Planning Management Flashcards
(45 cards)
What do you give to a patient who has had a STEMI or NSTEMI?
O2 (if req) Aspirin 300mg PO Clopidogrel 300mg (can give Prasugrel 60mg or Ticagrelor 180mg) Morphine 5-10mg IV \+ metoclopramide 10mg IV GTN spray/tablet (not if hypotensive) Primary PCI (preferred) or thrombolysis 5mg Atenolol Transfer to CCU
What drugs are given for the long term management of a STEMI?
- Statin
- Beta-blocker
- ACE Inhibitor
- Combination of Aspirin, Clopidogrel, Ticagrelor, Prasugrel, Warfarin
- GTN
How is acute left ventricular failure managed?
A-E
Sit patient up
Morphine 5-10mg IV + Metoclopramide 10mg IV
GTN spray/tablet
Furosemide 40-80mg IV
Isosorbide dinitrate infusion if inadequate response
Transfer to CCU
What drugs should be given in anaphylaxis?
Adrenaline 500 micrograms (1:1000) IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
How would you manage a patient with tachycardia who has adverse features?
Synchronised DC shock (upto 3 attempts)
Amiodarone 300mg IV over 10-20 mins and repeat shock then amiodarone 900mg IV over 24 hr
What features of tachycardia would you classify as adverse
Shock
Syncope
Myocardial ischaemia
Heart failure
How would an irregular broad complex tachycardia be managed?
SEEK HELP
- If AF with bundle branch block - treat as narrow complex (vagal manoevres, adenosine 6mg IV)
- Pre-excited AF - consider amiodarone
- Polymorphic VT - magnesium 2g over 10mins
How would you manage a regular broad complex tachycardia?
VT - amiodarone 300mg IV over 20-60 mins then 900mg over 24 hr
SVT plus bundle branch block - adenosine
How would you manage a regular narrow complex tachycardia?
Vagal manoevres
Adenosine 6mg IV rapid bolus
- if unsuccessful give 12mg IV bolus
- if unsuccessful again give further 12mg IV bolus
Monitor ECG continuously
If the regular narrow complex tachycardia doesn’t return to sinus rhythm following vagal manoeuvres and adenosine, what is the likely cause and how is it managed?
Atrial flutter
Control rate - beta blocker
How is an irregular narrow complex tachycardia managed?
Beta blocker or diltiazem
If evidence of heart failure, consider digoxin or amiodarone
How is acute asthma managed?
- 100% O2 via non rebreather mask
- Salbutamol 5mg nebuliser
- Hydrocortisone 100mg IV (severe/life-threatening) or Prednisolone 40-50mg PO
- Ipratropium bromide (500 micrograms nebuliser)
- Theophylline if life threatening
How is an acute exacerbation of COPD managed?
Similar to asthma but:
- Abx if infective
- Use high-flow O2 with care - use then review after ABG
- 28% O2 sage starter
How are pneumothoraces managed?
Secondary: Chest drain if >2cm or SOB or >50yo
Tension - Emergency aspiration then chest drain
Primary:
<2cm rim and no SOB - discharge and follow up in 4 wks
>2cm rim or SOB - aspirate –> aspirate –>drain
What is the mnemonic used to decide whether pneumonia requires inpatient treatment?
CURB-65 Confusion Urea >7mmol/L Resp rate >30 BP <90 systolic Age>65yo
How is pneumonia managed?
High flow o2
IV Abx - amoxicillin or co-amoxiclav
Paracetamol
IV fluids - low BP or raised HR
How is a pulmonary embolus managed?
High flow o2
Morphine 5-10mg IV and metoclopramide 10mg IV
LMWH - tinzaparin 175 units/kg SC
If low BP - IV gelofusine –> noradrenaline –> thrombolysis
What would you give in a GI bleed?
- High flow o2
- Catheter
- Crystalloid (0.9% NaCl) if BP normal/high, Colloid (gelofusine) if BP low
- X Match 6 units of blood
- Correct clotting abnormalities
- Endoscopy
- Stop drugs - NSAID’s, aspirin, warfarin, heparin
- Surgeons
How would you correct clotting abnormalities in a GI bleed
- if PT/aPTT >1.5x normal give FFP (or prothrombin complex if due to warfarin)
- platelets <50 and actively bleeding - give platelet transfusion
How is bacterial meningitis managed?
- High flow O2
- IV fluids
- Dexamethasone IV
- LP (+/-CT head)
- 2g cefotaxime IV (give pre LP if having CT head or prolonged LP)
- Consider ITU
Can also give 1.2g benzylpenicillin
How are seizures managed?
if seizure >5 mins:
- IV lorazepam 2-4mg or Buccal midazolam 10mg or Diazepam 10mg IV
- Repeat after 10 mins
- Inform anaesthetist
- Give phenytoin infusion if no response in 25 mins
- Intubate and RSI with propofol, midazolam or thiopental sodium
How is an ischaemic stroke managed?
<80 and <4.5hr - consider thrombolysis with alteplase
Aspirin 300mg PO
Transfer to stroke unit
What long term treatment is recommended for ischaemic stroke?
Clopidogrel
can consider dipyridamole + aspirin
Atorvastatin 40-80mg 48hrs after event
Target BP <130/90 - not beta blockers unless indicated by other condition
Lifestyle factor modification
When should hypertension be treated?
Ambulatory/home BP of :
- > 155/95 or
- > 135/85 + existing/high risk vascular disease or hypertensive organ damage (intracerebral bleed, CKD, left ventricular hypertrophy or retinopathy)
