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Final Osce > Clinical Emergencies > Flashcards

Clinical Emergencies Flashcards

1
Q

Define moderate asthma

A

SPO2 >92%, PEF >50-70% best or predicted, no features of acute asthma

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2
Q

Define acute severe asthma

A

PEF >50% of best/predicted
REsp rate >25
SPO2>92%
Tachycardia
Cannot complete sentences in one breath

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3
Q

Define life threatening asthma

A

spo2<92%
Silent chest
Arrhythmia, Hypotension, Exhaustion, Confusion, Coma
PEF <33%

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4
Q

What is the management of moderate asthma?

A

Give salbutamol inhaler, preferably via spacer

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5
Q

What is the management of acute severe asthma?

A

Give salbutamol 5mg via nebuliser, repeat if PEF does not improve/if patient does not stabilise and give 40g oral prednisolone

Repeat observations

If persistent, admit to hospital, contact respiratory team

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6
Q

What is the treatment of life threatening asthma?

A

Call for help

Give salbutamol 5mg plus ipratropium via nebuliser

If able to swallow, 40mg oral prednisolone, if unable, IV hydrocortisone 100mg

ABG

Continous salbutamol nebs if required

IV Magnesium sulphate

Correct electrolytes, CXR, repeat ABG

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7
Q

Management of low potassium

A

ECG

U&Es, VBG (check for magnesium)

Oral K+ replacement if mild

IV K+ if patient is unable to swallow/ if K+ is severely low

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8
Q

How to manage high potassium

A

ECG

VBG

10% Calcium gluconate 10ml over 10 mins then switch to infusion

IV soluble insulin (5-10 units) and 50ml glucose 50% (over 5-15 mins)

Salbutamol nebulisers

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9
Q

How to manage low calcium?

A

Mild - calcichew

Severe - IV calcium gluconate 10% then IV continuous infusion

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10
Q

How to manage high calcium?

A

IV sodium chloride 0.9% infusion over 4-6hours

Bisphosphonates

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11
Q

Anaphylaxis management

A

ABCDE
IM Adrenaline (1:1000)
Establish airway, high flow o2, ECG

If no response, repeat IM adrenaline after 5 mins, IV fluid bolus

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12
Q

What are the clinical parameters of DKA?

A

Hyperglycaemia >14mmol/L
Ketoneaemia >3mmol/L
Metabolic acidosis pH<7.3

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13
Q

What is the initial management of DKA?

A

0.9% sodium chloride infusion
Fixed rate insulin infusion

ABCDE

VBG, capillary and lab glucose

FBC, U&Es, cultures, ECG

Establish one hourly glucose and ketones

Potassium replacement if K+<3.5 mmol/l

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14
Q

How to manage a paracetamol overdose

A
  • take paracetamol level if time of overdose >4 hours, or if staggered
  • U&Es, LFTs, Glucose, Coag, ABG

NAC Chart - if on or above line, give NAC. If staggered, give NAC straight away

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15
Q

What are the three doses of NAC given in a paracetamol overdose?

A

Initial dose - 150mg/kg over one hour
Second dose - 50mg/kg over next four hours
Third dose - 100mg/kg over next 16 hours

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16
Q

What are the signs of an opioid overdose?

A

Reduced resp rate, drowsy, confused, pinpoint pupils
Hx of opioid prescription

17
Q

How are opioid overdoses managed?

A

Naloxone bolus

then naloxone infusion

18
Q

Management of status epilepticus

A

Call for help

IV lorazepam/buccal midazolam/rectal diazepam

Second dose of benzos if no response

If nil response, levitiracetam/sodium valproate/phenytoin

19
Q

Management of a pneumothorax

A

ABCDE

Aspirate to 16/18G cannula or chest drain

oxygen

20
Q

What is the management of hypoglycaemia?

A

Initial hypo
- quick-acting carbohydrate or glucotabs
- recheck capillary blood glucose after 15 mins

If patient unconscious
- ABCDE
- IV 10%/20% glucose
- IM glucagon

21
Q

Symptoms of hypoglycaemia

A

Confusion, weakness, malaise, tremor, dizziness, reduced GCS

22
Q

How to manage an upper GI bleed?

A

ABCDE
Blatchford Score

FBC, U&Es, Urea, CRP, Coag, group and save

Endoscopy once stable

Terlipressin if suspected variceal bleed

PPI if non-variceal GI bleed

23
Q

STEMI presentation

A

Sudden onset pain, tightness radiating to left arm and jaw, nausea, breathlessness, shortness of breath, sweating

Dyspnoea, arrythmia, pale, clammy and non-tender chest wall

ECG - STEMI/ New LBBB, increased troponin

24
Q

NSTEMI presentation

A

Sudden onset pain, tightness, radiating to jaw, breathlessness, sweating, nausea

Dyspnoea, arrhythmia, pale, clammy, non-tender chest wall

ST Depression, t-wave inversion, q waves, ECG can be normal, increased troponin

25
Q

Unstable angina presentation

A

Anginal pain at rest, increasing in frequency, severity, duration

Dyspnoea, arrhythmia, pale, clammy, tender chest wall

ST Depression, twave inversion, ECG can be normal, Troponin not elevated

26
Q

STEMI management

A

PCI within 12 hours of onset
O2, 300mg aspirin, ticagrelor or clopidogrel, anti-emetic, GTN, morphine, bisoprolol

Thrombolysis if no PCI available

27
Q

NSTEMI management

A

O2, aspirin, clopidogrel, morphine, anti-emetic, GTN, fondaparinux, bisoprolol

28
Q

Unstable angina management

A

Analgesia, aspirin, clopidogrel, bispoprolol, fondaparinux

29
Q

How does septic shock present ?

A

Dizziness, sob, chest pain, rigors, fever, confusion +/- abdo pain +/- oliguria +/- productive cough

Tachycardia, bounding pulse, low BP, Decreased GCS, skin mottling

30
Q

How do you manage septic shock?

A

FBC, Cultures, CRP, U&Es, LFTs, glucose, coag

VBG (lactate), monitor urine output

IV access then IV fluids - hartmanns, plasmalyte, normal saline

O2, broad spectrum antibiotics,

31
Q

Common ABG finding in COPD

A

Type 2 resp failure

32
Q

How to manage a stroke?

A

Call for senior help
ABCDE
Monitor saturations
Venous access
Bloods - FBC, UsEs, CRP, Coag, Glucose, lipids, trop
Nil by mouth and IV fluids
ECG

Examination
- neuro, cranial nerves, cardio, resp, swallow

CT Head

?carotid doppler

aspirin/ thrombolysis if ischaemic

33
Q

What are the indications for thrombolysis?

A

Symptom onset < 4.5 hours if under 80 years old
Symptom onset <3 hours if over 80
CT shows no haemorrhage
Significant symptoms with no improvement

34
Q

What are the indications for thrombectomy?

A

CT shows no haemorrhage or signs of early ischeamic changes
CT angio shows proximal occlusion of anterior circulation
Can be initated within 6 hours of symptom onset

35
Q

How to manage SAH?

A

Call for senior help
Urgent referral to neurosurg for coiling or clipping
Lie patient flat
A-E
Aim for BP control <130mmHg with IV bisoprolol
Urgent CT head
Lumbar puncture 12 hours post onset
Nifedipine

Final Osce (4 decks)

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