Abdominal Pain – General Information

Last Updated on December 20, 2020 by FRCEM Intermediate Abdominal Pain in above 65 years means you have to do a USG AAA Screen Think Mesenteric Ischemia/Ischemic Colitis when “Pain is out of Proportion” Distended Abdomen: Ascites, Bowel Obstruction, Urinary Retention Females in 40s = Gall Stones Alcoholic and Gall […]

Unconscious Patient

Last Updated on December 20, 2020 by FRCEM Intermediate Bed Side Test: Check Fingerstick Glucose, Temperature Think Overdose (Naloxone/Thiamine) – Anti dotes Look for RED FLAGS (Head Injury/Rash/Neck Stiffness/Fundus/Previous VP Shunt) Get a CT imaging

Septic Patient

Last Updated on December 20, 2020 by FRCEM Intermediate1 Hour Sepsis Bundle: Measure lactate level & Re measure lactate level if initial lactate was > 2 mmol, Obtain blood cultures before administering antibiotics. Administer broad-spectrum antibiotics. Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate level 2 4 mmol/L. […]

DVLA

Last Updated on December 20, 2020 by FRCEM IntermediatePatients are responsible for informing the DVLA about their medical conditions. Steps: Inform the patient to inform DVLA. If an incompetent patient, inform DVLA directly The patient refuses diagnosis: Advice/Arrange a second opinion. No driving until the second opinion Still driving: Persuade […]

Health promotion and Public Health

Last Updated on December 20, 2020 by FRCEM IntermediateAlcohol Advice on Alcohol cut down, alcohol diary and Cognitive behavioural therapy support. Advice: men and women are advised not to drink more than 14 units a week on a regular basis spread your drinking over 3 or more days if you […]

Infection Control

Last Updated on December 20, 2020 by FRCEM Intermediate Standard Precautions: Hand Hygiene, Gloves Transmission Based Precautions: Contact, Droplet & Airborne Contact Precautions: MRSA, C. Difficile, Scabies Droplet Precautions: Mumps, Rubella, N. Meningitis Airborne Precautions: Chicken Pox, Measles, TB An idea about notifiable diseases is essential Meningitis Chemoprophylaxis in Neisseria: […]

Therapeutic and safe prescribing

Last Updated on December 20, 2020 by FRCEM Intermediate Common CYP450 inducers (CRP: Carbamazepine, Phenytoin, Phenobarbital, Refiampicin)- Drugs used with any of these will be metabolized and their therapeutic efficacy will be reduced. CYP450 inhibitors (SICKFACES.com) : Sodium valproate, IHN, Clarithromycin, Ketoconazole, Fluconazole, Alcohol Binge, Amiodarone, Ciprofloxacin, Erythromycin , Sulfonamides, […]

Hypothermia

Last Updated on December 19, 2020 by FRCEM IntermediateOVERVIEW Hypothermia occurs when core body temperature is < 35°C mild: 32-35°C moderate: 28-32°C severe: < 28°C Swiss staging system I – clearly conscious and shivering II – impaired consciousness without shivering III – unconscious IV – not breathing V – death […]

Cardio-Respiratory Arrest

Last Updated on December 19, 2020 by FRCEM Intermediate Remember your 4 H’s & 4 T’s Targeted Temperature Management to 36 C Fine VF to treated as Asystole with Good Quality Compressions Adrenaline dose is 1 mg 1:10000 after/at 3rd Shock in Shockable Arrests and immediately in Non-Shockable Arrests. Amiodarone […]

ARDS – Lung Protective Ventilation

Last Updated on December 19, 2020 by FRCEM IntermediatePaO2/FiO2 Ratio Mild <300-200 mm Hg Moderate  <200 – 100 mm Hg Severe < 100 mm Hg Setting Low Tidal Volume (Based on Predicted Body Weight ~ 6 ml/kg) Static Inspiratory Pressure < 30 cm H2O Permissive Hypercapnia High PEEP Aim To […]