1
Q
Front
A
Back
2
Q
Presentation for Acute Confusion/Aggression?
A
GCS 13-15 with agitation/violence; differentials: hypoglycaemia (glucose <4 mmol/L), hypoxia (SpO2 <94%), tox (e.g., sympathomimetic), sepsis (qSOFA ≥2), CVA (FAST positive); elderly delirium common.
3
Q
Management for Acute Confusion/Aggression?
A
Ensure scene safety (2-person restraint if needed, MH Act), ABCDE approach (airway adjunct if GCS<8), bedside glucose/ABG/ECG, CT head if trauma/focal signs, tox screen/UEC/LFTs, de-escalate verbally; senior/psych consult; avoid physical if possible.
4
Q
Doses/Details for Acute Confusion/Aggression?
A
Haloperidol 5 mg IV/IM (max 20 mg/24h, titrate 2.5-5 mg q15-30min); droperidol 5-10 mg IM (monitor QTc <500 ms); midazolam 2-5 mg IV/IM PRN (max 10 mg, caution resp depression); thiamine 100-300 mg IV if alcoholic; glucose 50 ml 50% Dextrose IV if <4 mmol/L; ARC-compliant sedation protocol.
5
Q
Presentation for Acute Dizziness?
A
Vertigo (nystagmus on HINTS), presyncope (no prodrome); differentials: posterior stroke (NIHSS >4, new ataxia), labyrinthitis (hearing loss), BPPV (positional); exclude cardiac (AF, VT).
6
Q
Management for Acute Dizziness?
A
ABCDE, full neuro exam (HINTS: Head Impulse negative, Nystagmus direction-changing, Test of Skew present = central), ECG/CT head urgent if central signs, MRI if equivocal; ENT consult if peripheral; admit if stroke risk (ABCD2 ≥4).
7
Q
Doses/Details for Acute Dizziness?
A
Prochlorperazine 12.5 mg IM/IV for vestibular suppression (max 37.5 mg/24h); betahistine 16 mg TDS PO for 5 days if peripheral; aspirin 300 mg PO stat if TIA/stroke; thrombolysis alteplase 0.9 mg/kg IV (<4.5h if ischaemic, 10% bolus).
8
Q
Presentation for Acute Headache?
A
Thunderclap (peak <1h), worst-ever; differentials: SAH (Hunt-Hess grade 1-2, no focal deficit), migraine (aura, photophobia), meningitis (fever, neck stiffness); red flags: new, sudden, >55yo.
9
Q
Management for Acute Headache?
A
ABCDE, LP if CT negative (Xanthochromia for SAH), CTA/MRA for aneurysm, LP for CSF analysis (WCC <5, protein <0.45 g/L normal); neurosurg consult; treat cause (e.g., nimodipine for SAH).
10
Q
Doses/Details for Acute Headache?
A
Sumatriptan 6 mg SC/50 mg PO for migraine (avoid if vascular); paracetamol 1 g IV + metoclopramide 10 mg IV for analgesia; nimodipine 60 mg PO 6H (start within 96h SAH, monitor BP); ceftriaxone 2 g IV + vancomycin 15-20 mg/kg IV + dex 10 mg IV if meningitis suspected.
11
Q
Presentation for Acute Pain?
A
Severe VAS >7/10, guarding; differentials: ACS (troponin rise), AAA (pulsatile mass, hypotensive), renal colic (flank radiation); non-traumatic vs traumatic.
12
Q
Management for Acute Pain?
A
ABCDE, POCUS (eFAST for intra-abdominal), analgesia first (don’t delay), opioid PCA if ongoing, specialist consult (vascular/surg); serial exams.
13
Q
Doses/Details for Acute Pain?
A
Morphine 2.5-5 mg IV q5-15min titrate (max 20 mg/h, with naloxone 0.4 mg IV reversal); fentanyl 25-50 mcg IV PCA (bolus 10-20 mcg, lockout 5min); ketamine 0.3 mg/kg IV if opioid-resistant (dissociation risk); paracetamol 1 g IV QID (max 4 g/24h).
14
Q
Presentation for Acute Weakness?
A
Focal (NIHSS ≥1, e.g., hemiparesis), bilateral (GBS, myasthenia); differentials: ischaemic stroke (onset <4.5h), Todd’s post-ictal, hypokalaemia (<3 mmol/L).
15
Q
Management for Acute Weakness?
A
ABCDE, urgent non-contrast CT head (exclude bleed), NIHSS scoring, thrombolysis if eligible, MRI/DWI for posterior; neuro consult; admit to stroke unit.
16
Q
Doses/Details for Acute Weakness?
A
Alteplase 0.9 mg/kg IV (max 90 mg, 10% bolus over 1min, 90% over 60min <4.5h); aspirin 300 mg PO stat post-CT; IVIG 0.4 g/kg/day x5 days for GBS (if Miller Fisher); plasma exchange 1.5 plasma vol x5 if severe GBS.
