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1
Q

asthma patho

A

Allergen is inhaled and causes an inflammatory response in the lower airways. Mast cells release histamine which causes bronchoconstriction, mucosal oedema.

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2
Q

asthma signs/symptoms

A

SOB, increased WOB, cough, wheeze, accessory muscle use

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3
Q

asthma drugs used

A

Salbutamol, ipratropium bromide, dexamethasone, adrenaline

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4
Q

asthma tx adult mild/moderate

A

Salbutamol in pMDI + spacer, 4-12 doses, 4 breaths per dose, repeat 20 minutes.

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5
Q

asthma tx adult severe

A

Salbutamol 10mg (5mL) nebulised, ipratropium bromide 500mcg (2mL) nebulised. Repeat salbutamol 5mg (2.5mL) every 5 minutes.

Dexamethasone 8mg IV/oral

Adrenaline 500mcg IM, repeat 5-10 minute intervals, max 1.5mg (3 doses)

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6
Q

COPD patho

A

Group of respiratory disorders characterised by increased mucous production and secretion, airway inflammation and reduced lung elasticity. Irreversible and progressive.

Chronic bronchitis - obstructed airflow due to increased mucous production/secretion and inflamed bronchioles due to exposure to irritants.

Emphysema - permanent enlargement of the airways and damaged alveolar walls due to toxins inhaled, reduced area for gas exchange.

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7
Q

COPD signs/symptoms

A

Productive cough, SOB, increased WOB, sputum increase

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8
Q

COPD drugs used

A

Oxygen therapy, salbutamol, ipratropium bromide, dexamethasone

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9
Q

COPD treatment

A

Salbutamol 10mg + Ipratropium bromide 500mcg nebulised

Dexamethasone 8mg IV/oral

Oxygen therapy, nasal prongs

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10
Q

asthma tx paed mild/moderate

A

Salbutamol pMDI + spacer, 4 breaths each dose, repeat at 20 minutes
6+ = 4-12 doses
1-5 = 2-6 doses

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11
Q

asthma tx paed severe

A

Salbutamol nebulised, repeat at 20min intervals
2-4 = 2.5mg (1.25mL)
5-11 = 2.5-5mg (1.25-2.5mL)

Ipratropium bromide 250mcg (1mL) nebulised

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12
Q

asthma tx paed critical

A

Salbutamol nebulised 10mg (5mL)
Ipratropium bromide nebulised 250mcg (1mL)

Adrenaline 10mcg/kg IM, repeat at 5-10mins, max 3 doses

Dexamethasone 600mcg/kg oral (max 12mg)

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13
Q

APO patho

A

When the left ventricular muscle weakens or fails, there’s a reduction in cardiac output. Causes back flow into the pulmonary arteries and capillaries. Due to the pressure difference, fluid moves into the pulmonary interstitial space and the alveolar.

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14
Q

APO signs/symptoms

A

Crackles, pink sputum, SOB, feelings of drowning, chest pain

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15
Q

APO drugs used

A

GTN, CPAP, furosemide

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16
Q

APO treatment

A

GTN 50mg patch, GTN 600mcg every 5 minutes (300mcg if elderly/frail)

CPAP

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17
Q

ACS patho

A

When an artery is blocked causing the heart muscle to become ishcaemic and weaken/breakdown.

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18
Q

Unstable angina vs normal angina

A

Unstable is constant with no relief, lasts longer than 10 minutes

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19
Q

STEMI vs NSTEMI/UA

A

STEMI is when there is complete occlusion, NSTEMI is when there is partial occlusion

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20
Q

ACS drugs used

A

GTN, aspirin, anti-nausea

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21
Q

ACS treatment (normal)

A

Aspirin 300mg
GTN 50mg patch
GTN 600mcg every 5 minutes (300mcg for elderly and frail)

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22
Q

ACS treatment (STEMI)

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A

Aspirin, if inferior STEMI BP <160mmHg then no GTN. Defib pads on immediately and notify hospital.

