A-->E Mx Flashcards
(35 cards)
dosages & routes for Adrenaline
cardiac arrest
anaphylaxis
anaphylaxis in children
1mg–> 1:10,000–> IV
- 5ml–> 1:1,000–> IM
- 3 ml –> 1: 1,000–> IM
Mx of Acute asthma attack?
1) NEBS salbutamol 5mg (back to back)
2) Hydrocortisone 100mg IV or PO prednisolone 40mg
3) ipratropium 500mcg NEBS
Pre-partum Haemorrhage pregnant women?
1) Activate major obstetric haemorrhage protocol
2) Call for help! (midwife, obstetricians, neonatologists)
ALERT haematologist!
3) bloods –> G&S, cross match, FBC, U&E, LFT, CRP
4) ask for O- blood transfusion (its available in the emergency)
LEFT LATERAL LIE
Manual traction of uterus (push it to the left) (prevents naval compression during CPR)
EMERGENCY C-SECTION w/ in 5 minutes!
how many weeks must the baby be to prepare for emergency C-section?
how quick?
if > 20 weeks, must be done w/in 5 minutes of cardiac arrest!!!
Mx of STEMI
include routes of drugs and doses
CALL 2222, CRASH TEAM
Morphine if in severe pain–> 5-10mg IV in 10 mL slowly + antiemetic IV metaclopramide 10mg IV
Oxygen if sats less than 94%
Nitrates : sublingual 2 sprays
Aspirin: 300 mg PO
Refer for PCI w/in 2 hours
yes–> go for PCI
NOT available–> fibrinolysis–> TPA + antithrombin 3
Hyperkalemia Mx
when do u commence treatment?
K+ > 6.5 mmol/L or ECG changes or Cardiac arrest or AKI
1) 30 mL, calcium gluconate 10% –> repeat in 5-10 mins if no improving in ECG
2) 10 U of regular insulin + 50 mL of dextrose 50% in water (- Given over 15-30 mins)
3) 5mg of nebs salbutamol (back to back 4x)
4) 15g calcium resonium
Status Epilpeticus
Mx
lorazepam IV 4mg or 10mg PR diazepam
repeat after 10 mins
—-if after 20 mins not terminated
CALL SENIOR to give
20
Acute heart failure
pulmonary edema
S-LMNOP sit ptx upright Loop dieuretics- furesomide 40-80mg IV slowly Nitrates- 2 puffs Oxygen CPAP
PE
Ix: ABG, XRAY, d-dimer
Wells score
1st line: DOAC Apixaban or
rivaroxaban 15 mg 2x daily for 21 days
If not suitable……
LMWH for 5 days followed by dabigatran or edoxaban OR
LMWH + vit K antag for 5 days
Massive PE
Thrombolysis
COPD exacerbation
Ix: ABG, XRAY
Salbutamol 5mg/4h & ipratropium 500mcg/6h
Mx:
1) Prednisolone 30 mg for 5 days OR IV hydrocortisone 200mg
2) Amoxicillin 500mg/8h PO
3) Physiotherapy to aid sputum expectoration
if respiratory acidosis or rising PCo2—> NIV (BiPAP) if PH <7.35,
Tension Pneumothorax
1) Large wide bore cannula 2nd intercostal space mid clav above each rib
2) chest drain–> followed by xray to check position
5th intercostal space (or the inferior nipple line)
The mid axillary line (or the lateral edge of the latissimus dorsi)
The anterior axillary line (or the lateral edge of the pectoris major)
Subarachnoid hemmorhage
Ix: Urgent CT head
LP after 12 hours
1) mainstain cerebral perfusion FLUIDS
2) Nimodipine (60mg/4h PO for 3wks, or 1mg/h IVI) for 21 days!
3) Sx: endovascular coiling vs surgical clipping
Acute upper GI BLEED
1) activate major haemorrhage protocol
2) Ix: basic bloods, clotting, G&S, CXMATCH, CXRAY, ABG, ECG
3) Transfusion–> Hb <70
4) Correct clotting abnormalities (vitamin K (p274), FFP, platelets).
MEDS
5) if variceal suspicion–> IV terlipressin (1-2mg/6hr/ <3days) & broad-spectrum IV
(piperacillin/tazobactam IV 4.5g/8h).
