1st random 100 Flashcards
In TBI what is associated with poor outcomes?
Hypotension
Hypoxia
Poor jugular vein drainage
Spiking ICP
Hypertension
In capnography what do the angles represent and how might the change in a COPD patient?
alpha:
Beta:
Alpha: This represents the transition from dead space emptying to alveolar gas. This is often less pronounced in COPD due to uneven alveoli emptying and increased ETCO2.
Beta: This represents the transition from expiration to inspiration and often hyper angulated in COPD due to the increase in ETCO2 and the high levels that we see.
What are the strengths and weaknesses of Video laryngoscope?
Strengths:
- Ability to perform both DL and VL.
- Ability to audit.
- Others can see where you are at with obtaining a view (ELM).
- Great teaching aid
Weaknesses:
- Visual obstructions with white/pink out.
- May become obstructed in soiled airways.
- May forget to charge.
- Temperamental in extraem temperatures.
What presentations are we likely going to see with adrenal insufficiency?
Hypotension, Hyperpigmentation, Fatigue, Weight loss, Salt craving, Gastrointestinal, Abdo pain.
Will also see evidence of decreased aldosterone (hypoNa+ and hyperK+)
Anaerobic respiration is characterised by:
- absent beta oxygenation
- inability to access the citric acid cycle (Krebs cycle)
- low production of ATP
- over production of private which is converted to lactate.
What are the indications, contraindications and precautions of shoulder relocation?
Indications:
anterior Glenn-humeral dislocation, low energy.
Contraindications:
posterior Glenn-humeral dislocation, high energy injury, suspected clavicular or humeral #, acromio-clavicular dislocation.
Precautions:
large muscle masses, elderly, paediatrics, degenerative bone disease.
What is the dose of MgSO4 in pre-eclampsia?
20mmol
What is the MOA for fexofenadine and what is its primary role in allergies/anaphylaxis?
H1 (histamie)receptor antagonist which doesn’t cross the BBB.
It primarily has effects of preventing or treating urticria.
What are the length and weights for each IO needle?
Red)
Bleu)
Yellow)
Red) 3-39kg/15mm
Bleu) >20kg/25mm
Yellow) >40kg/45mm
when considering who would benefit from hospitalisation from a black spider bite?
≥ 4 hrs ago and no signs of funnel web sider bite, are unlikely to benefit from hospitalisation
what benefits does hydrocortisone have over prednisolone in adrenal insufficiency ?
hydrocortisone has greater minerocorticoid effects (increased K+ excretion). hydrocortisone was associated with less effects the liver but reduced control of oedema.
What is the risk of over oxygenation is some COPD patients?
increasing PAO2 is some aspects of diseased lung has the potential reverse hypoxic pulmonary vasoconstrictions. The vessels around these alveoli are filled with CO2 which would normally trickle into the vasculature. When the hypoxic vasoconstriction is reversed CO2 pools into the vasculature overwhelming gas exchange.
What is the significance of saturation on the R) hand in new borns?
Pre-ductal (before the ductus arteriosus) saturation give a fast reliable way of assessing lung function as blood travels straight from the left chamber to the R) subclavian
What is the risk of insulin therapy in DKA patients?
These patients often have a relative hyperK+ in the vasculature with a reduced k+ levels in the tissues. These patients have over the time of their disease progression excreted large amount of k+ through urine. The introduction of insulin will likely drive k+ into tissues with significant and rapid drop in k+ causing hypok+.
What is the MOA for benzodiazapines?
Potentates the effects of GABA increasing the influx of cl- ions hyperpolarising neurons.
What are the benifits/risks of fluid regiemes in trauma?
Prevention of coagulopathies through:
Maintaining perfusion
Haemodilution
Hypothermia
Hypercholoremic acidosis
why is it important to be overly cautious in reducing inferior shoulder dislocations with neuromuscular complications?
high likelihood of inferior dislocations (60% with axillary nerve impingement).
…..
Why is posterior glena-humeral shoulder dislocation reduced in hospital?
Injuries associated with Posterior dislocations include:
# tuberosity and humeral neck fractures, reverse Hill-Sachs lesions, and injuries to the labrum and rotator cuff.
Reduction in hospitable is important due to the forces that are likely required to reduce the shoulder.
What’s the risk of normal saline in the hypotensive pt with liver failure?
These patients have a large degree of hypoalbuminemia meaning that there is a significant reduction in oncotic pressure. Normal saline in these patients results in large fluid shifts as Na crosses into the tissue and fluid follows. These patients become oedematous quickly.
what are the considerations for prednisolone over hydrocortisone in Asthma?
Prednisolone has greater potency with high bioavailability when delivered orally. It also has an increased duration of action but is required to be taken orally.
You have a spinal patient who is presenting with hypertension and stroke like symptoms, what are your considerations?
this presents a difficult patient as GTN is contraindicated even if the cause of the stroke is from autonomic dysreflexia. Likewise the presentation of autonomic dysreflexia may present with similar signs of stroke.