17
Q
Presentation for Altered Conscious State/Coma?
A
GCS ≤8; differentials: metabolic (Na <120 or >160, glucose <4 or >20), tox (opioids, benzos), ICH (pupil asymmetry); AEIOU TIPS mnemonic.
18
Q
Management for Altered Conscious State/Coma?
A
ABCDE (intubate GCS<8), protect airway (NG for aspiration), thiamine/glucose stat, CT head, EEG if non-convulsive status, tox screen; ICU transfer.
19
Q
Doses/Details for Altered Conscious State/Coma?
A
Thiamine 100-500 mg IV (pre-glucose to avoid Wernicke’s); 50% dextrose 50 ml IV if hypoglycaemic; naloxone 0.4-2 mg IV q2-3min (max 10 mg); flumazenil 0.2 mg IV over 30s (benzo OD, risk seizures); mannitol 1 g/kg IV over 20min if herniation (osm >320 mOsm/L).
20
Q
Presentation for Airway Compromise?
A
Stridor, use of accessory muscles, SpO2 <92%; differentials: anaphylaxis (urticaria, wheeze), epiglottitis (drooling, fever >38.5°C), foreign body (sudden onset).
21
Q
Management for Airway Compromise?
A
ABCDE (call for RSI/surgical airway kit), 100% O2, nebulised adrenaline, IV access x2; ENT/anaes consult; prepare cricothyroidotomy.
22
Q
Doses/Details for Airway Compromise?
A
Adrenaline 0.3-0.5 mg IM (1:1000) q5min x3; dexamethasone 8-12 mg IV stat; salbutamol 5 mg neb q20min; hydrocortisone 200 mg IV if anaphylaxis; racemic epinephrine 0.5 ml 2.25% neb for croup/epiglottitis.
23
Q
Presentation for Apnoea?
A
Absent RR, cyanosis; differentials: opioid OD (pinpoint pupils), brainstem stroke (quadriplegia), neuromuscular (GBS nadir).
24
Q
Management for Apnoea?
A
ABCDE (immediate BVM ventilation, intubate), reverse agents, ABG (confirm PaCO2 >45 mmHg), CT head if central; ICU.
25
Doses/Details for Apnoea?
Naloxone 0.4 mg IV q2-3min (titrate to RR, up to 10 mg); flumazenil 0.2 mg IV over 30s, then 0.5 mg q1min x3 (benzo, monitor seizures); edrophonium 10 mg IV test for myasthenia; suxamethonium 1-2 mg/kg IV for RSI (avoid in hyperK).
26
Presentation for Arrhythmia with Shock?
Unstable (SBP <90, chest pain, HF); differentials: VT (wide QRS >120 ms, AV dissociation), AF (irregular, rate >150); exclude electrolyte (K <3.5 or >5.5).
27
Management for Arrhythmia with Shock?
ABCDE (synchronised DC cardioversion), IV access, amiodarone if chemical, echo for structural cause; CCU.
28
Doses/Details for Arrhythmia with Shock?
DC cardioversion 100-200 J biphasic (sedate with midazolam 2-5 mg IV); amiodarone 150 mg IV over 10min, then 1 mg/min x6h infusion; lignocaine 1-1.5 mg/kg IV if amio intolerant (max 3 mg/kg); magnesium 2 g IV over 10min for torsades.
29
Presentation for Cardiorespiratory Arrest?
Unresponsive, apnoeic, pulseless; shockable (VF/VT) vs non (asystole/PEA); differentials: hypoxia, hypovolaemia, hyperK.
30
Management for Cardiorespiratory Arrest?
ARC BLS/ACLS: CPR 100-120/min, defibrillate shockable q2min, adrenaline q3-5min, airway (i-gel if untrained); post-ROSC: targeted temp 32-36°C x24h.
31
Doses/Details for Cardiorespiratory Arrest?
Adrenaline 1 mg IV q3-5min; amiodarone 300 mg IV post-3rd shock (150 mg subsequent); calcium gluconate 10 ml 10% IV for hyperK PEA; sodium bicarb 8.4% 50 ml IV if TCA OD; defibrillation 200 J biphasic first shock.
32
Presentation for Critical Toxic Ingestion/Exposure?
Altered vitals post-ingestion (e.g., paracetamol >10g, staggered); differentials: salicylate (tinnitus, mixed resp/AG acidosis), paracetamol (delayed LFT rise >24h).
33
Management for Critical Toxic Ingestion/Exposure?
ABCDE, activated charcoal <1h (or whole bowel if sustained-release), NAC stat if paracetamol, ECG (QRS widening >100 ms), tox consult; admit to ICU if severe.
34
Doses/Details for Critical Toxic Ingestion/Exposure?
