Medical Flashcards
What is the guideline for mild/moderate allergy?
Consider
* oral fexofenadine 180 mg (pt ≥ 12 yrs)
* transport
* refer or self-care
What is the treatment for suspected anaphylaxis in adults?
IM adrenaline 10 microg/kg
up to 500 microg (every 5 mins prn)
Consider clinical support
**If bronchospasm **
- administer bronchodilators and ventilatory support as per asthma CPG
If upper airway angiodema
- Nebulised adrenaline 5mg/5ml
If hypotension
- IV saline 250ml aliquots up to 20ml/kg
If persistent wheeze
- Oral prednisolone 50mg
If persistent itch after systemic symptoms resolved
- Oral fexofenadine 180mg (pt>=12)
Prompt transport with early notification
What is the treatment for suspected anaphylaxis in pediatrics?
IM adrenaline 10 microg/kg
up to 500 microg (every 5 mins prn)
Mandatory clinical support
**If bronchospasm **
- administer bronchodilators and ventilatory support as per asthma CPG
If upper airway angiodema
-Pt >=6mo - neb adrenaline 5mg/5ml, or
- Pt <6mo - neb adrenaline 2.5mg/5ml (use 2.5ml saline)
If hypotension
- IV saline 10ml/kg aliquots (max 250ml) up to 20ml/kg
If persistent wheeze
- Oral prednisolone 1mg/kg up to 50mg
If persistent itch after systemic symptoms resolved
- Oral fexofenadine 180mg (pt>=12)
Prompt transport with early notification
What is the treatment for hypoglycemia in adults?
Use the least invasive therapy which restores BGL.
Consider any of
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* IM glucagon 1 mg,
* IV glucose 10% titrated against GCS and BGL
- first ensure IV patency with saline flush and follow infusion with IV saline 100 mL
If no return of normal neurological function despite treatment
* Consider clinical support/EOC consult
* Transport
What are the considerations for non-transport in adult hypoglycemia where normal GCS has been restored?
If considering non-transport, adult patients must have:
* Consumed complex carbohydrates
* BGL indicates a stable physiological range
* Been a previously stable diabetic
* An identified cause for the episode
* Residence in a suitable environment
Patients should be monitored by a responsible person until follow up medical assessment
What is the treament for hypoglycemia in pediatrics <25kg (< approx 6yrs)?
Consider
* Clinical support
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* Glucagon:
< 25 kg IM glucagon 0.5 mg
If glucagon ineffective or clinical support unavailable, consult EOC clinician who may advise:
* IV glucose 10% starting at 2 mL/kg
- ensure IV patency first with saline flush
- titrate against GCS and BGL
- total max dose 5 mL/kg
- follow infusion with IV saline 1 mL/kg
* Transport
What is the treament for hypoglycemia in pediatrics >=25kg (>= approx 6yrs)?
Consider
* Clinical support
* Oral carbohydrates or oral glucose 15 g (if GCS allows)
* Glucagon:
≥ 25 kg IM glucagon 1 mg
If glucagon ineffective or clinical support unavailable, consult EOC clinician who may advise:
* IV glucose 10% starting at 2 mL/kg
- ensure IV patency first with saline flush
- titrate against GCS and BGL
- total max dose 5 mL/kg
- follow infusion with IV saline 1 mL/kg
* Transport
What is the treament for hypoglycemia in neonates (BGL<2.5mmol/L) who are physiologically stable?
- Universal care and life support
- Assess BGL (sample from heel)
- Gently dry buccal mucosa with dressing
- Oral glucose gel 0.5 mL/kg dose using a 3 mL syringe
- Avoid squirting directly into neonate’s mouth / OGT, instead gently massage buccal mucosa with gloved hand
- Transport
What is the treatment for nausea/vomiting in adults?
Ondansetron 4mg ODT, IM or IV (slow push over >1min)
Repeat once prn
Max dose 8mg.
What is the treatment for adults with nausea/vomiting refractory to ondansetron?
If nausea and/or vomiting persist, consider:
IV droperidol 250 – 500 microg (slow push over ≥ 1 min)
- add droperidol (10 mg / 2 mL) to 100 mL saline bag
concentration created is 100 microg / mL
draw off required dose (2.5 – 5 mL)
What is the treatment for nausea/vomiting in pediatrics?
Ondansetron:
* ODT; 2 mg (2 to 5 yrs - half tablet) or 4 mg (≥ 6 yrs), or
* IM/IV ondansetron (1 - 15 yrs) 150 microg/kg to single max dose 4 mg
- If IV, slow push over ≥ 1 min
* Consult EOC Clinician for < 1 yr
* Transport or referral as required
What are the contraindications for ondansetron?
Absolute
Relative
* Prior hx of dystonic reaction to any drug
* Hx of hypersensitivity to any 5HT3-receptor antagonists
In which patients is ondansetron likely to be ineffective?
Ondansetron is inffective for motion sickness / vertigo.
May be ineffective in cannabinoid hyperemesis syndrome patients.
What are the goals in sepsis treatment?
Early identification
Optimal oxygenation
Targeted fluid resuscitation
Early hospital notification
What is qSOFA and when is it used?
In the presence of suspected infection, qSOFA (quick Sequential Organ Failure Assessment) is an adult screening tool for organ dysfunction.
qSOFA does not define sepsis, but the presence of at least two of the three qSOFA criteria is a predictor of increased mortality and ICU stays of more than three days.