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
2
Q
Cardiac Arrest
depth of chest compression
A
5-6cm
3
Q
Cardiac Arrest
rate of chest compression
A
100-120/min
4
Q
Cardiac Arrest
what 4 rhythms are identifiable in a cardiac arrest
A
- ventricular fibrillation
- pulseless ventricular tachycardia
- asystole
- pulseless electrical activity
5
Q
Cardiac Arrest
which rhythms are shockable
A
- ventricular fibrillation
- pulseless ventricular tachycardia
6
Q
Cardiac Arrest
which rhythms are non-shockable
A
- asystole
- pulseless electrical activity
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)
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
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
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
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
12
Q
Cardiac Arrest
resus after water rescue mnx if temp 30-35
A
double the intervals between drug doses cmopared with normothermia intervals
13
Q
Cardiac Arrest
name some specific drugs which can lead to cardiac arrest
A
- opioids (morpine)
- TCA
- benzodiazepines
14
Q
Cardiac Arrest
opioid reversal drug
A
naloxone
15
Q
Cardiac Arrest
TCA reversal drug
A
sodium bicarb
16
Q
Cardiac Arrest
benzodiazepine reversal drug
A
flumazenil but can cause cardiac arrest
17
Q
Cardiac Arrest
mnx in woman in later stages of preganncy
A
manually displace uterus to left
consider emergency caesarean
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
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
20
Q
Diabetic Emergencies
for hospital inpatients, what is hypoglycaemia defined as
A
blood glucose <4 mmol/litre
21
Q
Diabetic Emergencies
what can lead to reduced awareness of hypoglycaemic symtoms
A
frequent episodes of hypoglycaemia
22
Q
Diabetic Emergencies
how may hypoglycaemia during the night go unrecognised
A
the BG in the morning is misleadingly raised
23
Q
Diabetic Emergencies
early sx of hypoglycaemia
A
adrenergic:
- sweating
- tachy
- pallor
- palpitations
- hunger
- restlessness
24
Q
Diabetic Emergencies
late sx of hypoglycaemia
A
neuroglycopenic:
- confusion
- slurred speech
- drowsiness
- numbness of nose, lips and fingers`
- anxiety
- blurred vision
25
Diabetic Emergencies
which discontinuation of a drug may cause hypoglycaemia
long term corticosteroids
26
Diabetic Emergencies
mnx of conscious adult with BG <4mmol/litre
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
27
Diabetic Emergencies
symptomatic (hypoglycaemic) adults with BG >4 mnx
- small carb snack: banana, bread, meal if due
| - take BG conc at 10 min
28
Diabetic Emergencies
initial trx if person is conscious but confused and hypoglycaemic
1.5 - 2 tubes of glucogel or dextrogel
or
IM glucagon 1mg
29
Diabetic Emergencies
after initial trx mnx if person is conscious but confused and hypoglycaemic
2. repeat BG 10-15min later
3. repeat for up to 3 cycles if still <4
4. IV 10% glucose 150-200ml over 15min
when >4, 20g long acting carb or 40g if pt was administered glucagon
30
Diabetic Emergencies
mnx of hypoglycaemia if pt is semi or unconscious
and IV access is available
- 75 - 100ml glucose 20% over 15 min via a standard giving set
or
- 150-200ml glucose 10% over 15 min
31
Diabetic Emergencies
mnx of hypoglycaemia if pt is semi or unconscious
and IV access is not available
IM glucagon 1 mg
32
Diabetic Emergencies
if you don't find a convincing explanation for hypoglycaemic episodes, what do you do?
1. Bloods: insulin, C-peptide, insulin growth factor, 3-beta-hydroxybutyrate
2. give PO glucose or IV 20% glucose
33
Diabetic Emergencies
hypoglycaemia: inform DVLA if?
- 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
34
Diabetic Emergencies
1st hour of mnx of DKA
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
35
Diabetic Emergencies
how often should ketones be monitored in DKA
every hour
conc should fall by 0.5 mmol/litre/hr
36
Diabetic Emergencies
how often should capillary glucose me monitored in DKA
every hour
conc shold fall by 3 mmol/litres/hr
37
Diabetic Emergencies
what may insulin do to potassium levels
it may decrease K levels
give 40mmol/litre of replacement fluids if K 3.5 - 5.5
38
Diabetic Emergencies
how come DKA may present in someone with T2
SGLT2 inhibitors may cause DKA
39
Diabetic Emergencies
how long do you continue the insulin infusion for in DKA
until the
- ketone <0.6 mmol/litre
- venous pH > 7.3
or bicarb >18 mmol/litre
40
Diabetic Emergencies
characteristic features of hyperosmolar hyperglycaemic state
- hypovolaemia
- hyperglycaemia >30 mmol/litres
- raised osmolarity >320 mosmol/kg
41
Diabetic Emergencies
difference between DKA and HHS
in pure HHS:
- ketones <3
- pH>7.3, bicarb>15
42
Diabetic Emergencies
trx of HHS
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
Diabetic Emergencies
in the case of unexplained hypoglycaemia, which blood tests and results would indicate insulinoma
- raised insulin
- raised C-peptide
- low 3-beta-hydroxybutyrate conc
44
Drug Allergy and Anaphylaxis
which drug may cause pure angioedema
ACEi
45
Drug Allergy and Anaphylaxis
what are fixed drug eruptions
erythematous plaques which recur in the same [;ace each time the causative drug is taken
46
Drug Allergy and Anaphylaxis
what are the most common cross reacting drug classes
penicillins and cephalosporins
47
Drug Allergy and Anaphylaxis
pt has true allergic reaction to penicillin. Should you prescribe a carbapenem?