NAC IV: 150 mg/kg over 1h load, 50 mg/kg over 4h, 100 mg/kg over 16h (if level > threshold on Rumack-Matthew nomogram); N-acetylcysteine PO 140 mg/kg load, 70 mg/kg q4h x17 if IV contraindicated; fomepizole 15 mg/kg IV load for methanol/EG; insulin 1 U/kg bolus + 0.5 U/kg/h infusion for CCB/BB OD.
35
Presentation for Envenomation?
Local (pain, swelling) or systemic (ptosis, bulbar palsy for neurotoxic snake); differentials: red-bellied black (coagulopathy, CK rise), box jelly (cardiac arrest).
36
Management for Envenomation?
ABCDE, pressure immobilization bandage (not remove until antivenom ready), CSL snake venom detection kit, FBC/coags stat, antivenom in monitored bed.
37
Doses/Details for Envenomation?
Polyvalent antivenom 1-2 vials IV over 15-30min (pre-med adrenaline 0.01 mg/kg SC if allergic); taipan antivenom 1 vial IV; death adder 2 vials; FFP 10-15 ml/kg if INR >3; protamine 1 mg/unit heparin if enoxaemia.
38
Presentation for Extreme Temperature Abnormalities?
Hyperthermia >40°C (heat stroke: AMS, hot dry skin); differentials: NMS (rigidity, CK >1000 U/L post-neuroleptic), MH (tachycardia, masseter spasm peri-anaesthetic).
39
Management for Extreme Temperature Abnormalities?
ABCDE, active cooling (ice packs axillae/groin, evaporative), stop offending agent, dantrolene stat for MH/NMS, ICU; core temp probe.
40
Doses/Details for Extreme Temperature Abnormalities?
Dantrolene 2.5 mg/kg IV q5-10min (max 10 mg/kg, repeat 1 mg/kg q4-6h x48h for MH); bromocriptine 2.5-5 mg PO NG q8h for NMS; paracetamol 1 g IV q6h adjunct (ineffective alone); benzos lorazepam 2 mg IV for agitation/shivering.
41
Presentation for Major Burn?
>20% TBSA (rule of 9s), circumferential, inhalation (soot in nares, carboxyHb >10%); differentials: chemical (irrigate 20min), electrical (entry/exit wounds).
42
Management for Major Burn?
ABCDE (stop burning process), Parkland fluids, escharotomy if compartment syndrome, bronchoscopy if inhalation, burns unit transfer <8h.
43
Doses/Details for Major Burn?
Hartmann's 4 ml/kg/%TBSA over 24h (half in first 8h from time of burn); silver sulfadiazine 1% cream topical; tetanus toxoid 0.5 ml IM + human Ig 250 U IM if not immune; morphine 0.1 mg/kg IV bolus then PCA; escharotomy with #11 blade.
44
Presentation for Major Haemorrhage?
Class III shock (HR >120, SBP <90, >30% vol loss); differentials: trauma (ATLS primary survey), PPH (boggy uterus), GI varices (Child-Pugh B/C).
45
Management for Major Haemorrhage?
ABCDE (direct pressure, tourniquet if limb), massive transfusion (1:1:1 PRBC:FFP:plt), TXA stat, interventional radiology/surg; permissive hypotension <90 SBP pre-haemostasis.
46
Doses/Details for Major Haemorrhage?
TXA 1 g IV over 10min <3h from injury, then 1 g over 8h; PRBC 10 ml/kg bolus; cryoprecipitate 10 U if fibrinogen <1.5 g/L; calcium gluconate 10 ml 10% IV q30min with transfusions; tranexamic acid PO 1.3 g BD x3-5 days if ongoing.
47
Presentation for Major Head/Spinal Injury?
GCS <13 or deterioration, focal signs; spinal: midline tenderness, neuro deficit (ASIA scale A); differentials: epidural haematoma (lucid interval), SCIWORA in kids.
48
Management for Major Head/Spinal Injury?
ABCDE (C-spine immobilize with collar/blocks), CT head/C-spine urgent (Canadian rules), hyperosmolar if ICP >20 mmHg, neuro/surg consult; log-roll for exam.
49
Doses/Details for Major Head/Spinal Injury?
Mannitol 1 g/kg IV over 20min (repeat q6h if needed, monitor osm >320); hypertonic saline 3% 250 ml bolus (Na <155 mmol/L); TXA 1 g IV <3h for TBI; methylprednisolone 30 mg/kg IV load then 5.4 mg/kg/h x23h for spinal (controversial, NASCIS II); fentanyl 1-2 mcg/kg/h infusion for ICP control.
50
Presentation for Major Limb Injury?
Open fracture (Gustilo I-III), vascular compromise (cap refill >2s, absent pulses); differentials: compartment syndrome (pain on passive stretch, delta P <30 mmHg).
51
Management for Major Limb Injury?
ABCDE, splint/immobilize, tetanus/abx stat, ortho washout <6h, angio if vascular; fasciotomy if pressures >30 mmHg.
52
Doses/Details for Major Limb Injury?
