Acute Care

Question 1

Triad of anaesthesia?

Answer 1

Hypnosis
Analgesia
Paralysis

Question 2

Inhaled vs intravenous anaesthetic agents?

Answer 2

Inhaled = sevoflurane, desflurane, nitrous oxide (NO)
Intravenous = propofol, thiopental, etomidate, ketamine

Question 3

Depolarising muscle relaxant and life-threatening side effect?

Answer 3

Suxamethonium
Malignant hyperthermia

Question 4

Features and management of malignant hyperthermia?

Answer 4

Extreme pyrexia
Muscle rigidity
Management = dantrolene

Question 5

Fasting advice pre-surgery?

Answer 5

No solid or non-clear fluid < 6 hours before
No clear fluid < 2 hours before

Question 6

When should the COCP or HRT be stopped pre-surgery?

Answer 6

4 weeks before

Question 7

Antidotes for opioid, paracetamol, TCA, BZD, methanol/ethylene glycol, warfarin and iron overdose?

Answer 7

Opioid = naloxone
Paracetamol = acetylcysteine
Organophosphate = atropine
TCA = sodium bicarbonate
BZD = flumazenil
Methanol = fomepizole or ethanol
Ethylene glycol = fomepizole or ethanol
Warfarin = vitamin K
Iron = desferrioxamine
Carbon monoxide = 100% O2, hyperbaric O2

Question 8

Timeframe for using activated charcoal for paracetamol overdose?

Answer 8

< 1 hour of presentation

Question 9

Who should recieve acetylcysteine treatment?

Answer 9

• Plasma paracetamol conc. over treatment line
• Staggered overdose or unknown amount
• Presenting 8-24 hours after overdose of > 150 mg/kg paracetamol
• Presenting > 24 hours after overdose if signs of hepatic damage e.g. jaundice, raised ALT

Question 10

What constitutes a “staggered” overdose?

Answer 10

Not all tablets taken in the same hour

Question 11

Criteria for a liver transplant after paracetamol overdose?

Answer 11

Arterial pH < 7.3 after 24 hours
Or all 3 of the following:
→ PT time > 100 seconds
→ creatinine > 300 µmol/l
→ grade III or IV encephalopathy

Question 12

How to measure the correct size of an oropharyngeal vs nasopharyngeal airway?

Answer 12

Oropharyngeal = incisors to angle of the jaw
Nasopharyngeal = tragus to tip of nose

Question 13

Which artificial airway protects against aspiration?

Answer 13

Endotracheal (ET) tube

Question 14

List examples of hypovalaemic vs euvolaemic vs hypervolaemic hyponatraemia?

Answer 14

Hypovolaemic = GI loss, diuretics, Addison’s
Euvolaemic = SIADH, adrenal insufficiency
Hypervolaemic = heart failure, cirrhosis

Question 15

Complication of correcting hyponatraemia vs hypernatraemia too quickly?

Answer 15

Hypo = cerebral pontine myelinolysis
Hyper = cerbral oedema

Question 16

Acute management of stridor?

Answer 16

High-flow O2
Nebulised adrenaline
IV dexamethasone
IV antibiotics (if infection suspected)

Question 17

Sepsis bundle?

Answer 17

BUFALOS:
→ bloods
→ urine output
→ fluids
→ antibiotics
→ lactate
→ oxygen
→ senior review

Question 18

AMPLE history?

Answer 18

Allergies
Medication
PMH
Last meal
Events surrounding presentation

Question 19

SBAR handover?

Answer 19

Situation
→ your name, role and location
→ what/who you are concerned about
→ express your need for advice
Background
→ summary of patient
→ latest obs and interventions
Assessment
→ your impression and concerns
Recommendation
→ what you would like e.g. review
→ do they want more tests or info?
→ clarify timescale

Question 20

Paracetamol mechanism of action?

Answer 20

idk