Clinical skills Flashcards
(156 cards)
1
Q
What are the ABCDE of breathing
A
Airway and c spine
Breathing and oxygenation
Circulation and Defib and drugs
Disability [Neurostate]
Extremities
2
Q
What are the common physical causes of an airway obstruction 6
A
- Tongue
- Soft tissue swelling e.g. anaphylaxis
- Blood, secretions or vomit
- Foreign body
5 Direct injury to the airway - Laryngospasm
3
Q
Common infective causes of airway obstruction 4
A
- Retropharyngeal abscess
- Epiglottitis
3.Croup - Quinsy
4
Q
What are the contraindications for an airway maneuver
A
- Intact gag reflex
- Base of skull fracture
- Forgein body
- Cervical spine injury
5
Q
What should be done in the case of a cervical spine injury
A
Instead of the head-tilt chin lift a jaw thrust should be done
6
Q
How do you measure an OPA
A
One end reaches the angle of the jaw and the other the central incisors
7
Q
How to measure a nasopharyngeal airway
A
From the tip of the nose to the angle of the jaw
8
Q
What is the main indication for an nasopharyngeal tube insertion
A
This is a patient that has an upper airway obstruction e.g. enlarged tonsils
9
Q
What are the types of conditions that cause a failure to oxygenate 3
A
- Pneumonia
- PE
- Pulmonary edema
10
Q
What causes failures to ventilate 3
A
- Inadequate respiratory devices e.g. in a decreased level of consciousness
- Weak resp muscles
- Obstructions to chest expansion e.g. pneumothorax or a bronchospasm
11
Q
What is the treatment given to a patient that is wheezing
A
Subutamol
12
Q
What is the containdications for rescue breaths
A
If the patient has a DNR
13
Q
What are the risks to using a steroid inhaler
A
- Oral candidosis
- Mouth sores
- Hoarse voice
- Nose bleeds
14
Q
What is the indication for giving patients an oxygen delivery device
A
This is when they are ventilating well but remain hypoxic
15
Q
Why is it contraindicated to give chronic lung disease patients oxygen
A
It causes them to loose their hypoxic drive
16
Q
What is the FIO2 that is delivered by a nasal prong and what is the volume
A
24-40% and the volume is 1-6l and if above 4 it needs to be humidified
17
Q
What is the FiO2 of the simple face mask and the volume that is despenses
A
40-60% and 6-10l of volume
18
Q
What is the benefit of a venturi mask
A
It gives a specific FiO2 measure
19
Q
What does the blue and green venturi mean
A
Green is 60 and blue is 24%
20
Q
What is the indication for a venturi mask
A
Patients with chronic disease where you dont want their respiratory drive to decrease
21
Q
What is the indication for a partial rebreather mask and that is the FiO2 and the volume that it dispenses
A
It is used in cases of severe hypoxia and provides an FiO2 of 60-90% and a volume of 6-10l
22
Q
What is a non rebreather mask used for and what are the FiO2 and volume
A
This is used for short term severe hypoxia. 65-90% and can provide a volume of 10-15L
23
Q
What are the risks that are carried by nebulisation
A
- It causes areosilation of infective particles and so provides risk to HCW
- The nebulising fluids can cause side effects
24
Q
What is the mechanism of beta agonists and what is the type of receptor that they bind to
A
B2 receptor causing bronchial smooth muscle to relax and dilate
25
What is the mechanism of cation of Ipratropium Bromide
This causes relaxation of bronchial muscles due to its anticholinergic effects. Its bronchidilation effect is particularly effective in conjunction with B2 stimulants
26
What are the components of the AVPU score
1. A- Alert
2. V- Responds to voice
3. P- Responds to pain
4. U- Unresponsive to pain
27
What are the 3 components of the GCS
1. Eye response
2. Verbal response
3. Motor response
28
What are the 4 scores in the eye response of the GCS
1. No opening of the eyes
2. Open in response to pain
3. Open in response to speech
