Podcast
Questions and Answers
What is the first step in assessing a patient in emergency internal medicine?
What is the first step in assessing a patient in emergency internal medicine?
- Check airway, breathing, and give oxygen (correct)
- Insert 2 large cannula and send investigations
- Give IV fluid to support circulation
- Perform gastric lavage and activated charcoal
What should be done if the patient has no breathing and no pulse?
What should be done if the patient has no breathing and no pulse?
- Administer activated charcoal
- Insert a large cannula
- Start CPR (correct)
- Give IV fluids
What is the purpose of monitoring patient vital signs?
What is the purpose of monitoring patient vital signs?
- To predict the outcome of the patient
- To diagnose the condition
- To assess the patient's response to treatment (correct)
- To determine the severity of the condition
What investigation should be sent immediately in emergency internal medicine?
What investigation should be sent immediately in emergency internal medicine?
When should gastric lavage and activated charcoal be administered?
When should gastric lavage and activated charcoal be administered?
What should be checked immediately in emergency internal medicine?
What should be checked immediately in emergency internal medicine?
What is the purpose of admitting the patient to the ICU?
What is the purpose of admitting the patient to the ICU?
What should be included in the patient's initial assessment?
What should be included in the patient's initial assessment?
What is the first step in assessing a comatose patient?
What is the first step in assessing a comatose patient?
What is the indication for administering naloxone or naltrexone in a comatose patient?
What is the indication for administering naloxone or naltrexone in a comatose patient?
What is the primary goal of oxygen therapy in acute severe asthma attacks?
What is the primary goal of oxygen therapy in acute severe asthma attacks?
What is the dose of salbutamol given via nebulizer in acute severe asthma attacks?
What is the dose of salbutamol given via nebulizer in acute severe asthma attacks?
What is the primary cause of coma in patients with metabolic disorders?
What is the primary cause of coma in patients with metabolic disorders?
What is the treatment for acute severe asthma attacks if the patient does not respond to initial therapy?
What is the treatment for acute severe asthma attacks if the patient does not respond to initial therapy?
What is the primary laboratory test used to assess the severity of asthma attacks?
What is the primary laboratory test used to assess the severity of asthma attacks?
What is the indication for administering prednisolone in acute severe asthma attacks?
What is the indication for administering prednisolone in acute severe asthma attacks?
What is the initial step in managing an acute exacerbation of COPD?
What is the initial step in managing an acute exacerbation of COPD?
What is the target oxygen saturation level in managing an acute exacerbation of COPD?
What is the target oxygen saturation level in managing an acute exacerbation of COPD?
What is the dose of salbutamol administered via nebulizer in managing an acute exacerbation of COPD?
What is the dose of salbutamol administered via nebulizer in managing an acute exacerbation of COPD?
What is the indication for considering magnesium sulphate administration in managing an acute exacerbation of COPD?
What is the indication for considering magnesium sulphate administration in managing an acute exacerbation of COPD?
What is the dose of prednisolone administered orally in managing an acute exacerbation of COPD?
What is the dose of prednisolone administered orally in managing an acute exacerbation of COPD?
What is the frequency of reassessing the patient in managing an acute exacerbation of COPD?
What is the frequency of reassessing the patient in managing an acute exacerbation of COPD?
What is the indication for administering antibiotics in managing an acute exacerbation of COPD?
What is the indication for administering antibiotics in managing an acute exacerbation of COPD?
What is the goal of repeating drugs in managing an acute exacerbation of COPD?
What is the goal of repeating drugs in managing an acute exacerbation of COPD?
What is the initial treatment for a patient with an exacerbation of COPD?
What is the initial treatment for a patient with an exacerbation of COPD?
What is the indication for considering NIPPV in COPD exacerbation?
What is the indication for considering NIPPV in COPD exacerbation?
What is the drug that can be used as a respiratory stimulant in some individuals with COPD?
What is the drug that can be used as a respiratory stimulant in some individuals with COPD?
What is the condition that can cause respiratory failure, PTX, pulmonary hypertension, and Cor-pulmonale?
What is the condition that can cause respiratory failure, PTX, pulmonary hypertension, and Cor-pulmonale?
What is the next step in managing a patient with a simple pneumothorax?
What is the next step in managing a patient with a simple pneumothorax?
What is the location for inserting a chest tube in a patient with a secondary pneumothorax?
What is the location for inserting a chest tube in a patient with a secondary pneumothorax?
What is the indication for inserting a chest tube in a patient with a pneumothorax?
What is the indication for inserting a chest tube in a patient with a pneumothorax?
What is the differential diagnosis for a patient with a pneumothorax?
What is the differential diagnosis for a patient with a pneumothorax?
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Study Notes
General Basics
- Assess patient and admit to ICU if necessary
- Check airway, breathing, and circulation (ABC)
- Give oxygen and support circulation with IV fluids and large cannula
- Send investigations: CBC, U&E, LFT, ABG, blood glucose, PCR, coagulation profile, blood culture, CXR, ECG, and urine and serum toxicology if suspected
- Monitor patient vital signs including temperature, HR, BP, RR, and urine input-output
- Perform CPR if patient has no breathing and no pulse
- Consider gastric lavage and activated charcoal if toxic ingestion
- Assess patient's GCS and give glucose 50 ml 50% IV if comatose
- Correct any ABG and electrolyte disturbances
Causes of Coma
- Metabolic (hypo/hyperglycemia, acidosis, and alkalosis, hypo/hypernatremia, renal failure)
- Toxic (alcohol, opioid, TCA, atropine, etc.)
- Infection (encephalitis, meningitis, brain abscess, cerebral malaria)
- Structural lesion (ischemic and hemorrhagic stroke, brain tumor)
- Encephalopathy (epileptic, uremic, hepatic, Wernicke's)
Acute Exacerbation of Bronchial Asthma
- Assess patient for acute severe attack or near-fatal attack
- Give oxygen via poly mask and bronchodilators (salbutamol 5 mg/4hr nebulizer and ipratropium bromide 0.5 mg/6 hr nebulizer)
- Administer steroids (prednisolone 40-50 mg orally or hydrocortisone 100-200 mg IV/6 hr)
- Consider antibiotics if there is evidence of infection
- Monitor patient's PEFR, ABG, and vital signs
- Reassess patient every 15 minutes and repeat drugs until PEFR reaches 75%
- Consider Mg sulphate 1.2-2 g IV over 20 min or aminophylline bolus 5 mg/kg over 20 min if not responding
Acute Exacerbation of COPD
- Assess patient and admit to ICU if needed
- Give oxygen via venturi mask and bronchodilators (salbutamol 5 mg/4hr nebulizer and ipratropium bromide 0.5 mg/6 hr nebulizer)
- Administer steroids (prednisolone 40-50 mg orally or hydrocortisone 100-200 mg IV/6 hr)
- Consider antibiotics if there is evidence of infection
- Monitor patient's PEFR, ABG, and vital signs
- Reassess patient every 15 minutes and repeat drugs until PEFR reaches 75%
- Consider aminophylline bolus 5 mg/kg over 20 min or IV salbutamol if not responding
- Consider NIPPV if PH < 7.35 and MV if PH < 7.26 or high CO2
Pneumothorax
- Assess patient for simple pneumothorax or tension pneumothorax
- Give oxygen and send ABG, CXR, and pulse oximeter
- Determine if it is primary or secondary pneumothorax
- Insert chest tube connected to underwater seal in 5th ICS mid-axillary line as soon as possible
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