Emergencies

Question 1

Anaphylatactic shock drug doses

Answer 1

Adrenaline 0.5mg (1:1000)
Fluids if hypotensive
Chlorphenamine 10 mg IV
Hydrocortisone 200 mg IV
Salbutamol Nebs if whezze: 5 mg salbutamol + 0.5 mg Ipratropium Bromide

Question 2

The type of anti-coagulation in NSTEMI

Answer 2

Foundaparinux 2.5 mg plus heparin

Dalteparin

Question 3

INR>8 no bleeding

Answer 3

• stop warfarin

Vitamin K

Question 4

Major bleeding patient on WF

Answer 4

stop warfarin
Vitmain K
Dried prtohrobmin complex (2,7,9,10)

Question 5

Steroids in COPD

Answer 5

Hydrocortisone 200 mg IV

Prednisolone 40 mg PO for 7-14D

Question 6

If no improvement in severe asthma exacerbation 15-30 min

Answer 6

ITU
Nebulised Salbutamol 
Continue Ipratropium 0.5 mg 4-6h 
MgSO4 2g IV over 20 min 
IV salbutamol 3-20mg 
Aminophyline 5 mg/kg over 20 min

Question 7

Insuin-induced hypoglycemia management

Answer 7

1 mg glucagon IM /SC

Question 8

Bradycardia with adverse features management

Answer 8

500 mcg IV Atropine
repeat to a maximum 3 mg
- Isoprenaline
-Adrenaline

Question 9

INR>8 minor bleeding

Answer 9

• stop warfarin

- vitamin K

Question 10

Drugs used in Asthma Exacerbation

Answer 10

Nebulised Salbutamol 5 mg, ipratropium 0.5mg

Hydrocortisone 100mg IV or prednisolone 50 mg per o

Question 12

Hyperkalemia Emeregency

Answer 12

Evidence of Cardiac Instability K>6.5

• 10 mL 10% calcium gluconate
• 100 ml 20% glucose + 10 u insulin
• Salbutamol 5 mg nebulizer
• Hemofiltration
• Calcium Resonium 15g PO or 30 mg PR

Question 13

HONK management

Answer 13

• Rehydration
• Wait 1h before starting insulin (might not be needed), start low
• Heparin as occlusive events are common

Question 14

What’s Cushing Reflex?

Answer 14

Increased BP, decreased HR, irregular breathing signs of ICP

Question 15

NSTEMI

Answer 15

+ Beta-blocker: atenolol 50 mg/24h

IV GTN if pain continues

Question 16

Aminophyline Infusion in asthma exacerbation

Answer 16

1g in 1L of Saline, 0.5mg/kg/h

Question 17

Medications used in PE

Answer 17

Analgesia: Morphine plus minus metoclopramide
Thrombolysis Alteplase 50 mg bolus
LMWH sub cut 1.5mg/kg
if SBC < 90 500 ml colloid 
>90 start warfarin

Question 19

Antibiotics in COPD

Answer 19

Doxy 200 mg PO STAT then 100 mg OD for 5D

Question 19

STEMI

Answer 19

MONACH
Antiplatlet: Aspirin 300 mg PO
Clopidorgel 300 mg PO
Analgesia: Morphone 5-10 mg IV
Metoclopromadie 10 mg IV
GTN 2 puffs
Heparin: DVT prophylaxis 40 mg SC OD

Question 21

What is worrying sign in asthma exacerbation patients?

Answer 21

Normal or increased PaCO 4-7 to 6. It should be lower

Question 22

Management of hypercalcemia of malignacy

Answer 22

• rehydration

- Biphosphonates

Question 23

What’s the dose of ceftriaxone ?

Answer 23

2 g IV

Question 24

A 25-year-old female is found to have a left hemiparesis following a deep vein thrombosis. An ECG shows RBBB with right axis deviation. What is the most likely underlying diagnosis?

Answer 24

Ostium Secundum Atrial Septal Defect

Question 26

What are the shockable rhythms?

Answer 26

In the shockable rhythms - ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT), CPR should be immediately provided and the patient defibrillated as soon as possible.

Question 27

How would you correct hyponatremia?

Answer 27

Chronic 10 mM/d
Acute 1 mM/h
Danger: Central Pontine Myelinositis

Question 28

Broad complex tachycardia with adverse signs

Answer 28

DC cardioversion

Amiodarone 300 mg over 20-60 min

Question 29

What’s the management of hypernatremia?

Answer 29

water PO

dextrose 5% slowly IV

Question 30

Narrow Complex Tachycardia regular rythm

Answer 30

vagal manouvers
Adenosine 6 mg IV bolus, then 12 mg, 12 mg
Adverse signs: BP<90, HF, decreased consciousness > SYNCHRONISED CARDIOVERSION
Diagoxin
Amiodorane
Verapamil
Atenolol

Question 32

No adverse signs and elctrolyte disturbance

Answer 32

low K 60mm KCL at 20 mmol/h

low Mg 4 ml 50% MgSO4 in 30 min

Question 33

What is non-urgent management of hyperkalemia?

Answer 33

Calcium Resonium (Binds K in the gut and decreases K over a few days)

Question 34

Additional Drugs used in life-thretening Asthma Exacerbation

Answer 34

If life-threatening: MgSO4 2g IV over 20 min

Nebulised Salbutamol every 15 min

Question 35

Oxygen Theraphy with COPD

Answer 35

• sit up
• 24% via Venturi Mask Target SpO2 88-92
• FiO2 and SPO2 targets according to ABG
• AIM FOR PaO> 8 PCO <1.5kPa

Question 35

Delirium

Answer 35

only if disruptive: Haloperidol 0.5-2 mg PO/IM

Chlorpromazine 50-100 mg PO (avoid in eldery)

Question 35

Epilepsy

Answer 35

Buccal midazolam 10 mg
Diazepam 10 mg PR/IV
Lorazepam 2-4 mg IV bolus
2nd dose if not responsive within 2 min 
Phenytoin 18 mg/kg IV

Question 36

Hypoglycemia managemnt

Answer 36

50 ml 50% glucose

Question 38

INR 5-8 minor blled

Answer 38

stop warfarin, give vitamin K

Question 39

INR 5-8 no bleeding

Answer 39

withold one dose of warfarin and reduce subsequent maintencae dose

Question 40

Nebulised Bronchodilators in COPD

Answer 40

Salbutamol 5 mg/4h
Ipratropium 0.5mg/6h
IV aminophyline if no response

Question 40

Drugs used in pulmonary oedema

Answer 40

Diamorphine 2.5-5mg IV
Metoclopramide 10 mg IV
Frusemide 40-80 mg IV
GTN 2 puffs unless SBP<900
SBP <100 mg 
ISMN 2-10 mg 
CPAP

Question 41

DKA

Answer 41

1. Fluids 1L BP>90
2. K+ replecement in 2nd bag if K (3.5-5.5)=40 mM/L
3. <3.5 mM consult senior

Insulin Infusion 0.1u/kg/h Actrapid 6u if no weight

Question 41

Hypokalemia K<2.5

Answer 41

IV KCL 10 mmol/H

Question 42

Irregular Narrow Complex Tachycardia

Answer 42

• beta-blocker or dilitazem

- digoxin or amiodorane

Question 42

What do you give in variceal bleed?

Answer 42

Terlipressin IV (splanchic vasopressor)
Prophylactic Abx. ciprofloxacin