Section 3: Planning management Flashcards
How do you manage status epilepticus (seizure >5min)?
Give 1 dose of lorazepam 4mg IV, then repeat after 10 min, then give phenytoin 20mg/ kg IV (max 2g) [loading dose] - contact ITU
Alternatives: diazepam PR or buccal midazolam.
How do you manage bacterial meningitis in hospital?
IV ceftriaxone 2-4g OD in hospital + supportive Mx
How do you manage viral meningitis?
IV aciclovir 10mg/kg TDS + supportive Mx
Note: May be less unwell than bacterial meningitis, must be confirmed by CSF findings
How do you manage bacterial meningitis w suspected meningococcal septicaemia?
IV/ IM cefotaxime 8g QDS
In the community/ hospital transfer not possible - IM benzylpenicillin 1.2g STAT or IM cefotaxime 1g STAT (if PA)
What are the principles of managing AF?
If haemodynamically unstable - DC cardioversion
In younger patients/ not responsive to rate control - pharmacological cardioversion
In older patients/ not responsive to rhythm control - rate control
How do you manage upper GI bleed?
Fluid resuscitation with IV NaCl/ Hartmann’s
If variceal bleed suspected, give terlipressin and prophylactic antibiotics (high risk of SBP)
Urgent OGD to stop bleeding and locate source
What is the initial management for UC?
Prednisolone 20-40mg OD until remission occurs followed by reducing doses + mesalazine (PO/ TOP)
What is the management for Crohn’s to induce remission?
Prednisolone 20-40mg OD until remission occurs followed by reducing doses +/- azathioprine/ methotrexate/ biologics
What is the management for Crohn’s to maintain remission?
Azathioprine OR mercaptopurine +/- methotrexate
Note: use same drug used to induce remission, but do not use corticosteroids long term
What is the management for Crohn’s to maintain remission?
Azathioprine* OR mercaptopurine +/- methotrexate
*Check contraindications in BNF when prescribing e.g. low or absent TPMT activity
What is the management for acute gout?
1st line - NSAIDS e.g naproxen, diclofenac
2nd line - colchicine 500mcg BD-QDS (when NSAIDs CI e.g. heart failure, anti-coagulants)
3rd line - corticosteroids
What is the prophylaxis for gout?
Lifestyle modification, manage risk factors
Allopurinol 100mg OD PO (titrate accordingly, after food)
Febuxostat 80mg OD PO
How do you manage anaphylaxis, after adrenaline 0.5mg IM has been administered without symptom improvement?
Give another dose of adrenaline 0.5mg IM after 5 min, and every 5 min if not improving
Note: also give chlorphenamine 10mg IV and hydrocortisone 200mg IV
How do you manage acute pulmonary oedema?
Loop diuretics i.e. furosemide 80mg IV injection
A 5yo boy comes into the ED with a sore throat, strawberry tongue, fever >38C, macular rash. What is the treatment?
Likely scarlet fever/ group A strep.
If oral fluids tolerated, PO phenoxymethylpenicillin for 10 days.
If not, IV amoxicillin is an alternative.