Cefazolin 2 g IV stat (3 g if >120kg, add gent 5 mg/kg if contaminated); tetanus toxoid 0.5 ml IM + Ig 250-500 U if >10y since last; morphine 0.1 mg/kg IV; lignocaine 2% 5 ml IA for reduction; bivalirudin 0.75 mg/kg bolus if anticoag reversal needed.
53
Presentation for Major Torso Injury?
Positive eFAST (haemoperitoneum), flail chest (>3 ribs); differentials: tension PTX (tracheal deviation, absent BS), cardiac tamponade (Beck's triad).
54
Management for Major Torso Injury?
ABCDE (needle thoracostomy 14G 2nd ICS MCL if tension), chest tube #28Fr 5th ICS MAL, FAST/pericardiocentesis, thoracotomy if >1.5L initial output; trauma team.
55
Doses/Details for Major Torso Injury?
TXA 1 g IV <3h; fentanyl 50-100 mcg IV analgesia; ketamine 0.5-1 mg/kg IV for procedural; pericardiocentesis subxiphoid 18G needle (aspirate until tamponade resolves); thoracostomy 200-400 ml blood = massive.
56
Presentation for Missed Essential Therapy?
Dialysis miss >48h (hyperK >6.5, fluid overload >5% wt); differentials: hyperK (peaked T, wide QRS), acidosis (pH <7.2), uraemia (pericarditis).
57
Management for Missed Essential Therapy?
ABCDE, urgent dialysis, treat complications (e.g., temporising for hyperK), nephro consult; avoid K fluids.
58
Doses/Details for Missed Essential Therapy?
Calcium gluconate 10 ml 10% IV over 5min (repeat q10-20min if ECG changes); salbutamol 10-20 mg neb (onset 15min, lasts 2h); insulin 10 U + 50 ml 50% dextrose IV (onset 15min); sodium bicarb 50-100 mmol IV if pH <7.1; haemodialysis 4h session stat.
59
Presentation for Seizure?
Status epilepticus (>5min generalized or >2 in 24h); differentials: eclamptic (HTN >140/90 preg), hypoglycaemic (<4 mmol/L), Na channel (QRS widening).
60
Management for Seizure?
ABCDE (protect airway, O2), benzos first, 2nd line AED load, intubate if refractory (>20min), EEG; obstetrics if pregnant.
61
Doses/Details for Seizure?
Midazolam 10 mg IM stat or lorazepam 0.1 mg/kg IV (max 4 mg); phenytoin 20 mg/kg IV over 20min (fosphenytoin 20 PE/kg if unavailable); levetiracetam 40-60 mg/kg IV load (max 4500 mg); propofol 1-2 mg/kg bolus then 2-10 mg/kg/h infusion if refractory; MgSO4 4-6 g IV load over 15min for eclamptic.
62
Presentation for Severe Dyspnoea?
RR >30/min, SpO2 <90% on RA, accessory use; differentials: massive PE (Wells >6, RV strain on echo), tension PTX, anaphylaxis.
63
Management for Severe Dyspnoea?
ABCDE (sit up, high-flow O2), ABG (PaO2 <60 mmHg), CTPA/echo, thrombolysis if PE with shock; ICU if intubate.
64
Doses/Details for Severe Dyspnoea?
Alteplase 100 mg IV over 2h for massive PE (or 0.6 mg/kg if <65kg); heparin 80 U/kg bolus then 18 U/kg/h infusion (target aPTT 1.5-2.5x); salbutamol 5 mg neb q20min x3; ipratropium 0.5 mg neb q20min; hydrocortisone 100 mg IV q6h if anaphylaxis.
65
Presentation for Shock?
SBP <90 mmHg persistent, lactate >2 mmol/L; differentials: distributive (sepsis, SIRS qSOFA ≥2), cardiogenic (echo EF <40%), obstructive (tamponade, PE).
66
Management for Shock?
ABCDE (fluid challenge 500 ml crystalloid, assess response), norad if vasoplegic, echo/POCUS for type, source control; EGDT if sepsis.
67
Doses/Details for Shock?
Noradrenaline 0.05-0.5 mcg/kg/min IV (titrate to MAP ≥65 mmHg); vasopressin 0.04 U/min adjunct if refractory; dobutamine 2.5-20 mcg/kg/min for cardiogenic; hydrocortisone 50 mg IV q6h if refractory septic shock; balanced crystalloid 30 ml/kg initial.
68
Presentation for Syncope?
Transient LOC <1min, no prodrome in elderly/cardiac; differentials: arrhythmic (San Francisco rule positive: abnormal ECG, Hx CHF, Hct <30), orthostatic (drop >20 SBP on stand).
69
Management for Syncope?
ABCDE, post-syncope ECG/echo, risk strat (admit if abnormal ECG, age >75, exertional), carotid sinus massage if >40yo (CSH if asystole >3s).
70
Doses/Details for Syncope?
