A+E

Question 1

Where is a Jefferson #?

Answer 1

C1#

Question 2

Hangman #?

Answer 2

C2 axis # - hyperextension injures brainstem

Question 3

which part of the spine is a flexion teardrop #?

What causes this #?

Answer 3

C spine

caused by extreme hyperextension of neck

Question 4

what type of fracture can be caused by axial loading of the head?

Answer 4

Burst fracture

Question 5

when to CT head: indications for <1hr

Answer 5

GCS < 13 on initial assessment
· GCS < 15 at 2 hours after injury on assessment in ED
· Suspected open or depressed skull fracture
· Any sign of basal skull fracture
· Post-traumatic seizure
· Focal neurological deficit
· >1 episode of vomiting since the head injury

Question 6

indications for CT<8hours:

Answer 6

Age > 65 years
· Hx bleeding or clotting disorder
· Dangerous mechanism of injury (RTC or fall > than 1 metre/5 stairs)
· >30mins retrograde amnesia of events immediately before the head injury

Question 7

what shape bleed in CT of subdural haematoma?

Answer 7

crescentic shape - concave

crosses suture lines

Question 8

what shape in extradural haemorrhage on CT?

what can these head injuries lead to?

Answer 8

biconvex shape

can cause mass effect and herniation

Question 9

what haemorrhages are classically walk talk then die head injuries?

Answer 9

extradural

Question 10

what is air in cranium called?

Answer 10

pneumocephalus

Question 11

when to CT in trauma? (whole body)

Answer 11

polytrauma:-
haemodynamic instability 
mechanism of injury - >1 body part 
findings on FAST scan 
obvious severe injury

Question 12

anaphylaxis management:

Answer 12

IM adrenaline 500mcg
IV Hydrocortisone 200mg
IV chloramphenamine 10mg
1L Hartmanns

Question 13

Livedo Reticularis or “mottling” is caused by ?

Answer 13

reduced blood flow and oxygenation to the skin
(normal in kids)
in elderly -> sepsis/DIC

Question 14

PEA mx?

Answer 14

‘non-shockable’ rhythm – the treatment for this is CPR and adrenaline every 3-5 mins

Question 15

The Rule of Nines is one of the easiest ways to determine the percentage of skin affected by burns:

Answer 15

palm is 1% of the total body surface area

front of face and neck is 4.5%, the front of the chest is 9% and the whole left arm is 9%.

Question 16

Burns to his face and neck. Shallow breathing, a RR 45 and is making stridor like noises. Sats 95% on air. On closer inspection he has soot in his mouth and nose. Which two of interventions are appropriate?

Answer 16

senior anaesthetic review with view to early intubation

high flow o2 15L non-rebreath

Question 17

Indications for referral to a regional burns unit?

Answer 17

> 10% TBSA
burns over major joints
pregnant patient
chemical or electrical burns

Question 18

emergency first aid advice for burns (eg arm boiling water)?

Answer 18

20 mins under cold water

wrap in cling film after

Question 19

4yo burn on arm. analgesia?

Answer 19

PO paracetamol, ibuprofen

Question 20

The burn is described as painful and sensitive to touch. It is erythematous and wet with blistered areas. How would you describe the depth of the burn?

Answer 20

partial thickness

Question 21

how should burn with blisters be managed after initial first aid?

Answer 21

deroof blisters
dress with non-adherent dressing
review in clinic 48h

Question 22

Some patients with COPD will retain CO₂. why>

Answer 22

Increased VQ mismatch

The Haldane effect - deoxygenated haemoglobin binds to CO₂ with greater affinity than oxygenated haemoglobin

Question 23

Active bleeding point visualised on the nasal septum in the right nostril. The bleeding has not stopped despite firm pressure for 15 minutes. Which one is the next appropriate management?

Answer 23

Silver nitrate cauterisation

Question 24

if silver nitrate hasn’t controlled the epistaxis - what mx next?

Answer 24

rapid rhino into each nostril

24h

Question 25

At the end of the 21 hour NAC infusion, you must re-check the INR, plasma creatinine, venous pH or plasma bicarbonate and ALT. If all blood results meet the following criteria:

Answer 25

INR is 1.3 or less AND
ALT is less than two times the upper limit of normal AND
ALT is not more than double the admission measurement

Question 26

TCA OD: antidote?

Answer 26

Na bicarbonate