Your first night on call (ER style!)

Case 1 32 year old lady Acute SOB Wheeze Using accessory muscles of respiration Unable to complete sentences

Case 1 Acute severe asthma DrugDoseRouteRate/frequency 1Oxygen100%inhcontinuous 2Salbutamol5mgneb15-30mins 3Hydrocortisone200mgiviv push/6hourly 4Ipratropium bromide0.5mgneb6 hourly 5Aminophylline250mgslow iv100mls nacl/30mins then 750mg/24hrs 6Normal saline1Liv6-8 hourly

Case 2 62 years Crushing central chest pain x 30mins Sweating, pale

Case 2 Acute coronary syndrome DrugDoseRouteRate 1Oxygen100%inhcontinuous 2Morphine2.5-10mgivSlow iv 3Cyclizine50mgivSlow iv 4Aspirin300mgPo chewed 5Glyceryltrinitrate mcgs/lstat 6tPA10mgivBolus iv 7Atenolol5mgiv5mins 8Clopidogrel300mgpostat

Case 3 38 yr old male NKDA You’ve just given second dose of co-amoxyclav iv

Case 3 Anaphylaxis DrugDoseRouteRate 1Oxygen100%inhcontinuous 2Adrenaline1ml 1:1000IMstat 3Chlorphenamine10mgIv 4Hydrocortisone mgiv 5Salbutamol5mgneb

Case 4 78 yr old man Known IHD/CCF Acute SOB Tachycardia Gallop rhythm Wet crackles in bases

Case 4 Acute pulmonary oedema DrugDoseRouteRate 1Oxygen100%inhcontinuous 2Furosemide40-120mgivSlow 3Morphine2.5-10mgivSlow iv 4Cyclizine50mgivSlow iv 5Glyceryl trinitrate mcgs/lstat 6Glyceryl trinitrate2-10mg/hrivinfusion

Case 5 82 yr old Diabetic Unresponsive Glucometer 1.3mmol/l Very poor iv access

Case 5 Hypoglycaemia DrugDoseRouteRate 1Glucagon1mgIm 250mls 50% dextrose50mls 50%ivslow

Case 6 Collapse Bradycardia 36/min BP 70/50

Case 6 Bradycardia DrugDoseRouteRate 1Atropine0.5mgiv3-6 mins up to 3mg

Case 7 Conscious HR 180 BP 140/70

Case 7 Stable broad complex tachycardia DrugDoseRouteRate 1Oxygen100%inhcontinuous 2Amiodarone OR 150mg in 20 mls 5% dextrose IvSlow 10min Can repeat if persists 2Lidocaine50mgivSlow over 2min & repeat q 5min up to 300mg Infusion at mg per minute 3K+ Mg2+

Case 8 Lab calls Potassium 9.0 mmol/l

Case 8 Hyperkalaemia DrugDoseRouteRate 1Calcium gluconate10mls 10%IVPush q 10mins 2Short acting insulin 50mls 50% dextrose 10 unitsiv15-30mins 3Salbutamol5mgnebstat 4Calcium resonium15g qds 30g tds po pr

Case 9 55 year old man Palpitations & SOB HR 200 BP 115/70

Case 9 Supraventricular tachycardia DrugDoseRouteRate 1Oxygen100%inhcontinuous 2Carotid sinus massage Valsalva 3Adenosine 3mg IVFast with flush Can repeat at 6mg & 12mg

Case years SOB & palpitations Irregularly irregular pulse 200/min History of Wolfe Parkinson White syndrome

Case 9 Fast atrial fibrillation with WPW DrugDoseRout e Rate 1Oxygen100%inhcontinuous 2 Procainamide17 mg/kgIVinfusion not to exceed 50 mg/min 3Enoxaparin Img/kg sc bd (ACS dosing) Drugs slowing AV conduction may worsen arrhythmia in WPW by increasing conduction through accessory pathway Avoid adenosine, beta blockers, digoxin, verapamil

Adverse signs with arrhythmias VT/SVT/Fast AF systolic blood pressure less than 90 mm Hg pulse rate greater than 150 beats/minute chest pain evidence of heart failure Get anaesthetist (if you have time) Cardiovert (synchronised)