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NZATS Registration Exam study flash cards > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What are the signs of an air embolism?

A

Decreased CO2

Tachypnoea

Decreased oxygen saturation

Hypotension

Tachycardia

ECG changes

‘Pulmonary wheel murmur’

Pulmonary oedema may develop later

Altered mental status if awake

Cardiopulmonary collapse

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2
Q

What should you do in the event of an Air Embolism?

A

Call for help

Identify a hands-off leader and delegate roles

Turn FiO2 to 100% and stop any nitrous oxide use

Stop the source of air entry

Inform the surgeon to flood surgical field

Use ETCO2 to monitor progression

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3
Q

What are the main risks for air embolism?

A

Operative field above the heart

Spinal surgery

Sitting craniotomy

Large bore IV access

Rapid infusions

C section

Gas insufflation procedures

Head up during central line

RRT, ECMO, Bypass

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4
Q

What are the signs of anaphylaxis?

A

Severe grade reaction

Hypotension

Bronchospasm

High peak airway pressure

Decreased or lack of breath sounds

Tachycardia

Urticara

Cardiac arrest

Oedema

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5
Q

What should you do in the event of a suspected anaphylaxis ?

A

Call for help

Identify a hands off team leader

Turn FiO2 to 100% and consider reducing anaesthesia depth

Adrenalin bolus of 20-100mcg IV repeat 1-2 minutes

OR

Adrenalin IM 0.5mg every 5 minutes as needed

Remove potential causative agents

Secure the airway with ETT

Ensure large bore IV access

Give 2L fluid bolus and elevate legs

If no pulse or systolic BP <50 start CPR and follow PEA algorithm

Obtain and continue with anaphylaxis box cards

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6
Q

What should you next consider with a suspected anaphylaxis ?

A

Adrenalin infusion +/- any other vasopressor

Salbutamol +/- magnesium if bronchospams

Arterial line, central line, blood gases

Tryptase levels test 1 / 4 / 24 afters

Can the operation continue?

Referral to ICU

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7
Q

What is the IM adrenalin dose for children?

A

10mcg [0.01ml/kg] of 1:1000

[min dose 0.1ml]

[max dose 0.5ml]

Repeat every 5 minutes as needed

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8
Q

What is the IM adrenalin dose for adults?

A

0.5mg [0.5ml of 1:1000]

Repeat every 5 minutes as needed

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9
Q

Main causes of anaphylaxis?

A

Antibiotics

Muscle relaxants

Chlorhexidine

Latex

Colloids

Patient blue

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10
Q

What do you do in the event of an unstable bradycardia?

A

Call for help and the resuscitation trolley and attach defib pads

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Stop surgical stimulation

Give atropine 600mcg IV repeat up to 3mg

If atropine ineffective start either adrenalin infusion or transcutaneous pacing

Confirm pulse present if no pulse start CPR and follow cardiac arrest aystole/PEA algorithm

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11
Q

What are the signs of unstable bradycardia?

A

HR <50bpm with hypotension

Acutely altered mental state

Shock

Ischaemic ECG or acute heart failure

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12
Q

What are the signs of bronchospasm?

A

Persistant increased peak airway pressure

Wheezing

ETCO2 slowly increasing slope

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13
Q

What should you do during a bronchospasm emergency?

A

Call for help

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Examine patients chest for wheeze and air entry

Consider other differentials [aspiration, anaphylaxis, ARDS acute respiratory distress syndrome]

Deepen anaesthesia with sevoflurane

Use neuromuscular blocker and consider intubating if LMA

Start drug treatments

Review and adjust ventilator settings [volume control]

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14
Q

What drugs are given during bronchospasm?

A

Salbutamol inhaled 8-12 puffs

Salbutamol IV bolus 250mcg [100mcg/ml]

Magnesium

Adrenalin

ketamine

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15
Q

What are some additional steps to consider during a bronchospasm?