no but assess risk
48
Drug Allergy and Anaphylaxis
how long should pt be observed for in hospital after anaphylaxis
6-12h
49
Drug Allergy and Anaphylaxis
which drugs may aggravate pre-existing urticaria
NSAIDs and opioids
50
Drug Allergy and Anaphylaxis
mild moderate reaction presentation
no evidence of a systemic reaction
51
Drug Allergy and Anaphylaxis
mnx of a mild and moderate reaction
PO chlorphenamine
52
Drug Allergy and Anaphylaxis
initial trx for anaphylactic reaction
IM adrenaline 500micrograms
IV chlorphenamine 10mg
IM/IV hydrocortisone 200mg
53
Drug Allergy and Anaphylaxis
patient follow up care after anyphylactic reaction
- 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
Drug Allergy and Anaphylaxis
when is taking mast cell tryptase useful
in suspected reactions during anaesthesia
55
Drug Allergy and Anaphylaxis
what should be reported to the Yellow Card Scheme
adverse drug reactions (inc anapkylactic shock) or which have resulted in hospitalisation
56
Drug Allergy and Anaphylaxis
classic signs of a Type I allergic reaction
urticaria, itching, angiodema, bronchospasm
57
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?
1-2 hours (but no later than 4 hours) after the onset of symptoms.
58
Fluids
Maintenance fluids/day
- 25-30ml/kg/day
- 1mmol/kg/day each of Na, Cl, K
- 50-100g/day glucose
59
medical therapy for fluid overload
- stop IV fluid
- furosemide
- sublingual nitrate
- IV nitrate
- CPAP
60
Amitriptyline overdose sx
- coma
- hypertonia
- dilated pupils
- urinary retention
- sinus tachycardia
- hyperreflexia
61
Heroin overdose sx
- coma
- constricted pupils
- reduced RR
62
Ecstasy overdose sx
- delirium
- tachycardia
- agitation
- dilated pupils
- hyperthermia
63
how does activated charcoal work
binds many poisons in the GI tract
reduced absorption
only give if within 1h
64
antidote for paracetamol poisoning
acetylcysteine
65
antidote for cholinergic excess or BB, digoxin, CCB
atropine
66
antidote for iron poisoning
desferrioxamine
67
antidote for digoxin toxicity
digoxin specific antibody fragments
68
antidote for benzodiazepines
flumazenil
69
antidote for methanol and ethylene glycol poinsoning
Fomepizole
70
antidote for BB toxicity
glucagon
71
antidote for opioid poisoning
naloxone
72
antidote for warfarin poisoning
Phytomenadione (vit k)
73
iron overdose sx
- N+V
- Diarrhoea
- grey or black stools
- GI ulceration, haemorrhage
- haematemesis
- rectal bleeding
- CV collapse
74
when should you admit patients in iron overdose
ingested >20mg elemental iron/kg bodyweight
or symptomatic
75
pt presents within 1 hr. what is the mnx
gastric lavage or aspiration
do not use activated charcoal as its adsorption of iron is poor
76
salicylate overdose sx (aspirin)
- N+V
- deafness
- tinnitus
- dehydration
- sweating
- vasodilation
- hyperventilation
- tachycardia
- metabolic disturbance
77
which group of antidepressants are associated with cardiotoxicity in overdose
TCAs
78
what are the classical signs on an ECG following TCA overdose
- tachycardia
- wide WRS
- wide QT interval
- RBBB
- negative R wave deflection in lead I
79
name some amfetamines
meth, ecstasy
80
features of amfetamine + cocaine overdose
- agitations
- convulsions
- hallucinations
- hyperthermia
- cardiac arrhythmias
- intracerebral haemorrhage
- rhabdomyolysis
81
NEWS score of what prompts you to consider sepsis
5 or above
82
what are the red flag signs of sepsis
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
what is septic shock
the most severe form of sepsis
persisting hypotension requiring vasopressors to maintain MAP>= 65
and lactate>2 despite having fluid resus
84
what is cryptic shock
high lactate, normal BP
85
what is puerperal sepsis
infection in the postnatal woman:
- close contact with group A strep
- prolonged rupture of membranes
- diabetes
