospitalisation

56
Q

Drug Allergy and Anaphylaxis

classic signs of a Type I allergic reaction

A

urticaria, itching, angiodema, bronchospasm

57
Q

Drug Allergy and Anaphylaxis

For a suspected anaphylactic reaction take timed blood samples for mast cell tryptase as soon as possible after emergency treatment has started. When should a 2nd sample be taken?

A

1-2 hours (but no later than 4 hours) after the onset of symptoms.

58
Q

Fluids

Maintenance fluids/day

A
  • 25-30ml/kg/day
  • 1mmol/kg/day each of Na, Cl, K
  • 50-100g/day glucose
59
Q

medical therapy for fluid overload

A
  • stop IV fluid
  • furosemide
  • sublingual nitrate
  • IV nitrate
  • CPAP
60
Q

Amitriptyline overdose sx

A
  • coma
  • hypertonia
  • dilated pupils
  • urinary retention
  • sinus tachycardia
  • hyperreflexia
61
Q

Heroin overdose sx

A
  • coma
  • constricted pupils
  • reduced RR
62
Q

Ecstasy overdose sx

A
  • delirium
  • tachycardia
  • agitation
  • dilated pupils
  • hyperthermia
63
Q

how does activated charcoal work

A

binds many poisons in the GI tract

reduced absorption

only give if within 1h

64
Q

antidote for paracetamol poisoning

A

acetylcysteine

65
Q

antidote for cholinergic excess or BB, digoxin, CCB

A

atropine

66
Q

antidote for iron poisoning

A

desferrioxamine

67
Q

antidote for digoxin toxicity

A

digoxin specific antibody fragments

68
Q

antidote for benzodiazepines

A

flumazenil

69
Q

antidote for methanol and ethylene glycol poinsoning

A

Fomepizole

70
Q

antidote for BB toxicity

A

glucagon

71
Q

antidote for opioid poisoning

A

naloxone

72
Q

antidote for warfarin poisoning

A

Phytomenadione (vit k)

73
Q

iron overdose sx

A
  • N+V
  • Diarrhoea
  • grey or black stools
  • GI ulceration, haemorrhage
  • haematemesis
  • rectal bleeding
  • CV collapse
74
Q

when should you admit patients in iron overdose

A

ingested >20mg elemental iron/kg bodyweight

or symptomatic

75
Q

pt presents within 1 hr. what is the mnx

A

gastric lavage or aspiration

do not use activated charcoal as its adsorption of iron is poor

76
Q

salicylate overdose sx (aspirin)

A
  • N+V
  • deafness
  • tinnitus
  • dehydration
  • sweating
  • vasodilation
  • hyperventilation
  • tachycardia
  • metabolic disturbance
77
Q

which group of antidepressants are associated with cardiotoxicity in overdose

A

TCAs

78
Q

what are the classical signs on an ECG following TCA overdose

A
  • tachycardia
  • wide WRS
  • wide QT interval
  • RBBB
  • negative R wave deflection in lead I
79
Q

name some amfetamines

A

meth, ecstasy

80
Q

features of amfetamine + cocaine overdose

A
  • agitations
  • convulsions
  • hallucinations
  • hyperthermia
  • cardiac arrhythmias
  • intracerebral haemorrhage
  • rhabdomyolysis
81
Q

NEWS score of what prompts you to consider sepsis

A

5 or above

82
Q

what are the red flag signs of sepsis

A
  1. altered mental state
  2. systolic BP =<90
  3. > =130 bmp
  4. RR >= 25
  5. needs O2 to maintain O2>=92%
  6. non-blanching rash/mottled/cyanotic
  7. not passed urine in last 18h/ <0.5ml/kg if catheterised
  8. lactate>=2
  9. recent trx w/ chemo
  10. immunosuppression in U18s
83
Q

what is septic shock

A

the most severe form of sepsis

persisting hypotension requiring vasopressors to maintain MAP>= 65

and lactate>2 despite having fluid resus

84
Q

what is cryptic shock

A

high lactate, normal BP

85
Q

what is puerperal sepsis

A

infection in the postnatal woman:

  • close contact with group A strep
  • prolonged rupture of membranes
  • diabetes

PSA (6 decks)

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