Acute Care

Question 1

Clearance of C spine

Awak pt, no pain, no injury

Answer 1

Exam:
- remove collar, keep head still
- pt flex & extend neck, turn L and R passively
- THEN against resistance
- Any pain –> stop, replace collar, will need imaging

C-spine cleared without imaging if:
* no neck pain
* n opain to palpation of midline C spine
* awake + alert, GCS 15
* no intoxication (EtOH, drugs)

Aim to clear within 1 hour

Question 2

Clearance of C-spine

Awake, persistent C-spine pain

Answer 2

Needs CT C-spine (+/- MRI)

Both negative –> cleared
Bony or ligament injury –> ortho or neurosurg spine R/v

Question 3

Anaphylaxis Tx

Answer 3

Secure airway

Remove any cause

IM adrenaline 0.5ml/0.5mg 1:1000

Then
- IV access
- wheeze if asthma sx
- still hypotension —> ICU for IV adrenaline +/- aminophylline, nebuliser salbutamol
- antihistamines if cutaneous sx

Question 4

Status epilepticus

Answer 4

Airway adjuncts as needed

Oxygen +/- suction

If no IV = rectal diazepam

IV available or rapidly achieved = Lorazepam 4mg IV
- 2nd dose if no response 10-20m

Phenytoin
- 15-18mg/kg IV (50mg/min rate)
- monitor ecg, bp

Anaesthetics & ICU: RSI + intubation + ventilation

Question 5

Ix for Status epilepticus

Answer 5

Bedside:
- glucose
- pulse ox
- ABG
- ECG, cardiac monitoring
- urine dip

Bloods
- glucose
- anticonvulsant levels
- toxicology screen
- FBC, CRP (exclude infection)
- blood cultures

Question 6

Massive PE

Question 7

Management of ACS - STEMI

Answer 7

Attach ECG monitor
IV access: Trop, fbc, u&e, glucose, lipids
Brief CVS exam: BP,

Oxygen if sats <94%

Morphine & Metoclopramide if severe pain

Aspirin 300mg
Dual antiplatelet - Clopidogrel 300mg, Ticagrelor 180mg, Prasugrel

?Heparin

DEFINITIVE:
- PCI (if available within 120m)
- fibrinolysis/thrombolysis otherwise

Question 8

Management of DKA

Answer 8

A-E approach

C: 2 large bore cannulae
- 1L 0.9% saline over 1 hour (500mL bolus over 15m if shocked)

Ix:
- bedside VBG, glucose
- lab glucose and ketones, U&E, CRP, FBC
- ECG
- CXR

Definitive
- Insulin 0.1U/kg/hour
- continue any long acting insulin
- add dextrose to infusion when <14mmol/L blood glucose
- thromboprophylaxis + potassium replacement

Continue monitoring
- neuro Obs
- capillary blood glucose, ketones (hourly)
- VBG at 2, 4, 8, 12, 24h
- consider catheter
- consider NG if drowsy or vomiting