Atropine 0.5 mg IV q3-5min (max 3 mg) if bradycardic; temporary pacing if high-degree block; midodrine 5-10 mg PO TDS if neurogenic; aspirin 100 mg PO OD if vasovagal with CAD risk.
71
Presentation for Anaphylaxis/Anaphylactic Shock?
Acute onset (minutes) with skin/mucosal (urticaria, angioedema >2 sites), respiratory (wheeze, stridor), CV (hypotension <90 SBP, tachycardia >120); differentials: vasovagal (no rash), hereditary angioedema (no urticaria, C1-INH low).
72
Management for Anaphylaxis/Anaphylactic Shock?
ABCDE (high-flow O2, IV x2 large-bore), IM adrenaline stat, remove trigger, POCUS for IVC collapse; ICU if biphasic (20% recur 1-72h); allergy consult.
73
Doses/Details for Anaphylaxis/Anaphylactic Shock?
Adrenaline 0.3-0.5 mg IM (1:1000) anterolateral thigh q5min x3 doses (reduce if <50kg); salbutamol 4-8 mg neb q20min; hydrocortisone 200 mg IV stat then q6h; chlorphenamine 10 mg IV; fluids 20 ml/kg crystalloid bolus; glucagon 1-2 mg IV if beta-blocked refractory.
74
Presentation for Sepsis/Septic Shock?
qSOFA ≥2 (RR ≥22, altered mentation, SBP ≤100) + infection source (e.g., UTI, pneumonia); lactate >2 mmol/L, fever >38°C or <36°C; differentials: SIRS non-infectious (pancreatitis).
75
Management for Sepsis/Septic Shock?
ABCDE (fluids, source control <1h), blood cultures x2 pre-abx, EGDT (MAP ≥65, ScvO2 ≥70%), broad-spectrum abx <1h; ICU for vasopressors.
76
Doses/Details for Sepsis/Septic Shock?
Ceftriaxone 2 g IV stat + azithromycin 500 mg IV (community); piperacillin-taz 4.5 g IV q6h + vanco 15-20 mg/kg IV (load 1-2g) for hospital; noradrenaline 0.05 mcg/kg/min IV titrate; hydrocortisone 50 mg IV q6h if refractory; fluids 30 ml/kg balanced crystalloid <3h.
77
Presentation for Acute Coronary Syndrome (ACS)/STEMI?
Chest pain >20min, ECG ST elevation ≥2 contiguous leads (e.g., ≥2mm V2-V3 men <40, ≥1.5mm women); troponin rise; differentials: aortic dissection (tearing pain, unequal BP).
78
Management for Acute Coronary Syndrome (ACS)/STEMI?
MONA (morphine, O2 if SpO2<94%, nitrates, aspirin), urgent PCI <90min door-to-balloon; cath lab activation; heparin if NSTEMI.
79
Doses/Details for Acute Coronary Syndrome (ACS)/STEMI?
Aspirin 300 mg chewed stat; clopidogrel 600 mg PO load or ticagrelor 180 mg PO; GTN 0.4 mg SL q5min x3 (avoid if SBP<90); morphine 2-5 mg IV q5-15min; heparin 60 U/kg IV bolus (max 4000 U) then 12 U/kg/h infusion (aPTT 1.5-2x); tenecteplase 30-50 mg IV bolus if PCI >120min.
80
Presentation for Pulmonary Embolism (Massive PE)?
Acute dyspnoea, RV strain (echo McConnell sign, CT PA saddle embolus); shock (SBP <90 >15min); Wells ≥6 or Geneva ≥10; differentials: MI (ECG inferior changes).
81
Management for Pulmonary Embolism (Massive PE)?
ABCDE (O2 target 88-92% if COPD), CTPA stat, thrombolysis if RV dysfunction/shock; IVC filter if contra to lysis.
82
Doses/Details for Pulmonary Embolism (Massive PE)?
Alteplase 100 mg IV over 2h (or 0.6 mg/kg if <65kg); heparin 80 U/kg IV bolus then 18 U/kg/h (no bolus if thrombolysis); noradrenaline if hypotensive; LMWH enoxaparin 1 mg/kg SC BD bridge to DOAC (apixaban 10 mg BD x7 days then 5 mg BD).
83
Presentation for Aortic Dissection?
Tearing chest/back pain, unequal pulses/BP (>20 mmHg diff arms), widened mediastinum CXR; Stanford A (ascending, ascending aorta); differentials: ACS (ST changes).
84
Management for Aortic Dissection?
ABCDE (BP control SBP 100-120, HR 60-80), CTA stat, urgent CT surg if Type A; beta-blockers first-line.
85
Doses/Details for Aortic Dissection?
Labetalol 10-20 mg IV q10min (max 300 mg) or esmolol 500 mcg/kg load then 50 mcg/kg/min; GTN infusion 5-10 mcg/min if BP >120 after BB; morphine 2-4 mg IV analgesia; urgent TOE if unstable.
86
Presentation for Diabetic Ketoacidosis (DKA)/HHS?
