Scoring Systems & Emergency Drugs Flashcards
Describe the Glasgow coma scale (GCS) scoring system
Score is froom 3-5
Describe CHA2DS2VASc score
Describe BTS classification of asthma severity
Describe MRC dyspnoea score
Describe CKD classification
Describe MRC grading of muscle power
Describe CURB65 score
Describe Centor score
Describe FeverPAIN score
Must be able to complete a scoring chart (provided for you) and calculate Wells scoring for DVT and PE.
Whats cut off for likely DVT and likely PE?
- Likely DVT =/>2
- Likely PE >4
Must know how to record observations on EWS (NEWS2) chart and use it to calculte EWS score
Things to remember:
- Diff SpO2 scales. Scale 1 has target saturations of =/>96%. Scale 2 for if saturations target 99-92%
- If on oxygen record either L/min or % of O2 delivered
- BP put systolic and diastolic with line/arrow between
Score of 3 or more in one category or total score >5 need a review.
What is the ASA score used for?
American Society of Anesthesiologists (ASA) grade is used to describe current fitness prior to undergoing anaesthesia and surgery and indicate the risk of post-operative complications and absolute mortality.
E= used in emergency operations
What is HAS-BLED score used for?
Estimate the 1-year risk for major bleeding in patients with atrial fibrillation
What is the Rockall score used for?
Estimate the risk of death or rebleeding in pts with upper GI bleed; have pre- and post-endoscopic score
Score 0-1 is low risk
Score 2-4 is intermeidate risk
Score =/> 5 is high risk
What is the POSSUM score used for?
Interpret the score
Assesses morbidity and mortality for surgery. It can be used for both emergency and elective surgery; consists of both physiological and operative score. Should not be used for trauma pts/surgery!
What is the NELA score?
Provides an estimate of the risk of death within 30 days of emergency abdominal surgery/laparatomy
What is the Ranson criteria?
Interpret the score
Used to assess severity and mortality of acute pancreatitis
What is the ROME IV criteria?
Used to diagnose functional Gastrointestinal Disorders. Different criteria for different problems e.g. IBS, gastrodudoenal disoders, anorectal disorders etc.. Also have criteria for children e.g. for functional diarrhoea.
Describe the ROME IV criteria for IBS
Describe the ROME IV criteria for constipation
What is the PHQ-9 score/questionnaire?
The PHQ-9 is a 9-question instrument given to patients in a primary care setting to screen for the presence and severity of depression- based on DSM 5 criteria for depression
Give a rough indication as to what a high, medium and low score of PHQ-9 is
What is the GAD-7 score/questionnaire used for?
For screening and assessing severity of generalized anxiety disorder (GAD).
Give a rough indication as to what a low, medium and high GAD-7 score is
What is the FAST score used for?
Screening tool used to assess a service users level of risk to alcohol harm.
If pt scores 3 or more on FAST score, what should you do next?
AUDIT questionnaire
Describe the AUDIT questionnaire
Interpret the score
● 0 to 7 indicates low risk
● 8 to 15 indicates increasing risk
● 16 to 19 indicates higher risk,
● 20 or more indicates possible dependence
Questions from FAST & those in image
What is GPCOG used for?
The General Practitioner Assessment of Cognition (GPCOG) is a brief screening test for cognitive impairment.
Has two parts: patient section and informant section
What is the STarTBack score used for?
Risk stratify patients with back pain into low, medium and high risk groups for ongoing disability
*Subscore looks at Q5-Q9 which are psychological qeustions
What is the dose and administration route of adrenaline in anaphylaxis?
- 0.5ml (or 500 micrograms) of 1:1000
- IM
*1 in 1000 solution is 100ug in 0.1ml
What is the dose and administration route of adrenaline in cardiac arrest?
- 1mg of 1:10000 every 3-5 mins
- IV injection
*1 in 10000 is 100ug/mL therefore 1mg would be 10ml??
What is the dose and administration route of hydrocortisone in anaphylaxis?
- 100-300mg
- IV injection
What is the dose and administration route of chlorphenamine in anaphylaxis?
- 10mg (repeat dose if necessary up to 4 times in 24hrs)
- IV injection or IM injection
What is the dose and administration route of atropine for treatment of post-MI bradycardia?
- 500ug (0.5mg) every 3-5 minutes up to max of 3mg
- IV injection
What is the dose and administration route of aspirin in ACS?
- 300mg
- Chewable or dispersed in water
What is the dose and administration of clopidogrel in ACS?
- 300mg
- PO
What is the dose and administration of calcium gluconate in hyperkalaemia?
- 10-20mL of 10%
- Slow IV injection
Can be repeated as required or followed by continous infusion; initially 50 mL/hour, adjusted according to response, infusion to be administered using 100 mL of calcium gluconate 10% diluted in 1 litre of glucose 5% or sodium chloride 0.9%.
What medication and route of administration should insulin be given during a hypo if pt is alert and can swallow?
- Fast acting carbohydrate PO e.g. 10-20mg of glucose tablets, glucogel. Repeat afer 10-15 mins up to 3 times if required
- Once blood sugar >4mmo/L provide with long acting carbohydrate e.g. slice of bread
What medication, dose and route of administration should be given in a hypo if pt has decreased level of consciousness?
- Glucagon 1mg
- IM injection
If no response after 10 minutes give IV glucose:
- 125mL of 20% dextrose
- 250mL of 10% dextrose
**DO NOT GIVE 50% dextrose
What medication, dose and route of administration should be used if pt is having hypo and is having seizures or is unconscioius?
- 1mg glucagon
- Im injection
If no response after 10 minutes give IV glucose:
- 125mL of 20% dextrose
- 250mL of 10% dextrose
**DO NOT GIVE 50% dextrose
Who can you not give IM glucagon to in a hypo?
Why do we avoid 50% dextrose?
- Chronic liver disease as have impaired hepatic gluconeogenesis. Glucagon may provoke reboudn hypoglycaemia secondary to insulin release
- Hypertonic and has high viscosity and is irritant to venous system causing thrombophlebitis
What dose of insulin and dextrose would you use to set up variable rate insulin infusion?
What dose and route of administration of diazepam would you use for status epilepticus?
- 10 mg
- IV injection
….then 10 mg after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute.
What dose and route of adminstration would you give lorazepam in status epilepticus?
- 4mg
- Slow IV injection
Can be repeated after 10 mins if required. To be administerd into large vein.
What dose and route of administration would you give lorazepam in if pt has delerium tremens?
- 2-4mg
- PO
What dose of salbutamol can be given via inhalation of aerosol during asthma attack?
2–10 puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or when required, give via large volume spacer, each puff is equivalent to 100 micrograms.
What dose of salbutamol can be given via nebuliser during asthma attack?
5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available
What dose and route of administration should prednisolone be given in acute asthma attack?
40–50 mg PO daily for at least 5 days.
What dose and route of administration should morphine be given during ACS?
For Adult
- 5–10 mg, followed by 5–10 mg if required
- Slow IV injection (rate of 1–2 mg/minute)
For Elderly **Use dose for elderly in frail patients.
- 2.5–5 mg, followed by 2.5–5 mg if required
- Slow IV injection at a rate of 1–2 mg/minute.
For acute pain, what dose of morphine can adults have?
10mg every 4hrs (PO, SC or IM)
5mg every 4hrs (slow IV injection)
What dose and route of administration is required for naloxone in opoid overdose?
- IV injection
- Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients),
