PSA Flashcards
Mx of STEMI
ABC + resus + O2 Aspirin 300mg PO Morphine 5mg IV + metoclop 10mg IV GTN spray Primary PCI or thrombolysis (+ repeat ECG)
Mx of NSTEMI
ABC + resus + O2 Morphine 5mg IV + metoclop 10mg IV GTN spray Aspirin 300mg PO LMWH!!! 1mg/kg SC
Mx of acute pulmonary oedema
ABC + resus + 02 Sit up Morphine 5mg IV metoclop 10mg IV Furosemide 40mg IV If failing --> Isosorbide dinitrate infusion + CPAP
Mx of tachycardia + shock/MI/syncope/LVF
synchronised DC shock 3x
Amiodarone 300mg IV over 10-20 mins
Repeat amiodarone 900mg over 24 hours
Mx of a regular, narrow complex tachycardia?
Vagal manœuvres
Adenosine 6mg IV rapid bolus!
Repeat with 12mg. Repeat with 12mg
Mx of regular, broad complex tachycardia
Amiodarone 300mg IV over 20 mins
Then, amiodarone 900mg IV over 24 hours
Pt on warfarin w major bleed - what do you do?
- STOP warfarin
- Vitamin K 5-10mg IV
- Prothrombin complex
Pt on warfarin w INR 7
Omit warfarin for 2 DAYS
Then, reduce dose
if minor bleed –> also give oral vitamin K
Pt on warfarin w INR 9
Omit warfarin
Vitamin K 1-5mg oral (even if there’s no bleed)
If a pt is stable w acute exacerbation of COPD, how much oxygen should be given?
28% O2 (roughly 2L) –> check ABG 30 mins later
Mx of anaphylaxis
Adrenaline IM 500micrograms
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg
If wheeze - salbutamol nebs
CURB 65?
Confusion (AMTS 8)
Urea (>7.5)
RR (>30)
BP (<90)
> 65yo
Pulmonary embolism: how is LMWH given?
Tinzaparin
175 units/kg SC OD
In a GI bleed, if PT or APTT is >1.5x thermal range, what must you give?
FFP
UNLESS the bleed is due to warfarin, in which case give prothrombin complex
Mx of acute GI bleed
O2
Fluid resus - 0.9% saline 500mL bolus
Catheter to monitor UO
Bloods: clotting, G+S, X-Match 6 units, FBC, LFTs, U+Es
Correct clotting: if prolonged PT/APTT –> FFP
Urgent OGD
Call surgeons
immediate medication given for suspected bacterial meningitis
IM benpen
IV fluids
IV dexamethasone 10mg
Mx of status
Airway - patent?
Recovery position
O2
Bloods: look for precipitating factors (infection, electrolytes, glucose, drugs)
If lasting >5 mins:
-IV LORAZepam/buccal MIDAZolam/IV DIAZepam
- Repeat diazepam after 2 mins
- Inform anaesthetics + ITU + consider phenytoin
Timelimit for thrombolysis in acute ischemic stroke
<4.5hours
Mx of DKA
Airway - patent
Breathing - O2? ABG? order CXR?
Circulation:
- Bloods: FBC, U+Es, ketones, glucose, CRP
1) SBP<90 –> 0.9% saline 500mL bolus
2) Fluids: 0.9% saline 1L over 1 hour, then over 2 hrs, 4 hrs, 8hrs
3) Insulin: 1 unit/1mL of saline. 0.1 units/kg/hr.
4) Replace K if <5.5 –> 40mM of K/1L of saline
Aim for ketones to reduce by 0.5mM/L/hr
Diagnosis of HONK?
Mx of HONK
Glucose >35
Osmolality >340
No ketones
Similar to DKA but half the rate of fluid infusion (500mL over 1 hour, then 2 hours, then 4 hours etc)
+ insulin + K replacement
Mx of hypoglycemia
Eat food
IV glucose 100mL of 20%
Im glucagon 1g
target BP in <80yo?
>80yo?
<80yo: <135/85 at home (140/85 in clinic)
> 80yo: 145/85 at home (150/85 in clinic)
Atrial fibrillation:
in whom would u consider rhythm control?
New onset AF + Haemodynamically unstable –> Electrical cardioversion
Stable + onset <48 hours –> rate or rhythm control (amiodarone 5mg/kg IV)
Stable + onset >48 hours or uncertain –> rate control + anticoagulation for 3 weeks, delay rhythm control
Mx of new onset AF (24 hours ago):
Rate control or rhythm control w
Amiodarone IV 5mg/kg