A

ICU review and advice

If concerned about aspiration pass suction catheter down ETT

If haemodynamically unstable may have tension pneumothorax, gas trapping or anaphylaxis

Arterial line and serial ABG’s

Chest X-ray / scan

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16
Q

What are the signs of Cardiac Arrest – asystole / PEA?

A

Non-shockable pulseless cardiac arrest

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17
Q

What should you do in the event of an asystole / PEA?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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18
Q

What drug do you give for an adult cardiac arrest?

A

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

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19
Q

What are the 4 H’s of a cardiac arrest cause stand for?

A

Hypovolemia/ Haemorrhage

Hypoxia

Hyper/hypokalaemia / metabolic disorders

Hyper/hypothermia

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20
Q

What are the 4 T’s of a cardiac arrest cause stand for?

A

Tension pnumothorax

Tamponade

Thrombosis – pulmonary, coronary, air, fat

Toxins [beta blocker, Ca2+ channel blocker, local anaesthetic, drug error]

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21
Q

How do you treat hyperkalaemia?

A

Sodium bicarbonate

Insulin actrapid

Calcium chloride

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22
Q

What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA

A

Adrenaline 0.01mg/kg of the 0.1mg/ml concentration

Max dose 1mg

Repeat every 3-5 minutes

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23
Q

What are the steps to take during a Cardiac arrest VF / VT

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Defibrillate at 200J then recommence CPR

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

After 3rd cycle consider giving amiodarone 300mg IV

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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24
Q

What are the Defibrillator Instructions?

A

Attach defibrillator pads to patient in the appropriate way

Select energy 200J and press charge

Once charged stop CPR and assess rhythm

If shock advised ensure all staff stand clear of bed

Pressure shock and immediately restart CPR

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25
Q

What are the non-shockable rhythms?

A

Asystole/PEA

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26
Q

What are the shockable rhythms?

A

VF / VT

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27
Q

What are the Starting steps to take with an unanticipated difficult airway?

A

Call for help and the difficult intubation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Use Vortex approach

Ensure good neuromuscular relaxation and consider TIVA

One person to watch oxygen saturation, declare if <90%

Ask hands off leader to count and say airway attempts

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28
Q

What are the get ready for CICO steps in an uninticpated difficult airway?

A

Open FONA [front of neck access] kit on the side of the anaesthesia machine for scalpel and or needle technique

Contact ENT senior surgeon to help

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29
Q

What are the steps to take during a CICO event during an unanticipated difficult airway?

A

Declare CICO if oxygen saturations <90% or rapidly falling and all 3 lifeline best effort attempts not successful

Options are WAKE UP or FONA

For wake up ensure muscle relaxant reversal is complete

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30
Q

What are the signs of an unanticipated difficult airway?

A

Unsuccessful intubation and oxygenation attempts under optimized conditions

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31
Q

What are the initial steps should you take during a haemorrhage?

A

Call for help and ask for blood warmer or rapid infuser +/- cell saver

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and consider reducing anaesthesia depth

Confirm source control attempted by surgeon ask if help is needed

Get large bore IV access x 2

Give fluid bolus and vasopressors to maintain organ perfusion

Blood request

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32
Q

What are the signs of High airway pressures?

A

Persistant increased peak airway pressure >40cmH20

Hypoxaemia

Inadequate ventilation

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33
Q

What steps should you take during a high airway pressure event?

A

Call for help and ask surgeons to stop stimulation

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Consider TIVA

Exclude ligh anaesthesia or inadequate relaxation

Switch to manual ventilation

Disconnect LMA/ETT from circuit and squeeze bag to assess if the problem is with the airway, breathing or circuit

If pressure is normal now problem is with the airway or breathing

If pressure is still raised problem is with the circuit

Ensure HME filter checked/excluded

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34
Q

What steps should you take if its an airway problem during a high airway pressure event?

A

Review position, check patency by passing suction catheter, consider change of device

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35
Q

What steps should you take if it’s a breathing problem during a high airway pressure event?

