basic bitch things

Question 1

post MI give (secondary)

Answer 1

aspirin and clopidogrel
dual for a year then carry on one after
ACEi
BBlocker
Statin

Question 2

STEMI management

Answer 2

1 aspirin 300mg
2 if PCI (drug eluting stent) within 120mins-
prasugrel (clopidgrel if already on anticoagulant),
unfractionated heparin and glycoprotein IIb/IIIa

No PCI= fibrinolysis within 12 hours, (tissue plasminogen activator (tPA)), antithrombin III, ticagrelor

repeat ECG 60-90mins then PCI if ongoing (assess whether there has been a greater than 50% resolution in the ST elevation)

monitor oxygen saturation and give in < 94%, aiming for SpO2 of 94-98%
and 88-92% in COPD at risk

morphine should only be given for patients with severe pain

nitrates but not if hypotensive

Question 3

NSTEMI management

Answer 3

1 if unstable then PCI and aspirin 300mg. if not then fondaparinux
(if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given)
2 then do GRACE score > 3 or unstable then PCI within 72 hours
3 give unfractionated heparin and prasugrel/ticagrelor in PCI even if given fondaparinux already

if not PCI then give aspirin and ticagrelor /clopidorgel

Question 4

ECG normal ranges (PR, QRS, QT)

Answer 4

PR- 3-5 small squares (120-200ms)
QRS- 2-3 small squares (<120ms)
QT- within 2 big squares or 10 little squares (350-460ms)

Question 5

PPH management

Answer 5

ABCD
warm crystalloid fluids
cross matched blood

stimulate contravtions with uterine rub, catheterise

Iv syntocinon slow injection
ergometrine slow IV or IM (not hypertension)
IV syntocinon infusion
IM carboprost (not in asthma)
misoprostol rectally

Question 6

COPD management

Answer 6

SABA/SAMA

no asthma- add LAMA + LABA. if taking SAMA switch to SABA

asthmatic features- add LABA + ICS
then LABA + LAMA + ICS and change SAMA to SABA if needed

oral theophylline if cant tolerate inhalers or not working

if exaccerbation within a year - oral steroids and antibiotics at home

prophylactic azithromycin for some. if dont smoke

Question 7

whooping cough management

Answer 7

azithromycin or clarithromycin if the onset of cough is within the previous 21 days