Acute Care and Anaesthetics Flashcards
(64 cards)
Where is the needle inserted in an emergency pleural decompression?
Second intercostal space, mid-clavicular line
What is a recognised risk of epidural in labour?
Headache
On admission to A&E, the patient is aggressive, using inappropriate words, localising to a painful stimulus, and opening their eyes to voice. What is the GCS score?
11
Which drug is administered when patients become unresponsive, snoring and hypoxic on a benzodiazepine?
Flumazenil
Which of the following medication is most important to stop in the days prior to surgery?
A- amlodipine
B- clopidogrel
C - metformin
D - simvastatin
E - salbutamol inhaler
B - clopidogrel (antiplatelet)
A 20-year-old male returns from theatre following a laparoscopic appendicectomy. He has no other medical history. He is drowsy following anaesthesia and not managed to eat or drink yet. Estimated blood loss was 100ml. He had 500ml 0.9% saline administered in theatre.
What is the most appropriate fluid regimen for this patient?
A. IV 500ml 0.9% saline stat
B. IV 0.9% saline 500ml with 40mmol/L K+ at 100ml/hr
C. IV 5% dextrose 500ml at 83ml/hr
D. IV 0.9% saline 500ml at 100ml/hr
E. IV 5% albumin 500ml over 125ml/hr
D - IV 0.9% saline 500ml at 100ml/hr
A 78-year-old man collapsed on a medical ward. He is found to be in cardiac arrest. There is blood on the floor and around his head. You’re the FY1 on the ward and first doctor on scene. Nurses are doing CPR and ask you to manage his airways while the rest of the arrest team arrives.
What is an appropriate action to do?
A - Insert a laryngeal mask airway and attempt to ventilate the patient
B - Hand ventilate with an ambu-bag
C - Open his airway with a head tilt and chin lift and apply 15L oxygen
D - Attempt to intubate the patient
E - Avoid inserting an oropharyngeal airway as he might have a head injury
A - Insert a laryngeal mask airway and attempt to ventilate the patient
A 70-year-old man collapsed suddenly following a myocardial infarction. He has no pulse, no breathing effort and is unresponsive. No bystander CPR is performed. What would the ABG likely demonstrate?
A mixed respiratory and metabolic acidosis
What is the most appropriate immediate treatment of anaphylaxis in an adult?
Intramuscular adrenaline, 0.5mg
A 48-year-old woman is 18 hours post hysterectomy and bilateral salpingoopherectomy for ovarian cancer. She had a general anaesthesia and a spinal anaesthetic with 1mg of intrathecal diamorphine. She has a morphine PCA for post-op analgesia. On nursing review, she is drowsy, difficult to rouse and with a respiratory rate of 5 breaths per minutes.
What is an appropriate treatment option? 1 vial naloxone = 400 micrograms
A - Refer to ICU for intubation and ventilation
B - 400 micrograms bolus of naloxone and reassess
C - 40 micrograms increments of naloxone titrated to effect
D - 4mg bolus of naloxone and reassess
E - 2222 call for a medical emergency
C - 40 micrograms increments of naloxone titrated to effect
How do you choose the size of an oropharyngeal airway?
Measure between the patient’s incisor teeth and the angle of the mandible.
Order the cannulas from biggest to smallest
Orange
Grey
Green
Pink
Blue
What blood tests are useful in an acute situation?
FBC
U&Es
Blood glucose
What fluid do you give in hypotensive patients with no history or signs of bleeding?
500ml 0.9% Saline
What monitoring should be use in the assessment of circulation?
ECG
Blood pressure
What is the pupillary response consistent with a 3rd nerve palsy?
One large pupil, both reactive
What is the pupillary response consistent with a raised ICP?
One large pupil, both reactive
What is the pupillary response consistent with Horner’s syndrome?
One small pupil, both reactive
What is the pupillary response consistent with atropine medication?
Unreactive, dilated pupils
What is the pupillary response consistent with brain stem death?
Unreactive, dilated pupils
What is the pupillary response consistent with opioid overdose?
Bilateral pin point pupils, both reactive
What do you test for in disability?
ACVPU
Pupillary response
Glucose
How is hypoglycaemia treated in ABCDE?
100mI of 10% Glucose/Dextrose
What is assessed in exposure (E)?
Temperature
Assess for any obvious injuries
