Emergencies

Question 1

Management of acute exacerbation of asthma

Answer 1

OSHIM

oxygen, salbutamol, hydrocortisone, ipratroprium, IV magnesium sulphate

Question 2

What is the initial management of suspected ACS?

Answer 2

Aspirin and Clopidogrel 300 mg PO
IV access and 12 lead ECG
high-flow oxygen (beware COPD - start them on28%)
Diamorphine 2.5-10mg IV
GTN 2 puffs
Metoclopramide for nausea
Take blood
Portable CXR

Question 3

What blood is taken for suspected ACS?

Answer 3

FBC/U+E - pottassium must be kept between 4-5
glucose
markers for cardiac injury - troponin
lipid profile

Question 4

Differential diagnosis fro ACS?

Answer 4

pericarditis 
dissecting AA
PE
Oesophageal reflux
biliary tract disease
perforated peptic ulcer
pancreatitis

Question 5

how do you determine between the three conditions in ACS?

Answer 5

ST elevation on ECG - STEMI
No ST elevation, troponin T/I elevation - NSTEMI
No ST elevation, no biochemical markers - unstable angina

Question 6

What is the first line for emergency ref perfusion for STEMI?

Answer 6

PCI

Question 7

What is first line for anticoagulation in NSTEMI?

Answer 7

heparin - UFH or LMWH

Question 8

What is the long-term management of an MI?

Answer 8

Aspirin
Atorvastatin
ACE inhibitor
B blocker
for life

clopidogrel for 12 months

Question 9

Management of sepsis

Answer 9

give high flow oxygen
take blood
give IV antibiotics
start IV fluid resuscitation
measure urine output
measure serum lactate

Question 10

Management of suspected and then confirmed PE

Answer 10

wells score >4 or >4 but positive D-dimer -> CTPA

LMWH after CTPA and then warfarin

Question 11

what to do with suspected DVT in pregnant woman

Answer 11

refer immediately

Question 12

management of suspected and then confirmed DVT

Answer 12

wells score >2 -> ultrasound?d-dimer if waiting

then warfarin