SLMC ERPM flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Anaphylaxis first-line drug

Intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh, repeated every 5 minutes if needed. Antihistamines and steroids are adjuncts and never substitute for adrenaline.

Septic shock initial fluid

30 mL/kg of intravenous crystalloid given within the first 3 hours for sepsis with hypotension or lactate of 4 mmol/L or more, alongside broad-spectrum antibiotics within 1 hour.

Stroke thrombolysis window

Intravenous thrombolysis is offered up to 4.5 hours after symptom onset once CT or MRI has excluded intracranial haemorrhage and blood pressure is controlled below 185/110 mmHg.

DKA potassium rule

In diabetic ketoacidosis, replace potassium when the level is below 5.5 mmol/L and the patient is passing urine; insulin drives potassium intracellularly, so hypokalaemia can worsen rapidly.

Hyponatraemia correction limit

Correct serum sodium by no more than 8–10 mmol/L in 24 hours to avoid osmotic demyelination. Hypertonic 3% saline is reserved for seizures or reduced consciousness.

Acute severe asthma treatment

Give oxygen to target saturations of 94–98%, repeated nebulised salbutamol with ipratropium, early systemic corticosteroids, and intravenous magnesium sulphate 1.5–2 g for a poor response.

Silent chest in asthma

A silent chest means airflow is too poor to generate wheeze and indicates life-threatening asthma. Rising PaCO2 and exhaustion are signs of impending respiratory arrest requiring ventilatory support.

ACS troponin timing

High-sensitivity troponin is measured serially at 0 and 1 hour or 0 and 3 hours; a rise and fall with ischaemic symptoms or ECG changes confirms acute myocardial infarction.

Mean arterial pressure formula

MAP equals diastolic pressure plus one third of the pulse pressure, or (systolic + 2 × diastolic) divided by 3. A MAP below 65 mmHg generally indicates inadequate organ perfusion.

Cockcroft-Gault creatinine clearance

CrCl equals [(140 − age) × weight in kg] divided by (0.814 × serum creatinine in micromol/L), multiplied by 0.85 for women. It guides dosing of renally cleared drugs.

Hyperkalaemia emergency treatment

Give intravenous calcium gluconate for cardiac protection, shift potassium intracellularly with insulin-dextrose or salbutamol, then remove potassium using a binder or dialysis.

Opioid overdose antidote

Naloxone reverses opioid-induced respiratory depression; titrate small intravenous doses to restore adequate breathing rather than full consciousness, and monitor for re-sedation as its half-life is short.

Hypoglycaemia treatment

For conscious patients give 15–20 g of fast-acting oral carbohydrate and recheck glucose after 15 minutes. For unconscious patients give intravenous glucose or intramuscular glucagon.

Upper GI bleed management

Resuscitate with crystalloid and blood products, give a proton pump inhibitor infusion for suspected variceal bleeding plus prophylactic antibiotics, and arrange endoscopy within 24 hours of stabilisation.

Paracetamol overdose antidote

N-acetylcysteine is given based on the timed serum paracetamol level plotted against the treatment nomogram, or immediately if presentation is late or the level is unavailable.

Digoxin toxicity features

Toxicity causes nausea, visual disturbance such as yellow halos, and arrhythmias including bradycardia and heart block. Risk rises with hypokalaemia, renal impairment, and interacting drugs.

Acute pulmonary oedema treatment

Sit the patient upright, give oxygen, intravenous loop diuretic, and nitrates if blood pressure allows; non-invasive ventilation reduces intubation rates in severe respiratory distress.

Meningitis immediate therapy

Give intravenous ceftriaxone promptly after blood cultures, adding dexamethasone before or with the first antibiotic dose; do not delay antibiotics for lumbar puncture in unstable patients.

Surgical abdomen red flags

Rigidity, rebound tenderness, absent bowel sounds, and haemodynamic instability suggest peritonitis or ischaemia and warrant urgent surgical review and imaging rather than observation.

SOFA score purpose

The Sequential Organ Failure Assessment scores respiratory, coagulation, liver, cardiovascular, neurological, and renal dysfunction; a rise of 2 or more in suspected infection defines sepsis.

Glasgow Coma Scale components

The GCS sums eye opening (1–4), verbal response (1–5), and motor response (1–6), giving 3 to 15. A score of 8 or less indicates a need to protect the airway.

Atrial fibrillation stroke risk

The CHA2DS2-VASc score estimates stroke risk in atrial fibrillation and guides anticoagulation; the HAS-BLED score estimates bleeding risk but should not alone withhold anticoagulation.

Warfarin reversal agent

For major bleeding on warfarin, give intravenous vitamin K plus prothrombin complex concentrate; fresh frozen plasma is an alternative when concentrate is unavailable.

Heparin-induced thrombocytopenia

HIT causes a falling platelet count 5–10 days after heparin exposure with paradoxical thrombosis. Stop all heparin and start a non-heparin anticoagulant such as argatroban.

Thyroid storm treatment

Give a beta-blocker, thionamide such as propylthiouracil, iodine load at least one hour after the thionamide, plus corticosteroids and supportive cooling and fluids.

Adrenal crisis management

Give intravenous hydrocortisone 100 mg immediately, then rehydrate with 0.9% saline and treat the precipitating cause such as infection; do not wait for confirmatory cortisol results.

Acute kidney injury staging

AKI is a creatinine rise of 26.5 micromol/L or more in 48 hours, a 1.5-fold rise within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Rhabdomyolysis prevention of AKI

Aggressive intravenous crystalloid to maintain urine output, monitoring creatine kinase and potassium, prevents pigment nephropathy and hyperkalaemic cardiac arrest in rhabdomyolysis.

Carbon monoxide poisoning

Pulse oximetry is falsely normal because it cannot distinguish carboxyhaemoglobin. Give high-flow oxygen and consider hyperbaric therapy for severe poisoning or pregnancy.

Antibiotic stewardship principle

Start empirical broad-spectrum therapy in severe infection, then narrow based on culture and sensitivity results, and review the need for continuation at 48–72 hours to limit resistance.

Vancomycin monitoring

Monitor trough or AUC levels for vancomycin to balance efficacy against nephrotoxicity, especially with concurrent loop diuretics, aminoglycosides, or impaired renal function.

Tension pneumothorax action

Tension pneumothorax with hypotension and tracheal deviation is treated by immediate needle decompression followed by chest drain, without waiting for imaging confirmation.