A

Review cause by examination

Listen to chest

Consider ultrasound or chest X-ray

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36
Q

What steps should you take if it’s a circuit problem during a high airway pressure event?

A

Ventilate with AMBU bag

TIVA

Review circuit

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37
Q

What common problems could cause a circuit to create high airway pressures?

A

Blocked HME filter

Water in circuit

Kinked/compressed

Valves sticky

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38
Q

What can cause airway or breathing problems?

A

Anaphylaxis

Aspiration

Abnormal anatomy

Bronchospasm

Blocked or displaced LMA/ETT

Inadequate depth of anaesthesia

Inadequate muscle relaxation

Malignant hyperthermia

Pneumothorax

Pulmonary oedema

atelectasis

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39
Q

What is atelectasis?

A

The collapse of part or all a lung

Caused by a blockage of the air passages [bronchus or bronchioles]

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40
Q

What are the signs of hypotension?

A

Unexplained drop in blood pressure refractory to initial treatment

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41
Q

Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}

A

It extends the shelf life of RBC up to 42 days of increased functional viability

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42
Q

What steps should you take during a hypotension emergency?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and consider reducing the anaesthesia depth

Check pulse, BP, ECG and equipment

If Bradycardia, Tachycardia or Cardiac Arrest see specific checklist

Open IV / Pressurised fluid bolus / consider blood products

Optimize venous return with Trendelenburg positioning / low PEEP

Vasopressor treatment

Mild hypotension - phenylephrine, ephedrine, metaraminol

Severe / refractory – adrenaline, noradrenaline or vasopressin

Identify cause of hypotension

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43
Q

What additional steps should be taken during a hypotension emergency?

A

Arterial line
CVC
ABG

Hourly urine output monitoring

Consider echo

Referral to ICU

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44
Q

What surgical events can cause a hypotension emergency?

A

Mechanical / surgical manipulation

Insufflation during laparoscopy

Retraction and vagal stimulation

Vascular compression

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45
Q

Can sepsis cause a hypotension emergency event?

A

Yes

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46
Q

What are the signs of hypoxia?

A

Low oxygen saturation <92% or cyanosis

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47
Q

What should you do during a hypoxia emergency?

A

Call for help

Identify a hands-off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Confirm ETCO2 capnography and morphology

Confirm pulse oximeter position and patient colour

Hand ventilate and assess patient / circuit

Check;

Airway – Examine device +/- suction tube, laryngoscopy

Breathing – chest sounds, movement and lung compliance

Circulation – blood pressure, pulse and rhythm

Circuit – HME filter, tubing, one-way valves, anaesthesia machine

Depth and relaxation

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48
Q

What are the signs of laryngospasm?

A

Sustained closure of the vocal cords resulting I the partial or complete loss of the patients airway

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49
Q

What steps should you take during a laryngospasm emergency?

A

Call for help

Identify a hands off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Stop any stimulation

If has LMA remove and clear airway using suction if needed

Apply mask, jaw thrust and CPAP 30Cm H20

+/- Oropharyngeal airway

Deeping anaesthesia using propofol

Relaxation using IV suxamethonium

Plan to intubate if sats are <92%

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50
Q

Can laryngospasm break with sufficient time and hypoxia?

A

yes

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51
Q

Does ongoing laryngospasm increase the risk of negative pressure pulmonary oedema, bradycardia, cardiac arrest and aspiration?

A

yes

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52
Q

What is the intubation dose of propofol for adults?

A

1-2mg/kg

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53
Q

What is the intubation dose for suxamethonium IV?

A

2mg/kg

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54
Q

What is the intubation dose for suxamethonium IM?

A

4mg/kg

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55
Q

How much propofol do you give to break a laryngospasm event?

A

20% of an induction dose 0.25-0.5mg/kg

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56
Q

What are the signs of local anaesthetic toxicity?

A

Sudden alteration in mental status

Tonic clonic seizure

Arrhythmias or cardiovascular collapse

Sinus bradycardia

Conductional blocks

Asystole

Ventricular tacharrthymias

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57
Q

What’s steps should you take for a local anaesthetic toxicity emergency event?

