Acute care

Question 1

GCS: Eye opening

Answer 1

Out of 4

Opens spontaneously = 4
Opens to command = 3
Opens to pain = 2
No response = 1

Question 2

GCS: Verbal response

Answer 2

Out of 5

Orientated and talking = 5
Confused and disorientated = 4
Words = 3 
Sounds = 2 
No response = 1

Question 3

GCS: Motor response

Answer 3

Out of 6

Obeys commands = 6 
Localizes to pain = 5 (above clavicle) 
Withdrawal from pain = 4 (across midline but below clavicle)
Abnormal flexion to pain = 3 
Extension to pain = 2
No response = 1

Question 4

Cushing’s reflex:

Answer 4

Hypertension (widening pulse pressure) + bradycardia + irregular breathing

Question 5

Acute care guidelines:

Adult anaphylaxis:

Answer 5

Adrenaline 0.5 ml 1:1000 IM

No longer in guidelines
Hydrocortisone: 200 mg slow IV
Chlorphenamine: 10 mg slow IV

Question 6

In anaphylaxis how often can adrenaline be given

Answer 6

Every 5 minutes

Question 7

Adrenaline dose by age
< 6m
6m-6 yrs
6-12 yrs
adults (>12 yrs)

Answer 7

100-150 mcg
150 mcg
300 mcg
500 mcg

Question 8

Refractory anaphylaxis tx.

continued deterioration despite 2 doses of IM adrenaline

Answer 8

IV adrenaline

Question 9

Bradycardia mx.

Answer 9

500 mcg IV ATROPINE
repeat up to 3 mg. (6 cycles)

Then transcutaneous pacing if required
Isoprenaline/adrenaline infusion titrated to response

Then transvenous pacing

Question 10

Broad complex tachycardia :

Answer 10

IF haemodynamically unstable: shock

if not: Amiodarone 300 mg

Question 11

Narrow complex tachycardia:

Answer 11

Vagal manoeuvres

IV adenosine - 6 mg -> 12 mg -> 18 mg

Question 12

Adenosine is contraindicated in:

Answer 12

Asthma

Give Verapamil instead

Question 13

Adrenaline cardiac arrest dose:

Answer 13

10 ml

1: 10000 IV

Question 14

What to give after 3 DC shocks

Answer 14

Amiodarone 300mg

Question 15

Shock lactate level:

Answer 15

> 2.2

Question 16

Cardiogenic shock compensation

Answer 16

Increased HR

peripheral vasoconstriction

Question 17

Shock w/ vasodilation:

Answer 17

Distributive (septic) shock

Question 18

Anaphylactoid reaction to N-acetyl cysteine mx.

Answer 18

Stop infusion, restart at a lower rate

Question 19

When should acetyl cysteine be given in paracetamol overdose:

Answer 19

staggered overdose or doubt over time of paracetamol overdose

Plasma concentration is above the treatment line -> 100 mg/L at 4 hours
15mg/L at 15 hours

Question 20

How long is N-acetyl cysteine infused over:

Answer 20

1 hour

Question 21

Arterial pH for liver transplantation in paracetamol overdose:

Answer 21

< 7.3 -> 24 hours after ingestion

Question 22

Other factors which together could result in liver transplant in paracetamol overdose:

Answer 22

PT > 100 seconds
Cr > 300 umol
Grade III or IV encephalopathy

Question 23

BZP overdose
symptoms:
treatment:

Answer 23

Ataxia
Dysarthria
Reduced/LOC

Flumazenil

Question 24

Aspirin OD:

Answer 24

Supportive -> Bicarbonate

Question 25

TCA overdose:

Answer 25

Supportive -> Bicarbonate infusion

Question 26

Antifreeze OD:

Answer 26

Fomepizole

Question 27

ACEi: When to stop before surgery

Answer 27

24 hours before

Question 28

Warfarin: when to stop before surgery:

Answer 28

5 days before

Question 29

LMWH stopped when before surgery:

Answer 29

24 hours before

Question 30

Anti-platelet drugs when to stop before surgery:

Answer 30

7 days before

Question 31

Only cardio drug to be stopped in the peri-operative period

Answer 31

ACEi

Question 32

When warfarin is stopped five days before surgery - what is given to high risk patients:

Answer 32

LMWH to bridge gap

Question 33

What component must be on intubation device to ensure protection of airway

Answer 33

CUFFED tube