4. Opens spontaneously
29
What are the 5 possible scores in the verbal component of GCS
1. No verbal response
2. Incomprehensible sound
3. Inappropriate words
4. Confused
5. Oriented
30
What are the GCS components of motor component
1. No motor response
2. Extension due to pain
3. Abnormal Flexion due to pain
4. Withdrawal
5. Localises to pain
6. Obeys commands
31
When is a c spine immobilization not indicated 5
When all these are present:
1. There is a normal LOC
2. No spinal tenderness or anatomical abnromailies
3. No neurological findings
4. No distracting injuries
5. No intoxication
32
What are the Nexus rules to check if C spine imaging in necessary 5
1. No midline tenderness
2. No evidence of intoxication
3. Normal level of alertness
4. No neurological deficits
5. No distraction injuries
33
What are the canadian c spine rules
1. Patient is younger than 65
2. The patient is alert
3. No intoxication
4. No distracting injuries
5. It is not a high risk patient
6. Mechanism of injury was low risk
7. They have the ability to actively rotate the neck 45'
34
What is considered a brady in children and adults
Adults: Less than 50
Children: Less than 60
35
What is the treatment for a brady in adults
1mg Bolus of atropine this can be repeated 3 times
2-10ug of adrenaline can be given
36
Treatment for a brady in children
1. Chest compressions
2. Adrenaline 0.1ml/kg
3. Atropine 0.02mg/kg
37
What is considered a tach in children and adults
Children narrow complex: Above 180 and wide above 200
Adult a narrow or wide above 150
38
What is the treatment for a narrow complex tachy
1. Vagal stimulation
2. Adenosine 6mg rapiidly and then 12mg after 1 min
3. Amiodarone 150mg over 10 mins
39
Treatment for a wide complex tachycardia
Amiodarone 150mg over 10 mins
40
What are the 2 shockable rhythms
1. Vfib and V tach
41
What is the difference between a monophasic and a biphasic defibrillator
Monophasic: The current flows in one direction from one paddle to another
Biphasic: The current flows in one direction in the first phase and then after a predetermined time the current will flow in the oppisite direction to depolarise the myocardium that has already repolarised
42
What is a synctonsed cardioversion
This is when a small low energy shock is delivered in a specific part of the cardiac cycle
43
What are the setings used for a narrow tach both for the regular and the irregular
Regular: 50-100
Irregular: 120-200
44
What is the cardioversion setting used for a wide tachycardia both regular and irregular
Regular 100J
Irregular Unsynchronised defib
45
What does CSCATTT stand for in major incidence
C: Command and control
S: Safety
C: Communication
A: Assessment
T: Triage
T: Treatment
T: Transport
46
What are the areas of command around a schene
1. Bronze: This is where the actual incident occurred
2. Inner cordon: This is the barrier that separated the silver and the bronze zones
3. Silver: This is the tactical command area and the area where patients are triaged and contains the casualty clearing zone
4. Outer cordon: This is there area that is controlled by police that controls access to the general area
5. Gold area: This is the highest level of command and is generally outside of the area
47
What is the responsibility of the incident medical commander
They are the overall medical commander and act to liase with other agencies and the media
48
What is the function of the sector medical commander
They act as the managers of the bronze zone and function to coordinate the medical rescue operations
49
What is the function of the casualty clearing officer
This is the person that coordinates the secondary triage of patients after they have been removed from the bronze area
49
What is the function of the primary triage officer
They are incharge of primary triage of the patients and coordinate with the sector commander