A

Stop giving the local anaesthetic

Call for help and the resuscitation trolley and intralipid

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Assess airway, breathing, circulation and treat accordingly

If haemodynamically unstable consider intralipid

Hyperventilation may be helpful

Treat seizures with propofol

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58
Q

What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?

A

1.5mg/kg over 1 minute [100ml for 70kg]

If remains unstable Repeat 2 more doses at 5-minute intervals max

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59
Q

What is the infusion dose of 20% intralipid?

A

15ml/kg/hr [1000ml/hr for 70kg]

If remains unstable double infusion rate

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60
Q

Is propofol a substitute for intralipid?

A

No

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61
Q

What can trigger a Malignant Hyperthermia?

A

Volatile anaesthetic agents

Suxamethonium

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62
Q

What are the signs for malignant hyperthermia?

A

Unexpected increase in ETCO2

Unexplained tachycardia

Unexplained tachypnoea

Arrhythmias

Prolonged masseter muscle spasm after suxamethonium

Hyperthermia is a late sign

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63
Q

What steps should you take during a Malignant hyperthermia emergency?

A

Call for help and the MH box / Trolley

Identify a hands off leader and delegate roles

Remove precipants

Stop volatile anaesthesia and start TIVA

Hyperventilate with 100% oxygen at high flow of 15L/min

Consider changing soda lime if quick and easy

Do not waste time changing the circuit, machine or filter if event is actively happening

Start dantrolene

Obtain and continue with the MH box cards

64
Q

What are additional consideration steps to take during a MH event?

A

IV access, central line, arterial line

Blood tests every 30 minutes

Temperature probe and commence active cooling

Catheter – urine output aim should be 2ml/kg/hr

Discuss with ICU

65
Q

How do you prepare the dantrolene?

A

20mg vial mixed with 60mls sterile water

66
Q

What is the bolus dose of dantrolene?

A

2.5mg/kg [60kg = 8 vials]

67
Q

How long after immediate treatment of dantrolene should you consider giving another repeat bolus?

A

10 minutes if still symptomatic

68
Q

How does dantrolene work?

A

Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells

preventing electrical impulses traveling to muscles and preventing muscle contractions

69
Q

What complications can MH cause?

A

Acidosis – treat with hyperventilation, sodium bicarbonate

Arrhythmias

Disseminated intravascular coagulation [DIC] -abnormal blood clotting

Hyperkalaemia – high potassium levels in blood

Hyperthermia – cold fluids, ice

Hypotension – fluid bolus, vasopressor

Cardiovascular collapse and cardiac arrest

70
Q

What are the signs of unstable tachycardia?

A

Shock

Syncope – loss of consciousness

Severe heart failure

Myocardial ischaemia [obstructed blood flow to heart]

Altered mental status

Heart Rate > 150 BPM

Mean arterial pressure <65

71
Q

What are the signs of stable tachycardia?

A

Mean arterial pressure >65 and no adverse features

72
Q

What steps should you take with a tachycardia emergency?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Stop surgery and perform DRABCDE review

Identify any reversible causes and tailor treatment to patient

73
Q

What steps should you take with an unstable tachycardia emergency?

A

If conscious use gentle sedation

Cardioversion with synchronised shock

Review rhythm and confirm cardiac output

If problem persists repeat cardioversion up to 3 times

Amiodarone 300mg IV over 10-20 minutes

74
Q

What steps should you take with a stable tachycardia emergency?

A

Review rhythm and check underlying causes

Arterial line and bloods

Consider drug treatment

Seek expert help from cardiology or ICU

75
Q

How to set up a cardioversion with synchronised shock

A

Apply pads and select DEFIB

Select 50-150J energy

Press SYNC button

Check SYNC success – confirm marking ^ on R waves

Charge and deliver shock safely

If synchronisation not possible use high energy unsynchronised shocks

76
Q

What is SVT?

A

Supraventricular tachycardia

77
Q

What is PEA?

