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Emergencies

Emergencies. Dr. P Feldman. Chest pain. Causes MI Unstable angina Pulmonary embolism Pneumothorax Pericarditis Pleurisy Musculoskeltal Shingles. MI Management. Phone for admission Phone immediate ambulance Aspirin soluble 300mg Oxygen. MI Management. Pain GTN 1-2 pufs sublingual

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Emergencies

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  1. Emergencies Dr. P Feldman

  2. Chest pain • Causes • MI • Unstable angina • Pulmonary embolism • Pneumothorax • Pericarditis • Pleurisy • Musculoskeltal • Shingles

  3. MI Management • Phone for admission • Phone immediate ambulance • Aspirin soluble 300mg • Oxygen

  4. MI Management • Pain • GTN 1-2 pufs sublingual • Diamorph 2.5-5mg iv slowly 2-3 mins • Bradycardia • Atropine 300-600 micrpgrams iv slowly • LVF • 10-50mg iv slowly

  5. Meningitis • Treatment • Adult – benzyl penicillin 1200mg iv/im • Child 1-10 yrs benzyl penicillin 600mg iv/im • Child < 1yr benzyl penicillin 300mg im/iv • Penicillin allergy • Chloramphenicol adults 25mg/kg • Child 12.5mg/kg

  6. Anaphylaxis • Oxygen • Adrenaline 1:1000 IM • Adults 0.5mls = 500 micrograms • Child 6-12yrs 0.25mls = 250 micrograms • Child 6 months - 6yrs 0.12mls = 120 microg. • Child < 6 months 0.05mls = 50 micrograms • Doses can be repeated at 5-10min intervals

  7. Anaphylaxis • Chlorpheniramine 10-20mg im • Child <12yrs 250microgram/kg max 10mg • Hydrocotisone 100mg-300mg iv slowly • Nebulised salbutamol 2.5-5mg

  8. Unconscious patient • Causes • Syncope • Fits • Cardiovascular • Metabolic • Hypothermia • Poisonning • CVA

  9. Management • Call ambulance • Record vital signs – start resuscitation • Check blood sugar • Check pupils constricted ? Opiates • Medic alert bracelet

  10. Paediatrics • Epiglotitis • >2yrs sudden onset ill child high temp drooling insp stridor admit don’t examine throat • Croup • 6 months – 3yrs preceded by urti slow onset worse at nigth hoarse croupy cough insp stridor intercostal recession steam inhalation nebulised budesonide 2mg

  11. Vaginal bleeding • Pregnancy • <12/52 light arrange scan heavy + Colicy abddo pain admit • Ectopic send for urgent scan • APH admit • PPH admit if severe if light augmentin 375mg tds

  12. Pregnancy PET Raised bp ankle oedema proteinuria admit Symptoms of impending fit – headache visula disturbance epigastric discomfort vomiting twitching

  13. Abdominal pain • Causes • MI • Ruptured AA • Impacted faeces • Renal colic • Biliary colic • Testicular torsion • Salpingitis/dysmenorrhoea

  14. Abdominal pain • Causes • Ectopic preg • Appendicitis • Perforated peptic ulcer • Intussception • Acute diverticulitis • Intestinal obstruction • Acute pancreatitis

  15. Abdominal pain • Acute diabetic coma • Strangulated hernia • Mesenteric vascular occlusion

  16. Back Pain • Admit if • Sphincter disturbance • Saddle anaesthesiae

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