ALL ptx should have endoscopy within 24 hours
PEPTIC ULCER
ABC approach as with any upper gastrointestinal haemorrhage
IV proton pump inhibitor
1st-line treatment is –> endoscopic intervention
adrenaline and diathermy
if this fails (approximately 10% of patients) then either:
URGENT interventional angiography with transarterial embolization or
surgery
GCA
1) refer rheumatolgoist
raised ICP
investigate and treat the underlying cause
1) head elevation to 30º
2) IV mannitol may be used as an osmotic diuretic
3) controlled hyperventilation**
4) Restrict fluid to <1.5L/d
**aim is to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP
leads to rapid, temporary lowering of ICP. However, caution needed as may reduce blood flow to already ischaemic parts of the brain
5) Removal of CSF, different techniques include:
- drain from intraventricular monitor (see above)
- repeated lumbar puncture (e.g. idiopathic intracranial hypertension)
- ventriculoperitoneal shunt (for hydrocephalus)
IF ITS BRAIN METSS only
DEXAMETHASONE 10mg IV and follow with 4mg/6h IV/PO
Ascites
what if SBP
1) reduce dietary dietary Na
2) fluid restriction is sometimes recommended if the sodium is < 125 mmol/L
3) Spironolactone
4) drainage if tense ascites (therapeutic abdominal paracentesis)
large-volume paracentesis for the treatment of ascites requires albumin ‘cover’. Evidence suggests this reduces paracentesis-induced circulatory dysfunction and mortality
5 ) Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved’
If SBP confirmed you give–> cefotaxime
hypoglycaemia
LESS THAN 4 mmol/L
conscious can swallow–> 5-7 oral dextrose tablet or fruit juice 150 ml
conscious cannot swallow–> 1.5- 2 glucogel or 1mg IM glucagon
unconscious–> IV 75ml 20% glucose over 10-15 mins
test blood glucose after 10-15 mins, if still less than 4mmol/L repeat cycle to Max of 3x
DKA
TRIAD of
Glucose more than 11
PH less than 7.3
Ketones more than 3
Features: abdo pain, kussmuls breathing, sweating, palpitations, SOB, dizzy, pear drop smell breath
INSULIN
an IV should be started at 0.1 unit/kg/hou
Mx:
- 9% of 1L of normal saline in 1 hr
- 9% of 1L of normal saline 2hr
- 9% of 1L of normal saline 2hr
- 9% of 1L of normal saline 4h
- 9% of 1L of normal saline 4h
- 9% of 1L of normal saline 6 h
Add potassium Chloride in the SECOND BAG
if K+ is 3.5 - 5.5—> 20mmol per 500 ml
(10mmol per hr)
DKA is resolved when
pH MORE than 7.3
blood ketones LESS than 0.6 mmol/L
HCO3- MORE than 15.0mmol/L
Addisonion Crisis
CF: Weakness • Lethargy • Weight loss • Dizziness • LowBP • Nausea & vomiting
IV or IM Hydrocortisone 100mg stat
• IV Hydrocortisone 50mg QDS or 200 mg/24 hours
maintenance or 200mg/24 hr infusion
• IV fluids
Thyrotoxic Crisis
DPPL(mnemonic)
IV Propanolol 2mg
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
Propylthiouracil
After 4hrs, give Lugol’s solution (aqueous iodine oral solution). Iodine should typically be administered after thionamide therapy has been started to prevent stimulation of new hormone synthesis
sedate with chlorpromazine.
pheochromocytoma
Sweating, palpitations, headache
SEND ICU
Start with short-acting, IV A- blocker, exL phentolamine 2–5mg IV. Repeat to main-tain safe BP.
- -> When BP controlled, give long-acting a-blocker,
- phenoxybenzamine ** 10mg/24h PO
Hypothermia
Diagnosis : Check oral or axillary T°.
If ordinary thermometer shows <36.5°C
Tests: Urgent U&E, plasma glucose, and amylase. Thyroid function tests; FBC; blood cultures. Consider blood gases. The ECG may show J-wave
All should receive WARM, humidified O2; ventilate if comatose or respira-
tory insufficiency.
Remove wet clothing, slowly rewarm, aiming for rise of 1⁄2°C/h (check temp, BP, HR, and RR every 30min) using blankets or active external warm- ing (hot air duvets).
If T° rising too quickly stop & allow to cool slightly. Rapid rewarming causes peripheral vasodilation and shock. A falling BP can be a sign of too rapid warming.
- Warm IVI.
- Cardiac monitor is essential (AF, VF, and VT can occur at any time during rewarming or on stimulation).
- Consider antibiotics for the prevention of pneumonia, Give these routinely in ptx over 65yrs with T° <32°C.
- Consider urinary catheter (to monitor renal function).
