management Flashcards

1
Q

status epilepticus

A

check BM and toxicology
open and secure airway 2222
lorazepam IV, buccal midazolam, PR diazepam
after 5 mins and then can repeat after 10 mins
ICU review and phenytoin infusion
treat cause eg alcohol, overdose, pregnancy

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2
Q

head injury

A

immobolise c spine.
check for csf leak > tetanus toxin and neurosurgeons
NICE guidelines for CT head criteria

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3
Q

addisonian crisis

A

Hydrocortisone IV
fluids
correct any U&E imbalance
long term steroid regimen

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4
Q

phaeochromocytoma

A

ICU
alpha blockade IV
once bp controlled > long acting alpha blockade anf can add beta1 blocker
elective surgery 4-6 weeks later

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5
Q

acute asthma attack

A

warn ICU if severe or life threatening
PEFR
Salbutamol nebs 5mg and high flow o2
ipratropium bromide nebs
IV magnesium sulphate
not responding > ICU, intubation, IV aminophyllline
give pred 40mg 7 days, gp follow up, check inhaler technique, 4 week resp follow up

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6
Q

sepsis

A

blood cultures
o2
VBG for lactate
catheter
broad spec ABX
IV fluids

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7
Q

PE

A

wells score, CTPA, D-Dimer
o2, morphine
DOAC (rivaroxiban)
VTE 3 months

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8
Q

massive PE

A

iv unfractionated heparin and thrombolysis (alteplase)
VTE 3-6 months

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9
Q

Acute COPD exacerbation

A

Sputum
Nebulised salbutamol, neb ipratropium bromide
o2 15L unless known co2 retainer > venturi 24-28% aim for 88-92% sats
IV hydrocortisone, abx trust guidelines,
ITU, IV aminopphylline
oral pred 40mg 7 days

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10
Q

acute HF

A

Troponin, BNP
15L o2
morphine
GTN
Furosemide

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11
Q

acute coronary syndrome

A

morphine, metoclopramide, o2, aspirin, clopidogrel
STEMI
NSTEMI

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12
Q

STEMI

A

ACS treatment plus
<12 hour symptoms and can have PCI<2 hours - PCI
<12hour symptoms cannot make PCI in 2 hours - Thrombolysis with PCI after if necessary
>12 hours since symptoms started angiography and possible PCI

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13
Q

NSTEMI

A

ACS treatment plus
Fondaparinux

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14
Q

Discharge MI drugs

A

aspirin, clopidogrel, ACEi, Statin, Beta blocker

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15
Q

pneumothorax

A

primary
<2cm discharge and review in OPD
>2cm or breathless aspirate then consider discharge and review in outpatients if not sucessful then chest drain and admit
secondary
<1cm admit high flow o2 observe 24hr
1-2cm aspirate sucess - admit high flow o2 and observe 24hr not sucess then chest drain and admit
>2cm chest drain and admit
if bilateral chest drain

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16
Q

tension pneumothorax

A

large bore cannula
2nd ics mcl
request CXR
insert chest drain

17
Q

anaphylaxis

A

lie flat, secure airway 2222
adrenaline IM 1:1000 repeat after 5 mins every 5 mins
IV fluids
adrenaline infusion ITU
allergy clinic, Epipen, educate

18
Q

stroke

A

o2, Ct scan, haemorrhagic ruled out>300mg aspirin.
thrombolysis <4.5hrs from start
physio, SALT
clopidogrel 75mg after 2 weeks aspirin. statin, antihypertensive abd abticoag if AF

19
Q

HB<70g/l

A

give RBCS
do iron studies, b12, folate
signs of blood anywhere

20
Q

CPR

A

give o2 compressions continuous
gain IV/IO access
give adrenaline every 3-5 mins
give amiodarone after 3 shocks
identify & treat reversible causes (hypoxia, hypovolaemia, hyper/hypokalaemia, hyper/hypothermia, thrombosis, tension pneumothorax, tamponade, toxins)
shockable rhythm - VT,pulseless VT
non-shockable rhythm - asystole, PEA

21
Q

hypoglycaemia

A

glucose gel
10% dextrose IV
glucagon IM-must have reserve (not malnourished)
once recovered give long acting carb eg toast

22
Q

HHS

A

LMWH (clot risk)
Rehydrate slowly over 48 hours (8-15L)
replace K+ when urine starts to flow
give insulin if glucose does not fall with rehydration

23
Q

Acute upper GI bleed

A

peptic ulcer, varices, mallory weiss tear, malignancy
major haemorrhage and alert surgeons and endoscope
stop anticoag/platelets (reverse them)
IV hartmans and o- blood until crossmatched is available
catheter - monitor losses
endoscopy to treat

24
Q

DKA

A

glucose >11 ketone >3 or ++ acidaemia<7.3 bicarb <15
NaCl bolus and continuous
insulin IV fixed rate (actrapid) 50 units in 50ml NaCl (0.1 unit) per hour increase to 1 unit/hour if fall in ketones not >0.5/hour
once glucose <14 start 10% dextrose 125ml/hour to prevent hypo
treat underlying cause eg infection, infarction, poor control
continue/initiate long acting insulin regime
check K+ may need to infuse
continue insulin until ketones <0.6mmol/L

25
Q

AKI

A

treat the cause
urgent dialysis - AEIOU - Acidosis <7.3 electrolytes unresponsive hypokalaemia, intoxication (overdose), odema (unresponsive pulmonary oedema), uraemia symptoms (encephalitis, seizures)

26
Q

hypernatraemia

A

oral fluids and IV dextrose 5%

27
Q

hyponatreamia

A

hypovolaemic - IV NaCl
Euvolaemic - fluid restrict
hypervolaemic - fluid restrict and diuretics
do not correct faster than 10mmol/day. need expert advice for hypertonic saline

28
Q

hyperkalaemia

A

> 6.5 or ECG changes
calcium gluconate 10ml 10% can repeat every 15 mins till K+ corrected
insulin 10 units in 50ml and 200 ml of 10% dextrose IV
salbutamol nebs

29
Q

hypokalaemia

A

hold diuretics, insulin, salbutamol
give IV KCL 40mmol/L over 4 hours if need higher dose > ITU

30
Q

hypercalaemia

A

IV NaCl
IV bisphosphonates if malignancy

31
Q

hypocalcaemia

A

severe > 10% calcium gluconate and 50ml 5% dextrose 10 mins
followed by IV calcium gluconate infusion in NaCl 1L