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Flashcards in Common Management Deck (20)
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1

Explain the stages till giving a blood transfusions

1. Consent the patient
2. Cross-match or group & save (PRCs, Platelets, FFB (clotting factors, albumin)
3. Prescribe it on relevant chart (each unit must be prescribed separately. Duration 2 hours

2

ECG changes for ACS:
Inferior
Anterior
Lateral

II, III, aVF
V1-V4
V5-V6, I & aVL

3

How to confirm STEMI and acute treatment

ABCDE
ECG
Bloods: FBC, U&E, CRP, glucose, cardiac markers, D-dimer

If new ECG changes: ST elevation or T wave inversion.

ROMANCE

Oxygen
Aspirin 300mg PO (if not given)
Buccal GTN
Clopidogrel 300mg
Diamorphine 2.5mg-5mg IV
Anti-emeitc
(+/- bisoprolol)

Ring cath lab:
PCI (within 12 hours) or thrombolysis

4

Chronic management of ACS

Lifestyle factors: Smoking, diet, excessive

Pharm:
- Dual anti-platelet
1) aspirin 75mg OD
2) Clopidogrel 75mg or Ticagrelor 90mg
- ACEi Ramipril 2.5mg
- B-blocker: bisoprolol 2.5mg
-Statin: atorvostatin 80mg
- GTN spray

5

How to diagnose ketoacidosis

treatment

Type 1 diabetic + trigger (infection, not taking insulin, surgery, alcohol, MI)

Patient: abdo pain, drowsy, N&V, dehydration (thirst), heavy laboured breathing

High BM > 11mmol/L
Urinary (dipstick ++) or cap ketone test (>3mmol)
Acidotic <7.3

ABCDE
Ask for protocol

NaCL 0.9% IV infusion 1:2:2:4:4:6

Insulin Actrapid 0.1units/kg/hr in 0.9% NaCL 50ml (own chart)

If:
glucose < 14mmol start 10% glucose 125ml/hr

If:
K: 3.5-5 = 40mmol KCL added into infusion
<3.5 call senior help

6

Treatment Upper GI bleed

ABCDE
Bloods: FBC, U&E, crossmatch & clotting
ABG (look at Hb)
- consider blood transfusion (PRC)
IV access: 2 large bore cannulas + resus
PR

Glasgow-Blatchford Score
Will determine if need endoscopy (assess cause and stop bleed)

Long term
PPI (non-variceal)
Terlipressin: vatical bleeding e.g glypressin 2mg IV

7

Head injury assessment

ABCDE
Full neurological (arm & legs)
Check pupils /glucose/gcs
basal skull fracture: battle sign

Hx:
mechanism of injury
LOC
witness
amnesia retrograde, anterograde
Ass symtoms: vomit, nausea, headache, dizzy
other injuries
Check Hx of bleeding easily, anticoagulation, prev brain surgery

8

When to CT head after head injury and how to safety net

- GCS <13 o.a, <15 2 hrs
- suspected skull fracture
- basal skull
- post traumatic seizure
- Focal neuro deficit
- More than 1 episode of vomit
- Warfarin
- LOC or amnesia + >65, Hx bleeding, dangerous MOI, more than 30 min retrograde amnesia


Safety net:
- worsening headache not better with para
- drowsy
- confusion, strange behaviour
- loss of use of part of body
- Dizzy, loss of balance
- Visual or hearing changes
- Blood or clear fluid from nose/ear
- Unusual breathing

9

When to immobilise C-spine

How to immobilise

Suspected neck injury and any of:
- >65 yrs
- immediate pain at time of injury
- GCS < 15 at time
- Midline pain/tenderness
- Altered sensation/weakness
- Dangerous MOI

3 points: collar, head blocks, back support

10

6 points before they can be cleared from c-spine injury

- fully alert and oriented
- no head injury
- no drugs or alcohol
- no neck pain
- no neurological problems
- no other significant 'distracting injuries

11

Investigations for hypoglycaemia

- Blood: FBC, U&Es, LFT
- Blood glucose
- Insulin or C-peptide

12

Treatment for hypoglycaemia

If conscious
1. 20g of fast acting glucose (4 glucose tablets)
2. Re-peat BM in 10 mins
3. If > 4mmols give long acting carb (toast)
4. Fails to rise after 4 attempts 1mg glucagon IM or IV 10% glucose over 15 mins

Semi-consious: glucogel 1.5-2 tubes

Unconscious:
ABCDE
IV 200mls 10% glucose in 15 mins
IV 100mls 20% glucose in 15 mins
Glucagon 1mg IM
Repeat BM 15 mins

13

Stroke acute management

ABCDE
(neuro exam)
Hx:
- when symptoms started, symptoms worsening, static or improving
- intracranial pathology, clotting problems, bleeding problems, pregnancy, recent trauma, surgery, invasive problems

Once stable:
request emergency CT
Consider thrombolysis or aspirin 300mg PO STAT
re-assess
refer to acute stroke ward

If AF: CHADVASC

14

Treatment for meningitis

Treat before investigations
Community: IM benzylpenicillin 1.2g
Hospital: IV ceftriaozone 2g

Investigations:
IV access: culture, blood (clotting, ESR), VBG
Throat Swab
PCR
CT
LP

15

Seizure

Start timing:
- Oxygen
- Safe environment, recovery position
- Monitor
3-4 mins: venous access: FBC, U&E, LFT, Ca2+, glucose, blood culture, anticonvulsant levels
If glucose <3.5: 100ml 20% glucose

At same time take Hx

5 min
call senior
consider airway adjunct
IV access: lorazepam 4mg repeat at 10 mins if not effect or Diazepam 10mg
If alcoholic give pabrinex

20 mins gibe phenytoin 20mg/kg and contact anaesthetics

16

Management for alcohol withdrawal

1. chlordiazopoxide (2-4 weeks)
2. IV pabrinex I+II
3. CIWA-Ar score
4. B vitamins and Thiamine
5. Fluids
6. Management of blood sugar

17

Investigation for paracetamol overdose

serum paracetamol level
FBC, U&E, Clotting
Liver test: INR, AST, ALT (increase 24hr-72hr after)
Glucose
ECG
Find time of dose > plot on graph

18

Management of paracetamol overdose

>75mg/kg in last 1 hour: activated charcoal

N-acetylcystiene IV
- unknown time of ingestion
- time exceeds 8 hours
- staggered dose
- patient is unconscious
- overline on graph

19

benzodiazepine overdose: sign & treamtoer

↓GCS, ataxia, anterograde amnesia, ↓RR

Flumazenil

20

codeine overdose sign and management

↓GCS, pinpoint pupils, ↓RR, bradycardia, coma

Naloxone
check for patches on elderly