(Featured image: via Ben Avey on wikimedia commons, public domain)
I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
Describe intranasal diamorphine?
(from the OHEM)
- unlicensed use I think but common practice
- Contraindications:
- Age<1,
- Weight<10kg
- nasal obstruction
- base of skull fracture
- Dosing
- 0.1mg/kg in a volume of 0.2ml
- add appropriate amount saline to get the right concentration – in reality use a pre made table as this is way too easy to screw up
- If using a MAD device remember there is 0.1 ml dead space so you need to draw up 0.3ml of your solution
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How do you use intranasal fentanyl?
Fentanyl (From Melbourne RCH guidelines)
- Increasingly common
- Dose
- 1.5 mcg/kg (can be repeated)
- use the 100mcg/ml concentration (what we usually use for IV use)
- MAD recommended and remember the 0.1ml dead space
- Split between the nostrils
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What are the RCEM standards for paeds analgesia?
- moderate or severe pain – analgesia within 20 minutes and reevaluated 60 mins later
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What are some of the main recommendations from RCEM Ketamine guidance?
- fasting considered but not absolute contraindication
- 3 staff minimum
- 1mg/kg IV, 2.5mg/kg IM (with supplementals of 0.5mg/kg IV and 1mg/kg IM)
- Contraindications include
- <12 (12-24 with expert)
- risk of spasm
- airway issues
- psych issues
- porphyria
- procedure in the mouth or pharynx
- intracranial hypertension with CSF obstruction (this is probably one of the most genuine contraindications)
- recovery in 60-120 mins
- should mobilise and communicate to pre sedation levels before home. leave food for 1-2 hours
- no routine atropine or midazolam
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