Management Flashcards
(43 cards)
Features of life threatening asthma
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Management of acute asthma
- Admit
- O2 15L non re breathe
- SABA nebulised
- all patients should be given 40-50mg of prednisolone orally (PO) daily, which should be continued for at least five days or until the patient recovers from the attack
- Ipatropium Bromide (SAMA)
- IV MgSO4
- IV aminophylline
- ITU AND Ventillation
When can be discharged for asthma attack
been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted
Difference between STEMI and NSTEMI
NSTEMI no ST elevation but raised cardiac biomarkers
Management of all ACS
MONA
What is management for STEMI
if within 2 hours then PCI with drug eluting stent otherwise fibrinolysis
Drug therapy prior to PCI
Asprin + prasugrel (if on oral anticoag give clopidogrel instead)
NSTEMI management
Asprin 300mg and fondaparinux then measure GRACE score
NSTEMI conservative treatment
Further drug therapy
further antiplatelet (‘dual antiplatelet therapy’, i.e. aspirin + another drug)
if the patient is not at a high risk of bleeding: ticagrelor
if the patient is at a high risk of bleeding: clopidogrel
Indication for adenosine and MOA
SVT - transient block of AV node (A1 receptor)
Angina management
aspirin and a statin in the absence of any contraindication
sublingual glyceryl trinitrate to abort angina attacks
BB (atenolol) OR CCB then dual therapy
Which CCB in angina
if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used
What CCB not used with BB
Verapamil - will cause heartblock
What CCB to be used with BB in angina
if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)
Severe - life threatening asthma in a child immediate symptomatic relief
salbutamol 2.5 mg
Acute exacerbation of COPD
Prednisolone 30mg PO 7-14 days
First line COPD treatment
SAMA + ICS
When is LTOT required in COPD
LTOT – PaO2 <7.3 or PaO2 <8 with pulmonary hypertension, polycythemia, nocturnal hypoxaemia or peripheral oedema
DVT anticoagulation
Apixaban 10mg PO 2X day
Anti coagulation in renal failure patient
unfractioned heparin 5000 units SC twice daily
What is prophylactic dose of anticoagulation
LMWH - Dalteparin 2500 units 1 dose in surgical patients
prophylaxis in medical patient 5000 units SC
Neuropathic pain
amitriptyline, pregabalin, gabapentin
If unable to take tablets and pain localised – lidocaine patch
Trigeminal neuralgia treatment
Trigeminal neuralgia – carbamazepine
Migraine treatment
Acute treatment: no aura = aspirin or ibuprofen, aura = sumatriptan
Prevention: propranolol