50
What is the 123 of safety
1. Self: Make sure that it is safe for you to approach
2. Scene: Make sure that the scene is safe for you e.g. no hazards
3. Survivors: They need to be moved to a safe area
51
Which department is primarily responsible for decontamination
Fire department
52
How is information of a scheme given when you are the first to arrive
You need to provide a methane report:
M: My call sign
E: Exact location
T: Type of incident
H: Types of hazards
A: Access to the scene
N: Number of casualties
E: The emergency services that are present and what is required
53
Explain the triage sieve
1. Are they walking
2. Yes = Green
3. No = Are they breathing
4. No = Blue
5. Yes Resp rate less than 9 or over 30 = Red
6. Yes but between 10 and 29
7. Check the pulse rate
8. Above 120 = Red
9. Less than 120 = Yellow
54
What are the components of the triage sorting score
1. GCS
2. Resp rate
3. Systolic blood pressure
55
What are the categories for GCS in TSS
13-15 = 4
9-12 = 3
6-8 = 2
4-5 = 1
Less 3 = 0
56
What are the categories of resp rate in TSS
10-29 = 4
Above 30 = 3
6-9 = 2
1-5 = 1
0 = 0
57
What is the systolic blood pressure (Systolic) scaling in TSS
Above 90 = 4
76-89 = 3
50-75 = 2
1-49 = 1
0=0
58
What is the calculation of the TS score and what is the priority level
TSS= GCS + Resp rate + Systolic BP
12= Priority 3
11= Priority 2
Less than 10 = Priority 1
59
What is the time goal of the SATS scale
Red: Immediate care
Orange: 10 mins
Yellow: 60mins
Green: 4 hours
60
What is the AMPLE history
A: Allergies
M: Medications that the patient is taking
P: Past medical and surgical histories
L: Last meal
E: Events leading up to presentation
61
What is the differnence between an open and closed fracture
Open: The bone breaks the skin
Closed: The bone does not come into contact with the outside enviroment
62
What is meant by a pathological fracture
This occurs in a bone that has a disease process that weakens the bone e.g. malignancy
63
What is meant by a stress fracture
This is a fracture that occurs in a bone that is subjected to constant repeative strain
64
What are the 7 types of fractures that can occur
1. Transverse
2. Linear
3. Oblique: Runs at an angle to the bone
4. Displaced: This is when there is movement of the bone
5. Spiral
6. Greensticks: This occurs when the bone bends causing it to fracture on one side
7. Comminuted: This is when there are multiple small fragments of bone
65
What are the 3 possible fracture patterns
1. Simple: This is where there is a single fracture line
2. Segmental: This is where there is at least 2 fracture lines
3. Comminuted: This is where there is multiple smaller fragments that form
66
What is the general x ray pattern that is asked for in a fracture
2 views, 2 joints, 2 sides, 2 opinions
2 view: 2 xrays that are at 90 to one another
2 joints: The x ray should show the joint above and below the fracture
If there is any doubt get an x ray of the other side and a second opinion
67
What is the general follow up time line for a patient with a fracure that is given a POP immobilisation
1. The cast is placed on
2. After 24 hours the fracture should be checked to rule out insufficient circulation
3. After 2 weeks we should check that the cast is not too lose
4. After 2-4 weeks the swelling will subside and so another check up can be done at 4 weeks
5. By 6 weeks we can check that the fracture is healing in place
68
What is the general management of an open fracture
1. Evacuation of any contaminant e.g. soil and loose fragments
2. Tetanus toxoid given sub cut 0.5 ml
3. Antibiotics
4. Debridement of wound
69
What is the difference between a subluxated joint and a dislocated joint
A subluxation is a partial displacement of the joint, while a dislocation is a complete separation of the joint surfaces.
