Clinical Emergencies Flashcards
(68 cards)
What is the chest compression to ventilation ratio in adults?
30:2
What is the chest compression to ventilation ratio in children?
15:2
What are shockable rhythms?
Ventricular fibrillation
Pulseless ventricular tachycardia
How do you manage cardiac arrest with a non-shockable rhythm?
Start chest compressions at 30:2
1mg Adrenaline 1:10,000 ASAP
Recheck pulse every 2 mins
Repeat 1mg Adrenaline every other cycle
How do you manage a cardiac arrest with a shockable rhythm?
Single shock followed by 2 mins of compressions (UNLESS: Witnessed arrest in a monitored patient, then give 3 shocks)
Check pulse every 2 mins and repeat shock + compressions
1mg Adrenaline 1:10,000 and 300mg Amiodarone after 3rd shock
1mg Adrenaline given every 3-5 mins
Can give 150mg Amiodarone after 5th shock
What are the reversible causes of cardiac arrest?
4 H’s and 4 T’s
Hypoxia, hypothermia, hypovolaemia, hypokalaemia/hyperkalaemia/hypoglycaemia/hypocalcaemia
Tension pneumothorax, tamponade, thrombosis, toxins
How do you manage suspected sepsis?
SEPSIS 6
3 in - fluids, abx, oxygen
3 out - cultures, lactate, urine output
What are paediatric red flag signs?
Pale/mottled skin
Unresponsive/does not wake or stay awake
Continuous cry
Resp: Grunting, tachypnoea >60, chest recessions
Reduced skin turgor
Aged <3 months with a temp of 38 or higher
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
How does anaphylaxis present?
Symptoms: SOB Itching Abdomina pain Lightheadedness
Signs: Urticaria Angioedema Wheeze Hypotension Tachycardia Stridor due to laryngeal oedema Shock
What type of hypersensitivity reaction is anaphylaxis?
Type 1 Hypersensitivity reaction
How do you manage anaphylaxis
ABCDE
A - secure airway B - provide O2 if required C - provide IV bolus D - lie patient flat to prevent cerebral oedema E - flushing? angioedema? urticaria?
IM Adrenaline - REPEAT AFTER 5 mins
Antihistamines - Oral Chlorphenamine
IV Hydrocortisone
What are symptoms of hypoglycaemia?
Can be split into early ADRENERGIC symptoms and late NEUROGLYCOPENIC symptoms
Adrenergic = sweating, tachycardia, palpitations, pallor, hunger, restlessness
Neuroglycopenic = confusion, slurred speech, drowsiness, numbness of extremities, anxiety, blurred vision
How do you manage hypoglycaemia?
Conscious patient = Oral glucose
Unconscious/drowsy/unable to swallow =
If IV access = IV Glucose 10% or 20%
No IV access = IM Glucagon (only once, then switch to IV)
How do you manage DKA?
Fluid resus:
Adults = 500ml 0.9% NaCl over 15 mins
Children = 10ml/kg 0.9% NaCl over 15 mins
Insulin at 0.1 units/kg/hr
Check potassium regularly - hypokalaemia may occur due to insulin pushing potassium into cells
How fast should the ketones and glucose fall in DKA?
Ketones should fall by 0.5mmol/l per hour
Glucose should fall by 3mmol/l per hour.
Which diabetic drug is most likely to cause DKA?
SGLT2 inhibitors
How to manage HHS?
1L 0.9% NaCl per hour!!
Replace potassium if below 5.5
Aim for glucose reduction of 5mmol/l per hr
Insulin DOES NOT form part of initial management plan
If glucose has stopped dropping with fluids alone can start insulin at 0.05U/kg/hr.
What are causes of metabolic acidosis? (Normal anion gap and raised anion gap)
Normal anion gap = diarrhoea, renal tubular acidosis, Addison’s disease
Raised anion gap = DKA, alcohol, shock, sepsis, hypoxia, renal failure, methanol
In hyperkalaemia, what drug can be used to stabilise the cardiac membrane?
IV Calcium gluconate
In Hyperkalaemia, what can be used to quickly reduce serum potassium?
IV insulin (+Dextrose)
Nebulised salbutamol
In hyperkalaemia, what other drugs can be used to remove potassium from the body?
Calcium resonium
Loop diureics
Dialysis - if AKI and hyperkalaemia is not resolving w/ fluids
What is status epilepticus and how is it managed?
A tonic clonic seizure lasting more than 5 mins OR two or more seizures consecutively without full recovery in between
ABCDE
If IV Access: IV Lorazepam 4mg - can repeat once after 10-20 mins
If no IV access: Buccal midazolam or rectal diazepam
What is a thyrotoxic storm and how is it managed?
Emergency presentation of hyperthyroidism
Fever, Tachycardia, confusion/agitation, nausea+vomiting, HTN
Management = IV Dexamethasone + IV Propranolol + IV Propylthiouracil + fluid resus
What is myxoedema coma and how is it managed?
Emergency presentation of hypothyroidism
Fluid resus + IV Thyroid replacement + IV Hydrocortisone