Hyperglycaemia >14 mmol/L, acidosis pH <7.3/anion gap >16 (DKA) or osm >320 (HHS); polyuria, AMS; differentials: starvation (no ketones).
87
Management for Diabetic Ketoacidosis (DKA)/HHS?
ABCDE (fluids first), hourly BM/UEC/ABG, insulin infusion, K replacement <3.5 mmol/L hold insulin; ICU if pH<7.0.
88
Doses/Details for Diabetic Ketoacidosis (DKA)/HHS?
0.9% saline 1-1.5 L bolus then 250 ml/h (switch 0.45% if Na>155); insulin 0.1 U/kg/h IV infusion (e.g., 5-10 U/h Actrapid); KCl 40 mmol/L in fluids if 3.5-5.5 mmol/L; bicarb 100 mmol IV if pH<6.9; target glucose fall <3 mmol/L/h.
89
Presentation for Status Asthmaticus?
Severe asthma (peak flow <33% best, silent chest, RR>30); silent on auscultation, accessory use; differentials: foreign body (unilateral wheeze).
90
Management for Status Asthmaticus?
ABCDE (O2 target 93-98%), continuous nebs, MgSO4 stat, steroids, NIV if pH<7.35; intubate if CO2>6.5 kPa.
91
Doses/Details for Status Asthmaticus?
Salbutamol 5 mg + ipratropium 0.5 mg neb continuous; MgSO4 2 g IV over 20min; hydrocortisone 200 mg IV stat q6h or pred 1 mg/kg PO; ketamine 1-2 mg/kg IV if intubating (bronchodilator); aminophylline 5 mg/kg load over 20min if refractory.
92
Presentation for Tension Pneumothorax?
Acute SOB, hypotension, tracheal deviation, absent BS, distended neck veins; eFAST positive; differentials: tamponade (distant HS).
93
Management for Tension Pneumothorax?
ABCDE (immediate needle decompression), chest tube insertion, POCUS confirm; thoracotomy if re-accumulation.
94
Doses/Details for Tension Pneumothorax?
14-16G cannula 2nd ICS mid-clavicular line (or 5th ICS mid-axillary); #28Fr chest tube 5th ICS anterior axillary line; analgesia fentanyl 1-2 mcg/kg IV; tetanus if open wound.
95
Presentation for Eclampsia?
New-onset seizures in pregnancy >20wks with pre-eclampsia (BP>160/110, proteinuria); differentials: epilepsy (prior Hx), CVT (headache + focal).
96
Management for Eclampsia?
ABCDE (protect airway, left lateral), MgSO4 stat, BP control <160/110, delivery plan; neuro CT post-seizure.
97
Doses/Details for Eclampsia?
MgSO4 4-6 g IV load over 15min then 1-2 g/h infusion (monitor reflexes/Patella 1+ absent = toxic); labetalol 20 mg IV q10min (max 300 mg) or hydralazine 5-10 mg IV q20min; phenytoin 15-20 mg/kg IV if Mg fails.
98
Presentation for Upper GI Bleed (Variceal)?
Haematemesis/melaena, shock (HR>100, Hb<70); Rockall ≥5 or GBS ≥12 high-risk; differentials: peptic ulcer (no cirrhosis Hx).
99
Management for Upper GI Bleed (Variceal)?
ABCDE (2 large-bore IV, cross-match 6U), octreotide stat, endoscopy <12h; balloon tamponade if exsanguinating.
100
Doses/Details for Upper GI Bleed (Variceal)?
Octreotide 50 mcg IV bolus then 50 mcg/h infusion x3-5 days; terlipressin 2 mg IV q4h (monitor ischaemia); pantoprazole 80 mg IV bolus then 8 mg/h; ceftriaxone 1 g IV stat (prophylaxis); Sengstaken-Blakemore tube with 25 ml traction.
101
Presentation for Addisonian Crisis?
Hypotension refractory to fluids, hyponatraemia <130, hyperK >5.5, abdominal pain; differentials: sepsis (fever absent).
102
Management for Addisonian Crisis?
ABCDE (hydrocortisone stat), fluid bolus, electrolytes stat, ACTH stim test post-stabilise; endo consult.
103
Doses/Details for Addisonian Crisis?
Hydrocortisone 100 mg IV stat then 50 mg q6h x24h (taper to oral); 0.9% saline 1 L bolus then 250 ml/h; fludrocortisone 0.1 mg PO day 3 if confirmed; dextrose 50 ml 50% if hypoglycaemic.
104
Presentation for Myxoedema Coma?
Hypothermia <35°C, bradycardia <60, hyponatraemia, AMS (GCS<8); differentials: sepsis (WBC normal).
105
Management for Myxoedema Coma?
ABCDE (passive rewarming, avoid active if <32°C), levothyroxine stat, hydrocortisone (adrenal insufficiency risk), ICU.
106
Doses/Details for Myxoedema Coma?