What is the benefit of prednisolone over hydrocortisone in COPD?
The bioavaliability of prednisolone is 100% making it a more potent and effective gluccocortcoid steroid. It is also longer acting hence only the need to give it if patient haven’t had prednisolone within the last 24hrs.
Why might Ketamine be appropriate in prolonged seizures?
as seizures are prolonged GABA receptors/Cl- channels migrate within the cells meaning there is little action to be had. In the absence of being able to affect the resting membrane potential directly Ketamine may be able to reduce the excretory nature of the rapid depolarisation.
What is the starting Adrenaline dose for paediatrics in sepsis?
0.5microg/kg/min
ie 18kg pt would get 9 microg/min
adjusted dose is 0.1 microg/kg/min
ie 18kg pt would receive 1.8 microg/min
What is the MOA for atropine?
Muscirenic (ach) receptor antagonist => inhabiting of parasympathetic innervation at the sites of the SA and AV node.
What is the MOA in Droperidol for both nausea and agitation.
Nausea: D2 receptor antagonist acting in the CTZ to reduce stimulus.
Agitation: D2receptor antagonist in the brain, midbrain and brain stem. MOA is largely unknown.
What is the benefit of bougie and stylets in ETT?
Stylet:
- able to be bent to shape of airway.
- may be good in a low resource setting.
- able to be used in the heat when bougie/tube is floppy.
- able to be used in ETT < size 5.
Bougie:
- supported by literature.
- everyone is trained in this as a standard approach.
- able to oxygenate through it if stuck.
What is an adult IM dose of midazolam in agitation?
50 microg/kg up to a single Max dose 5 mg repeat up to a total max dose of 10mg.
What are your treatment options and considerations for each patient in wide comple tachycardia?
Fluid resuscitation
Amioderone (stable patient)
- caution in torsade due to risk of r on t.
- caution inhyperK+ and tricyclic overdose (qrs >200ms) due to Na+ channel effects of combined treatment.
Cardioversion (+/- midazolam)
what is the dose and considerations for Ketamine for sedations?
Dose: 25-50mg
Considerations:
Setting up for potential over (partial) sedation.
Team is prepped and roles allocated.
Patient is briefed about the process.
Patient is briefed about the potential dreams.
therapeutic dose and use of Midazolam/Fentanyl should also be considered. Pt’s will likely be traveling through multiple therapeutic ranges (disassociated, emergent and analgesic) during their time with you.
What is the MOA for ipratropium in bronchospasm?
Muscarenic (Ach) 3 receptor antagonist => inhibits intracellular messaging that contributes to mucus production and bronchospasm.
how often and to what extent do we see hypotension with paracetamol?
Most commonly seen in the septic patients and/or patient with large surface area’s (paeds), in these groups a drop of 5-15mmHg SBP may be seen in up to 20% of patients. This is thought to be related to the dulling of thermoregulation in these disease processes.
What is the MOA for adrenaline in the peripheral vasculature?
a1 receptor agonise => cAMP => increased intracellular Ca+ => increased myosin/actin interaction => peripheral vasoconstriction.
What are our checks for conformation of ETT placement?
- Visualisation
- Positive ETCO2
- Rise and fall of the chest
- Auscultation
- Misting in the tube
What is Neuroleptic malignant syndrome and pheochromocytoma and their relevance to practise?
Both are contraindications for the Droperidol administration.
Neuroleptic malignant syndrome: caused by antipsychotic agents and characterised by mental status change, rigidity, fever, and dysautonomia.
Pheochromocytoma (paradoxyal HTN):
adrenal gland tumour in the medulla characterised in fluctuating catecholamine release causing head aches, HTN and diaphoresis.
What is the role of bicarbonate?
H2O + CO2 = H2CO3 = HCO3 + H.
a constant state of flux occurs where carbon dioxide and free hydrogen ions are able to be buffered to ensure that pH is maintained.
What are the key components that cause a R) ward shift on the oxygen-haemaglobin disassociation curve? and what is it’s significance?
Factors:
increased temp
increased DGP
increased CO2
decreased pH
This results in reduced affinity for oxygen to haemoglobin (SpO2 drops faster and harder to re-establish)
In the dialysis renal patient, what piece of information may help drive your fluid regime?
These patients will likely know their urine out put and pre/post dialysis weight.
what are the preferred sites for IO access and what are two alternate sites which may be considered.
Primary sites:
proximal tibia and humeral head.
Alternate sites:
distal tibia and distal femur.
What is the likely occurrence and cause of a posterior Glenn-humeral dislocation and what will is look like?
Occurrence:<5%
Causes:
Seizures, outstretched arm with inward rotation forward falls.
Presentations:
bilateral dislocations, patient holds the arm in adduction and internal rotation, prominent coracoid process.