A

Pulseless electrical activity

78
Q

When is amiodarone given and what dose?

A

After third shock for VF and VT that is unresponsive to shock delivery, CPR and vasopressor

300mg

79
Q

How can you raise concerns of ideas during the crisis?

A

Your input may be crucial

Probe – make observation or ask clarifying question

Alert – suggest problem and offer possible alternative

Challenge – address person using their name, directly question plan or decision

Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient

80
Q

What should your checks be during any crisis?

A

Oxygen delivery FiO2, FGF, bellows or bag moving

Airway – ETT or LMA patent

Breathing – Sats ETCO2 waveform, tidal volumes and rate

Circulation – Rate, rhythm, ischaemia, BP, Peripheries

Depth – MAC or TIVA value, BIS or entropy

Surgery – ask how is the operation going? Review blood loss

81
Q

What does BCIS stand for?

A

Bone cement implantation syndrome

82
Q

What are the patient signs of BCIS?

A

Hypoxia

Hypotension

Or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion

83
Q

True or False: a small current may be sufficient to induce ventricular fibrillation

A

True

84
Q

True or false: macro shock cannot cause ventricular fibrillation

A

False

85
Q

What is the adult cardiac arrest adrenaline dose? Include units

A

1mg

86
Q

What is the adult anapahylaxis adrenaline dose? Include units

A

0.5mg

87
Q

What is the paediatric cardiac arrest adrenaline dose? mcg/kg

A

10 mcg/kg

88
Q

What is the paediatric amiodarone cardiac arrest dose? mg/kg

A

5 mg/kg

89
Q

What is the energy dose for paediatric defibrillation? J/kg

A

4 J/Kg

90
Q

What is the energy dose for adult defibrillation?

A

200J

91
Q

What is the intralipid bolus dose in ml/kg?

A

1.5ml/kg

92
Q

Which emergency causes tachycardia, hypotension, urticaria and bronchospasm?

A

Anaphylaxis

93
Q

Which emergency causes visual disturbances, confusion, bradycardia and hypotension?

A

Local toxicity

94
Q

What emergency causes tachycardia, tachypnoea, hypotension, and hyperkalaemia?

A

Malignant hyperthermia

95
Q

Which medication can be used to increase potassium uptake in malignant hyperthermia, reducing hyperkalaemia?

A

Insulin

96
Q

Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?

A

Sodium Bicarbonate

97
Q

True or false – nitrous oxide is a triggering agent for malignant hyperthermia

A

False

98
Q

Which blood test is used to confirm anaphylaxis after the incident?

A

Tryptase

99
Q

When should tryptase be taken after an anaphylaxis event?

A - Immediately and after 24 hours

B- 1 hour, 4 hours and 24 hours

C - Immediately, 2 hours and 6 hours

D - When I can be bothered doing a blood gas

A

B

100
Q

MTP box 1 contains what?

A) 4 RBC, 4 FFP

B) 2 RBC, 2 FFP

C) 4 RBC, 4 FFP, 3 Cryo

D) 4 RBC, 4 FFP, 1 Platelets

A

B

101
Q

MTP box 2 contains what?

A - 4 RBC, 4 FFP, 3 Cryo

B - 2 RBC, 2 FFP

C - 4 RBC, 4 FFP, 1 Platelets

D - 4 RBC, 4 FFP

A

A

102
Q

MTP box 3 contains what?

A 2 RBC, 2 FFP

B 4 RBC, 4 FFP, 1 Platelets

C 4 RBC, 4 FFP, 3 Cryo

D 4 RBC, 4 FFP, 1 Cryo

A

B 4 RBC, 4 FFP, 1 Platelets

103
Q

Which boxes are repeated in an MTP?

A - 1 & 2

B - 3 & 4

C - 1 & 4

D - 2 & 4

A

B

104
Q

What does DRSABCD stand for?