Levothyroxine 200-500 mcg IV load (reduce if cardiac risk), then 50-100 mcg PO daily; liothyronine 10-25 mcg IV q8h optional; hydrocortisone 50 mg IV q6h; passive warming blankets; avoid vasopressors pre-thyroid replacement.
107
Presentation for Thyrotoxic Storm?
Tachycardia >140, AF, fever >38.5°C, Burch-Wartofsky >45; differentials: pheo (paroxysmal).
108
Management for Thyrotoxic Storm?
ABCDE (BP control, beta-blockers), PTU stat, iodine post-thyroid block, cooling; ICU.
109
Doses/Details for Thyrotoxic Storm?
Propylthiouracil 200-400 mg PO/NG q4-6h x3 days; potassium iodide 5 drops PO q6h (after PTU); propranolol 60-80 mg PO q4-6h or esmolol 50-100 mcg/kg/min IV; hydrocortisone 100 mg IV q8h; cholestyramine 4 g PO q6h for enterohepatic.
110
Presentation for Opioid Overdose?
Pinpoint pupils, resp depression RR<12, GCS<8; differentials: benzo co-ingest (flumazenil risk).
111
Management for Opioid Overdose?
ABCDE (BVM support), naloxone titrate, monitor for withdrawal/PAED; tox screen.
112
Doses/Details for Opioid Overdose?
Naloxone 0.4 mg IV q2-3min (titrate to RR>12, up to 2 mg initial if severe); IM 0.8 mg if no IV; infusion 2/3 ED dose/h if recurrent; avoid full reversal in addicts (agitation).
113
Presentation for Tricyclic Antidepressant (TCA) Overdose?
Anticholinergic (mydriasis, dry skin), cardiotox (wide QRS >100 ms, VT), seizures; differentials: other Na channel (quinidine).
114
Management for Tricyclic Antidepressant (TCA) Overdose?
ABCDE (bicarb stat for QRS), charcoal <1h, benzos for seizures; ICU for NaHCO3 infusion.
115
Doses/Details for Tricyclic Antidepressant (TCA) Overdose?
Sodium bicarb 1-2 mEq/kg IV bolus (repeat q3-5min if QRS wide), then infusion 150 mEq in 1L D5W at 1.5x maint; lignocaine 1 mg/kg IV if VT; diazepam 10 mg IV for seizures.
116
Presentation for Calcium Channel Blocker (CCB) Overdose?
Bradycardia <50, hypotension, hyperglycaemia >10 mmol/L, high-degree block; differentials: BB OD (beta-specific).
117
Management for Calcium Channel Blocker (CCB) Overdose?
ABCDE (calcium stat, high-dose insulin), atropine, lipid emulsion if refractory; ICU.
118
Doses/Details for Calcium Channel Blocker (CCB) Overdose?
Calcium gluconate 10 ml 10% IV q5min x3 (or chloride 10 ml 10% if central line); insulin 1 U/kg IV bolus + 1 U/kg/h infusion (glucose 1 g/kg bolus); lipid emulsion 1.5 ml/kg 20% bolus x2 then 0.25 ml/kg/min; glucagon 5-10 mg IV.
119
Presentation for Beta Blocker (BB) Overdose?
Bradycardia, hypotension, hypoglycaemia <4 mmol/L, bronchospasm if non-selective; differentials: CCB (no hypoG).
120
Management for Beta Blocker (BB) Overdose?
ABCDE (glucagon stat, atropine), high-dose insulin, pacing if block; ICU.
121
Doses/Details for Beta Blocker (BB) Overdose?
Glucagon 2-5 mg IV q5min x3 then infusion 2-5 mg/h; calcium 10 ml 10% IV; insulin 1 U/kg bolus + 1 U/kg/h; atropine 0.5 mg IV q3-5min (max 3 mg).
122
Presentation for Salicylate Overdose?
Tinnitus, resp alkalosis pH>7.5 then AG acidosis, fever, AMS; levels >500 mg/L toxic; differentials: mixed OD.
123
Management for Salicylate Overdose?
ABCDE (bicarb for alkalinisation), urinary alkalinisation, dialysis if severe (levels >900 mg/L, renal failure).
124
Doses/Details for Salicylate Overdose?
Sodium bicarb 1-2 mEq/kg IV bolus then infusion 100-150 mEq in 1L D5W (target urine pH 7.5-8, serum pH 7.45-7.55); activated charcoal 50 g PO multidose; haemodialysis if coma/seizures.
125
Presentation for Paracetamol Overdose?
Often asymptomatic <24h; staggered chronic >150 mg/kg/24h; LFT rise >24h; differentials: viral hepatitis.
126
Management for Paracetamol Overdose?
ABCDE, levels 4h post-ingestion on Rumack nomogram, NAC if above line; psych consult.
127
Doses/Details for Paracetamol Overdose?
