Planning management Flashcards
Management of STEMI
“Acute treatment:
* PCI (if available within 2 hours of presentation) + (fondaparinux or unfractionated heparin)
or
* thrombolysis agents (e.g. alteplase, tenecteplase)
Plus (MONAC):
* Morphine (if in severe pain) & Metoclopramide
* Oxygen (if sats <94%)
* Nitrates (caution in hypotensive patient)
* Aspirin 300mg
* Clopidogrel 300mg/Prasugrel/Ticagrelor
Management of NSTEMI
“Acute treatment (BATMAN):
* Beta blocker
* Aspirin 300mg loading dose
* Ticagrelor 180mg loading dose
* Morphine 5-10mg IV + antiemetic
* Anticoagulant - LMWH (fondaparinux)
* Nitrates e.g. GTN
Secondary prevention with lifestyle factors and medical management (6A’s):
* Aspirin
* Another antiplatelet e.g. clopidogrel, prasugrel or ticagrelor for upto 12 months
* ACEi
* Atenolol
* Aldosterone antagonist for those with heart failure
* Atrovastatin
Secondary prevention with revascularisation procedures:
* PCI: GRACE Score to assess for PCI - if medium (5-10%) or high risk (>10%) they should have PCI within 4 days of admission
Management of acute LVF
Morphine
Oxygen
GTN
Furosemide
if inadequate response isorbide dinitrate infusion
Pneumothorax management
- If secondary(i.e. patient has lung disease), then always needs treatment: chest drain if >2 cm or patient has shortness of breath (SOB) or if >50 years old; otherwise aspirate.
- If tension pneumothorax(i.e. clinical distinction but often tracheal deviation +/− shock), then emergency aspiration required, but will need chest drain quickly.
GI bleed management
8C’s
management of bacterial meningitis
A GP will normally give 1.2g benzylpenicillin if there is any suspicion
Note - A computerized tomography (CT) scan of the head is not always required before lumbar puncture (LP); scanning the patient can delay the LP and hence antibiotics.
Management of seizures
Acute (status epilepticus - seizure failed to self terminate terminate) “Oh My Lord Phone the Anaesthetist”:
* Oxygen
* Midazolam (buccal or intranasal)
OR
* Lorazepam (IV)
* Phenytoin
* RSI of Anasthesia (profolol or thopentone) with intubation and ventilation
Note - Midazolam in children and Diazepam PR in community
Management of ischaemic stroke
Management of DKA
Management of acute renal failure
Management of hypoglycaemia
If the patient is able to eat, then give a sugar-rich snack, e.g. orange juice and biscuits. However, if unable to eat (i.e. drowsy/vomiting) give IV glucose via a cannula, e.g. 100 mL 20% glucose (traditionally 50 mL 50% glucose IV but can cause extravasation). If unable to eat and no cannula, give IM glucagon 1 mg.
Management of acute poisoning
chronic heart failure
Medical management (ABAL):
* ACEi (avoid in valvular heart disease) or ARBs
* Beta blocker
* Aldosterone antagonist (spironolactone or eplerone) when symptoms are not controlled with A and B
* Loop diuretics (furosemide or bumentanide)
stroke prevention scoring system in AF
the CHA2DS2-VASc score where each factor contributes one point unless indicated:
* Congestive heart failure (or left heart failure alone)
* Hypertension
* Age >75 (contributing 2 points)
* Diabetes mellitus
* Stroke or TIA before (contributing 2 points)
* Vascular disease (e.g. peripheral arterial disease or IHD)
* Age 65–74
* Sex (female).
Generally if:
* Score 0 may not require anticoagulation
* Score 1 consider anticoagulation in men using apixaban, dabigatran etexilate, rivaroxaban, or a vitamin K antagonist (warfarin).
* Score 2 or more consider anticoagulation in men and women as described above.
Bleeding risk tool used for anticoagulation in AF
Calculate the HAS-BLED score where each factor contributes one point unless indicated:
* Hypertension i.e uncontrolled BP
* Abnormal renal function (creatinine >200 umol/L or transplant or dialysis) Abnormal liver function (cirrhosis or bilirubin >2x normal or AST/ALT/ALP >3x normal)
* Stroke
* Bleeding tendency or predisporition
* Labile INR
* “Elderly” (aged >65)
* Drugs (e.g concomitant aspirin or NSAIDs) or alcohol
Generally if:
Score 0 = low risk of bleeding. Anticoagulation should be strongly considered.
Score 1–2 = low–moderate risk of bleeding. Anticoagulation should be considered.
Score ≥3 = high risk of major bleeding. Alternatives to anticoagulation should be considered.