Planning management - Acute conditions Flashcards
Management of acute conditions: STEMI
ABC
15L by non-rebreathe mask (unless COPD)
Hx, O/E, ix (ECG, troponin)–> diagnosis STEMI
Aspirin 300mg oral
Morphine 5mg-10mg IV with metaclopramide 10mg IV
GTN spray/ tablet
Primary PCI (preferred) or thrombolysis
Beta-blocker e.g. atenolol 5mg oral - unless LVF or asthma
Transfer CCU
Management of acute conditions: NSTEMI
ABC and O2 15L via non-rebreathe mask unless COPD
Hx, o/e, ix (ECG & trops) –> diagnosis = NSTEMI
Aspirin 300mg oral
Morphine 5-10mg IV with metaclopramide 10mg IV
GTN spray/ tablet
Clopidogrel 300mg oral and LMW heparin e.g. enoxaparin 1mg/kg BD S/C
Beta blocker e.g. atenolol 5mg except LVF/ asthma
Transfer CCU
Management of acute conditions: acute LVF
ABC and O2 15L via non-rebreathe mask unless COPD
Hx, o/e, ix(ECG & trops, bloods)
Diagnosis LVF +/- cause
Sit patient up
Morphine 5mg-10mg IV with metaclopramide 10mg IV
GTN spray/ tablet
Furosemide 40-80mg IV
If inadequate response isosorbide mononitrate infusion +/- CPAP
Transfer CCU
Management of acute conditions: anaphylaxis
ABC and O2 15L via non-rebreathe mask unless COPD
Remove the cause ASAP e.g. blood transfusion
Adrenaline 500micrograms of 1:1000 IM i.e. 0.5ml of 1:1000
Secure IV access
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
IV 0.9% saline 500ml over 15mins, up to 2L titrate against BP
Asthma tx if wheeze - salbutamol nebs
If still hypotensive consider ITU, adrenaline infusion +/- aminophylline
Amend drug allergies box on drug chart
Management of acute conditions: acute exacerbations of asthma
ABC
Hx, o/e, ix, diagnosis acute asthma
Sit up
100% O2 by non-rebreathe mask
Salbutamol 5mg nebs & Ipratropium 500micrograms nebulised with O2
Hydrocortisone 100mg IV if severe or life threatening or prednisone 40-50mg oral if moderate
CXR to exclude pneumothorax
Theophylline only if life threatening -only if not on aminophylline
Inform seniors and ITU & Magnesium sulphate 1.2-2g over 20 min if not improving
Management of acute conditions: COPD
Same as acute asthma management but add IV antibiotics if infective exacerbation
Give 28% oxygen and do ABG within 30 mins to check for type 2 resp failure
Management of acute conditions: pneumothorax
If secondary I.e. patient has lung disease —> pt needs tx
Chest drain if >2cm or patient SOB or if >50 years old otherwise aspirate
If tension pneumothorax i.e. tracheal deviation +/- shock then emergency aspiration is required but will need chest drain quickly
If primary determine whether the pt needs tx:
If <2cm rim and not SOB then discharge pt with outpatient follow up in 4 weeks
If >2cm rim on CXR or SOB then aspirate and if unsuccessful aspirate again and if still unsuccessful then chest drain
Management of acute conditions: pneumonia
Use CURB65 to assess severity of CAP Confusion - AMTS <8/10 Urea >7.5mmol/L Respiratory rate >30/min Blood pressure (systolic) <90mmHg Age >65 years Score 0 or 1 home treatment Score 2 or more hospital tx with oral or IV abx >3 ITU care
ABC
Hx, o/e, ix, diagnosis pneumonia
High flow oxygen
Antibiotics e.g. amoxicillin or co-amoxiclav
Paracetamol
If low BP or raised HR IV fluids as normal
Management of acute conditions: pulmonary embolism
ABC
Hx, o/e, ix (d-dimer, CTPA), diagnosis –> PE
High flow oxygen
Morphine 5-10mg IV
Metaclopramide 10mg IV
LMWH e.g. tinzaparin 175units/kg SC daily
If low BP, IV gelofusine –> adrenaline –> thrombolysis
Management of acute conditions: Gastro emergencies
Gastrointestinal bleeding
ABC 15L O2 via non-rebreathe mask Hx, o/e, ix --> diagnosis acute GI bleed 8 Cs Cannulate - 2 large bore Catheter (and strict fluid monitoring) Crystalloid/ colloid Cross match 6 units of blood Correct clotting abnormalities** Camera - endoscopy Stop Culprit drugs - NSAIDs, aspirin, warfarin, heparin Call the surgeons
**if PT/aPTT more than 1.5 normal range –> give fresh frozen plasma (unless due to warfarin –> give prothrombin complex e.g. beriplex
If platelets <50x10^9/L and actively bleeding give platelet transfusion
Management of acute conditions: Neuro emergencies
Meningitis
GP would have already given 1.2g benzylpenicillin if meningitis suspected
ABC Hx, o/e, ix, diagnosis meningitis High flow oxygen Iv fluid Dexamethasone IV unless severely immunocompromised LP +/- CT head 2g cefotaxime IV - give pre-LP if having a CT head or prolonged LP Consider ITU
Management of acute conditions: Neuro emergencies
Seizures and status epilepticus
Management of any seizure
ABCDE
Ensure airway patent
Put in recovery position to prevent vomits/ aspiration
Check for provoking factors - plasma glucose, electrolytes
Seizures lasting >5min
Buccal midazolam 10mg, diazepam IV 10mg or lorazepam 2-4mg IV
If still fitting after 2 min repeat diazepam
Inform anaesthetist
Phenytoin infusion
Intubate and then propofol
Status epilepticus = seizing for longer than 30 min
Management of acute conditions: Neuro emergencies
Stroke
ABCDE
H/x, o/e, ix (blood glucose and CT head to exclude haemorrhage) –> diagnosis ischaemic stroke
If aged <80 years and onset <4.5 hours ago consider thrombolysis
Aspirin 300mg oral
Transfer to stroke unit
Management of acute conditions: Metabolic emergencies
Hyperglycaemia
ABCDE
Hx, o/e, inv, diagnosis: DKA
IV fluid: 1L stat then 1L over one hour, then 2 hours, then 4 hours then 8hours
Sliding scale insulin & continue long acting insulin
Hunt for trigger - infection, MI, missed insulin
Monitor BM, K+ and pH
How do you diagnose DKA?
Diabetic i.e. hyperglycaemia with BM >30mmol/L
Keto i.e. check blood or urine ketone levels
Acidosis i.e. low pH on ABG
& watch out for increased potassium