NAC IV: 150 mg/kg over 1h load, 50 mg/kg over 4h, 100 mg/kg over 16h; PO 140 mg/kg load then 70 mg/kg q4h x17 doses; monitor ALT/AST, stop if anaphylactoid reaction (slow infusion).
128
Presentation for Carbon Monoxide Poisoning?
Cherry-red skin, headache, carboxyHb >10% (mild) or >25% (severe); differentials: CN (lactate high).
129
Management for Carbon Monoxide Poisoning?
ABCDE (100% O2 stat, hyperbaric if coma/CNS symptoms), co-oximetry, neuro exam.
130
Doses/Details for Carbon Monoxide Poisoning?
100% O2 NRB mask (HBO if >25% or preg); hyperbaric 2.5-3 ATA x60-90min (if levels >25%, neuro sxs); avoid normobaric delay >6h.
131
Presentation for Organophosphate Poisoning?
SLUDGE (salivation, lacrimation, urination, defaecation, GI upset, emesis) + bradycardia, miosis; differentials: carbamate (shorter).
132
Management for Organophosphate Poisoning?
ABCDE (atropine stat, pralidoxime), decon (remove clothes), ICU for resp failure.
133
Doses/Details for Organophosphate Poisoning?
Atropine 1-2 mg IV q5min titrate to secretions dry (may need 10-20 mg total); pralidoxime 2 g IV over 30min then 0.5 g/h x24h (within 48h onset); diazepam 10 mg IV for seizures.
134
Presentation for Hypovolaemic Shock (Non-Trauma)?
History loss (GI bleed, dehydration >10% wt), tachycardia >120, cool clammy skin, urine <0.5 ml/kg/h; differentials: distributive (warm shock).
135
Management for Hypovolaemic Shock (Non-Trauma)?
ABCDE (fluid bolus 20 ml/kg, reassess), source control (e.g., NG for varices), monitor CVP 8-12 mmHg.
136
Doses/Details for Hypovolaemic Shock (Non-Trauma)?
Crystalloid 20 ml/kg bolus (Hartmann's preferred); blood if Hb<70 or ongoing loss; octreotide if variceal as above.
137
Presentation for Distributive Shock (Neurogenic)?
Cervical injury, bradycardia + hypotension (no tachycardia), warm extremities; ASIA A complete; differentials: spinal shock (flaccid).
138
Management for Distributive Shock (Neurogenic)?
ABCDE (fluids cautious 500 ml, vasopressors), spinal immobilise, methylprednisolone controversial.
139
Doses/Details for Distributive Shock (Neurogenic)?
Noradrenaline 0.05 mcg/kg/min; methylprednisolone 30 mg/kg IV load then 5.4 mg/kg/h x23h (NASCIS, use if within 8h); fluids 10-20 ml/kg.
140
Presentation for Cardiogenic Shock?
Cool peripheries, raised JVP, crackles, echo EF<40%; differentials: tamponade (pulsus paradoxus >10 mmHg).
141
Management for Cardiogenic Shock?
ABCDE (dobutamine if fluids fail), IABP if refractory, PCI if ACS; CCU.
142
Doses/Details for Cardiogenic Shock?
Dobutamine 2.5-10 mcg/kg/min IV; noradrenaline if MAP<65; furosemide 20-40 mg IV if overload; inotrope levosimendan 0.1 mcg/kg/min x24h alternative.
143
Presentation for Obstructive Shock (Tamponade)?
Beck's triad (hypotension, muffled HS, JVP), pulsus paradoxus >12 mmHg, eFAST pericardial fluid; differentials: tension PTX.
144
Management for Obstructive Shock (Tamponade)?
ABCDE (pericardiocentesis stat), subxiphoid approach, drain to 50 ml, echo guide.
145
Doses/Details for Obstructive Shock (Tamponade)?
Pericardiocentesis 16-18G needle (aspirate until BP rises); fluids 500 ml bolus preload; avoid positive pressure vent if possible.
146
Presentation for Heat Stroke?
Core >40°C, AMS, hot dry skin (exertional vs classic); CK >1000, DIC; differentials: NMS (recent neuroleptic).
147
Management for Heat Stroke?
ABCDE (rapid cooling ice-water immersion), dantrolene if MH-like, ICU for rhabdo.
148
Doses/Details for Heat Stroke?
Cooling to <39°C <30min (evaporative + ice packs); benzos lorazepam 1-2 mg IV for agitation; fluids 1 L bolus then maint.
149
Presentation for Hypothermic Cardiac Arrest?
Temp <30°C, VF/asystole, Osborn waves ECG; differentials: immersion (cold water drowning).
150
Management for Hypothermic Cardiac Arrest?
ARC modified: CPR until >30°C, defibrillate once per cycle, no adrenaline <30°C; ECMO if available.
151
Doses/Details for Hypothermic Cardiac Arrest?
Rewarming: AV rewarming 42°C fluids 1-2 L; active peritoneal lavage 45°C; ECMO target 37°C; adrenaline q6-8min once >30°C.