A

Check for DANGER

Check for a RESPONSE

SEND for help

Check the AIRWAY

Check for BREATHING

Start CPR

DEFIBRILLATION

105
Q

Continuous Positive Airway Pressure, Propofol and Suxamethonium is textbook treatment for what emergency?

A - Bronchospasm

B - Laryngospasm

C - Difficult intubation

D - Anaphylaxis

A

B

106
Q

Bronchospasm may be treated with:

A -Salbutamol via ETT or IV

B - Adrenaline

C - Volatile anaesthetics (increased MAC)

D - All the above

A

D

107
Q

Five common causes of anaphylaxis?

A

Latex

Colloid

Antibiotics

Muscle relaxant

Chlorhexidine

Patient blue

sugamadex -[likelihood appears to be dose-related]

108
Q

What are 5 symptoms of anaphylaxis?

A

Difficult/noisy breathing

Wheeze/Persistent cough

Swelling of the face and tongue

Swelling/tightness in the throat

Difficulty talking

Persistent dizziness/ loss of consciousness

Abdominal pain and vomiting

Hives, welt and body redness/rash

Hypotension

109
Q

What are the signs and symptoms of Local Anaesthetic Toxicity?

A

Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness

Convulsions and loss of consciousness

Hypotension, bradycardia, and respiratory arrest

110
Q

What are the early signs and symaptoms of Malignant hyperthermia?

A

Prolonged muscle spasm after Suxamethonium

Tachycardia

Tachypnoea in a spontaneous breathing patient

Increased CO2

Cardiac arrhythmias

111
Q

What are the Developing Signs and Symptoms of Malignant hyperthermia?

A

Rapid increase in temperature (0.5 degrees every 15 minutes)

Respiratory and metabolic acidosis

Hyperkalaemia

Profuse sweating

Decrease SpO2

Mottled skin

Cardiac instability

Muscular rigidity

112
Q

What are the Late Signs and Symptoms of Malignant hyperthermia?

A

Cola coloured urine

Increase CK serum

Coagulopathy

Severe muscle ache

Cardiac Arrest

113
Q

What does TACO stand for and what is it?

A

Transfusion Related Circulatory Overload

Pulmonary oedema primarily caused by volume excess

Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.

114
Q

What does TRALI stand for and what is it?

A

Transfusion Related Acute Lung Injury

Repaid onset of excess fluid in the lungs.

Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest

115
Q

What is Acute Haemolytic Transfusion Reaction

AHTR

A

A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)

116
Q

What is ROSC?

A

Return of spontaneous circulation

Generally detected by arterial pulse palpation and end tidal CO2 monitoring

117
Q

What is the flow rate of a 14g cannula?

A

Just gravity - 250ml/min

Pressurized – 380ml/min

118
Q

What is the flow rate of a RIC line?

A

1000ml/min

119
Q

What is the normal heart rate range for a child?

A

70-160 BPM

120
Q

Discuss the immediate management of an airway fire;

A

Stop laser immediately

Turn O2 off

Call for help

Establish a hands-off team leader and delegate roles

Use saline swabs to put out fire

Get the fire extinguisher and fire blanket and attempt to extinguish the fire

Turn off medical gases and disconnect ventilator

Remove ETT and remove flammable material from airway

Pour saline into airway

After fire extinguished re-establish tube and reintubate and reestablish ventilation

Using AMBU bag with room air

Assess airway for injury

Emergency tracheostomy if intubation failed

121
Q

Give 5 reasons why a women would require an emergency LSCS

A

Prolonged labour

Foetal distress

Cord prolapses

Exhaustion

Placenta problem

122
Q

Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;

A

3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells

This can lead to problems such as oedema, reduced cardiac output and hypotension

3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids

123
Q

Define vasovagal;

A

Over activity of the vagus nerve resulting to a temporary fall in blood pressure, heart rate, fainting

124
Q

Discuss first degree burn;

A

Effect the outer layer of skin – superficial

125
Q

Discuss second degree burn;

A

Involves the epidermis and part of the lower layer of skin - dermis

126
Q

Discuss third degree burn;