23
Q

cardiac arrest patho

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A

Heart is not in a normal sinus rhythm

24
Q

cardiac arrest signs/symptoms

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A

No response, unconscious, no breathing, no pulse

25
cardiac arrest treatment
High performance CPR, adrenaline administration 1mg (1mL) every 2 minutes
26
stroke patho
When a part/parts of the brain isn't receiving adequate blood supply and oxygen, due to a clot or haemorrhage, causing focal injury of the brain
27
TIA
Momentary blood flow obstruction causing a brief episode of neurological dysfunction. Usually only lasts 1-24 hours, no damage caused.
28
stroke signs/syptoms
Facial droop, low GCS, severe headache, nausea vomiting, slurred speech, motor deficits. ICH - more likely to have severe headache, nausea and vomiting, quick fall in GCS, bradycardia Left side - slow mobility Right side - perceptual disturbances
29
Stroke mimics
``` S - syncope S - sepsis S - subdural haematoma S - seizures H - hypoxia I - intoxication I - inner ear disturbance T - tumour (brain) M - migraine M - multiple sclerosis E - electrolyte disturbance ```
30
stroke/TIA treatment
Suspected stroke or TIA should always be transported. Oxygen therapy if SpO2 <92%. ICH suspected: if awake/responding transport to nearest stroke hospital, if unconscious then nearest neurosurgical centre MASS +, ACT-FAST - , >12 hours = non urgent transport MASS +, ACT-FAST -, <12 hours = Non ECR eligible stroke. IV access, pre-notify hospital MASS +, ACT-FAST + = possible ECR eligible stroke. IV access, pre-notify hospital, urgent.
31
seizures patho
Sudden uncontrolled episodes of electrical activity in the brain. Neurons rapidly fire, and depending on where in the brain, can cause movements, sensations, altered consciousness etc.
32
seizure types
Focal: starts in one part of the brain, may spread - simple partial (aware) - complex partial (unaware) Generalised: both sides or the brain simultaneously - absence (disconnected) - clonic tonic (sudden jerking) - myoclonic (twitch jerk) - tonic (limp)
33
seizure signs/symptoms
Altered conscious state, convulses
34
seizures treatment
Oxygen and ventilations (OPA or NPA if trismus) Move head so it's protected, laterally for tongue Midazolam 10mg (IM) (5mg for elderly, repeated 5min) Repeat once more if unsuccessful (adults, not elderly)
35
pain relief
Morphine IV 5mg, repeat every 5 minutes, consult after 20mg Fentanyl IV 50mcg, repeat 5 minutes, consult after 200mcg IN fentanyl 100-200mcg repeat every 5 minutes, up to 200-400mcg Methoxyflurane 3mL inhaled, only 2 doses
36
atherosclerosis
``` deposits in arteries risks: - diabetes - obesity - smoker - gender - high cholesterol - hypertension ```
37
Nausea and vomiting
Ondansetron = 4mg orally (repeat at 5-10 minutes if needed, max 8mg) Prochlorenzepane = 12.5mg in 1mL single dose
38
Hypothermia treatment
Remove wet clothes, pat dry the patient, heater on, remove from cold environment, thermal wrap over and under. Warm normal saline IV 20mL/kg
39
Hyperthermia treatment - environmental
``` Remove from warm environment, strip, spray, fan Cold fluids (normal saline IV) 20-40mL/kg ```
40
Hyperthermia treatment - drug induced
Remove from environment Perform cooling techniques (not very effective) Cooled normal saline IV (20-40mL/kg)
41
Opioid overdose - heroin
Manage/maintain airway and ventilations | Naloxone 1.6-2mg single dose IM
42
Opioid overdose - other opioids
Manage/maintain airway and ventilations Naloxone 100mcg IV every 2 minutes, (max 2mg) Naloxone 400mcg IM if IV unavailable
43
Psychostimulant overdose
Remove from environment Check for hyper/hypothermia Manage agitation or seizures
44
Autonomic Dysreflexia
Try to remove/fix stimulus that caused episode | GTN (no patch) 300mcg/600mcg every 10 minutes
45
Sepsis
Assessment (at least 2), call MICA | Normal salin 20mL/kg over 30 minutes (if chest is clear)
46
Sepsis assessment
- temperature >38º or <36º - resp rate >20 - heart rate >90 - blood pressure <90
47
Meningococcal treatment
IV access: Ceftriaxone 1g - dilute with water for injection to make 10mL - administer in 2 minutes No IV access: Ceftriaxone 1g IM diluted in 3.5mL 1%Lig
48
Meningococcal symptoms
``` Typical purpuric rash Septicaemia signs: - fever, rigor, joint pain - cold hands/feet - tachycardia/hypotension - tachypnoea Meningeal signs: - headache, photophobia - neck stiffness - nausea and vomiting - altered conscious state ```
49
Hypoglycaemia treatment
<4, responding to commands: 15g of glucose oral if conscious <4, not responding to commands: Dextrose 10% 15g (150mL) IV with 10mL flush Repeat 10g (100mL) IV after 10 minutes If no IV access: Glucagon 1(IU) IM
50
Hyperglycaemia treatment
Normal saline 20mL/kg
51
Agitation assessment
responsiveness and speech
52
Agitation treatment +2
Midazolam 5-10mg IM, 2.5-5mg for elderly/frail | Repeat after 10 minutes if needed
53
Agitation treatment +3
Ketamine IM

clinical prac 3 (9 decks)

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