A

Destroys the epidermis and dermis

This may go into the subcutaneous tissue

127
Q

Discuss fourth degree burn;

A

Go through both layers of skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone

128
Q

Explain the rule of nines and how it is used to estimate the extent of a burn’s injury;

A

Dividing the bodies surface area into percentages to calculate the extent of the burns injury

Front + back of head and neck = 9%

Front + back of each arm = 9%

Chest = 9%

Stomach = 9%

Upper back = 9%

Lowerback = 9%

Front and back of each leg and foot 9% each side

Genital area = 1%

129
Q

Explain common complications associated with burns surgery;

A

Blood loss – debrided tissue bleeds freely

Hypothermia

Infection

Breathing problems

Fluid loss

Difficult placement of monitoring and IV

130
Q

Define ACVPU;

A

Alert

Confusion [new onset or worsening] confusion

Voice

Pain

Unresponsive

131
Q

Define GCS;

A

Glasgow coma scale

132
Q

What are the 3 consciousness ratings of the Glasgow coma scale?

A

Severe - 3-8

Moderate - 9 - 12

Mild - 13-15

133
Q

What are the 3 assessments for the Glasgow coma scale?

A

Eye opening
Spontaneous – 4
To sound – 3
To pressure – 2
None - 1

Verbal response
Orientated – 5
Confused – 4
Words – 3
Sounds – 2
None - 1

Motor response
Obey commands -6
Localising - 5
Normal flexion - 4
Abnormal flexion - 3
Extension - 2
None - 1

134
Q

State normal range of an ICP measurement;

A

5-12mmHg

135
Q

Normal CBP pressure range

A

8-12mmHg

136
Q

State the relationship between CSF, CBF and ICP;

A

CSF, CBF, ICP are constant so an increase in one should cause a reciprocal decrease in one both remaining two

Vice versa

137
Q

Briefly explain the relationship between CPP/MAP and ICP

A

Cerebral perfusion pressure is the effective pressure that results in blood flow to the brain

CPP = Mean Arterial Pressure – Intracranial Pressure

138
Q

Define CPP;

A

Cerebral perfusion pressure

139
Q

Explain Cushing’s triad;

A

Refers to a set of signs that are indicative of increased intracranial pressure

Consists of bradycardia

Irregular respirations

Widened pulse pressure

Increase between systolic and diastolic pressure

140
Q

What is the normal range for CO2?

A

35-45 mmHg

141
Q

Define AHTR

A

Acute haemolytic transfusion reaction

142
Q

Is this arterial waveform normal, under or over damped?

A

Normal

143
Q

Is this arterial waveform normal, under or over damped? And what can cause it?

A

Overdamped

Loose connections

Air bubbles

Kinks

Clots

Spasms

No volume or low pressure in pressure bag and tubing

144
Q

Is this arterial waveform normal, under or over damped?

A

Underdamped

Increased vascular resistance

Hypothermia

tachycardia

Excessive movement of the catheter within the artery leading to false high systolic or a false low diastrolic pressure

145
Q

What is this capnography trace?

A

Oesophagus intubation

Low level ETCO2 that quickly tapers off

146
Q

What is this capnography trace?

A

CPR

147
Q

What is this capnography trace?

A

ROSC

Return of spontaneous circulation

148
Q

What is this capnography trace?

A

Airway obstruction or apnoea

Interrupted breaths

149
Q

What is this ECG trace?

A

Sinus Arrhythmia

150
Q

What is this ECG trace?

A

Normal sinus Rhythm

151
Q

What is this ECG trace?

A

Sinus tachycardia

152
Q

What is this ECG trace?

A

Sinus bradycardia

153
Q

What is this ECG trace?

A

Paroxysmal supraventricular tachycardia PSVT

Rate changes abruptly and unexpectedly

154
Q

What is this ECG trace?

A

Ventricular tachycardia

155
Q

What is this ECG trace?

A

Ventricular Fibrillation

156
Q

What is this ECG trace?

A

asystole

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