70
What is meant by a congruent joint
This is where the 2 sufaces of the joint fit into one another
71
What are the 3 factors that give joints their stability
1. Bone congruity
2. Joint capsule and the surrounding ligaments
3. Muscles action across the joint
72
What are the 2 reasons that disloctions are normally higher priority than fractures
1. The articulatory ends of the bones are generally thicker than the bone so there is a high risk of compression of vital structure surrounding the bone
2. Large dislocations put excessive tension on the neurovascular structures threatening lower structures
73
What as the general management for a dislocation
The general treatment involves splintage and resting of the joint to allow for the capsule to heal
74
What are the 4 possible mechanisms of injury to peripheral nerves
1. Laceration: This occurs when the nerve is cleanly cut
2. Traction: This occurs when there is a large displacement causing pulling
3. Ischemia: Occurs in compartment syndrome, prolonged tourniquet use and freezing
4. Compression: Excessive pressure is place on the nerve
75
What us meant by neuropraxia
This is where there is compression or disruption of the blood supply that supplies the myelin sheath of the nerve causing death however the nerve still remain anatomically intact and so recovery is possible normally within 12 weeks
76
What is meant by axonotmesis
This is where there is injury to both the nerve and the myelin sheath but the framework around the nerve remain intact. Nerve recovery is still able to occur as the nerve can grow along the framework and reestablish a connection
77
What is meant by neurotmesis
Complete severing by a sharp object that normally means that there is scar tissue that forms in between the 2 ends preventing regeneration of the nerve
78
What are the 4 indications for placing a patient in traction
1. Fracture: To realign the bones
2. Dislocation: A high weight for a short period to relocate the joint and stabilise it
3. Deformities: Help correct contractions or misalignment
4. Analgesia: Relieve the pain and helps with spasms
79
What are the contraindications for skin traction
1. Elderly patients on steroid treatments: They have frail skin that can easily be torn
2. Allergies
3. Patients with PVD: They already have decreased blood flow to areas and so the increased pressure from skin traction can cause ischemia to the areas
4. Distal injury: The subsequent swelling can cause impaired circulation
5. Impaired sensation: Pressure from the traction apparatus will cause the patient to develop bedsores
80
What are the early complications that can occur from a fracture
1. Arterial injury
2. Nerve injury
81
When should a plaster of paris slab be used rather than a circumferential POP
When there is still significant swelling of the joint expected
82
What are some of the immediate injuries that can occur soon after the fracture has occurred
1. Fat emboli
2. Compartment syndrome
3. Venous thrombosis leading to PE
83
What are the 6Ps of clinical presentation of compartment syndrome
1. Pain of proportion to the clinical situation
2. Pain on a passive stretch
3. Paraethsia
4. Palpable swelling
5. Pallor
6. Paralysis
7. Absence of peripheral pulse
84
What is the treatment for compartment syndrome
Open fasciotomy and delayed closure if needed
85
What are the 3 types of union complications that can occur in the healing of a frecture
1. Malunion: This is where the union occurs but it occurs at an angle or at an cosmetically unacceptable way
2. Delayed union: This is were the union takes longer than in the average person
3. Non union: Here there is no union of the bonesW
86
What are the cause of delayed union of the bones 5
1. Malnutrition
2. Vascular diseases e.g. Diabetes ,smoking and PVD
3. Compound or comminuted fracture
4. Excessive interposition of the soft tissue
5. Iatrogenic causes e.g. a large fracture gap
87
What are the 2 main forms of non union
1. Hypertrophic: Here there is significant callus formation but the gap is just too large or there is repeated non immobilisation.
2. Atrophic: Here there is no significant callus formation
88
What are the 5 moments of hand hygine
1. Before touching a patient
2. After touching a patient
3. After a procedure
4. After being exposed to body fluids
5. When touching the patient's surroundings
89
What does a sterile object become if it touches a non sterile object
Non sterile
90
Above where are things considered sterile
Above the waist
91
If you lose sight of a sterile field what happens
It becomes non sterile
92
What happens of moisture or a tear happens in a sterile field
Then everything becomes non sterile
93
How large around a sterile field is considered non sterile
2cm
94
If you are unsure of an objects sterility what should be done
It should be considered non sterile
95
Can a sterile person touch a sterile field
Yes
96
Should the movement around a sterile field be limited
Yes
97
What are the diagnostic indications for an NG tube 3
1. Suspected upper GI bleed
2. Aspiration of gastric content
3. Releasing imaging contrast
98
What is the therapeutic cause if an NG tube insertion 5
1. Decompression of a distended stomach
2. Preventing aspiration in surgery
3. Giving nutritional support
4. Lavage to remove toxins
5. Administering medications if the patient can not drink
99
What are the contraindications for a NG tube 6
1. Patient refusal
2. Severe facial trauma
3. Recent sinal or bariatric surgery
4. Obstructive abnormality
5. Coagulopathies
6. Esophageal varices
100
how to measure an NG tube
From the tip of the nose to the earlobe to the xiphoid process
101
What are the 2 possible complications of an ECG
1. Allergy to the electrodes
2. Skin damage when removing the electrode
102
What are the contraindications to Venous blood sampling
1. Damaged skin and infection at the site of drawing blood
2. Sclerosed veins
3. Haematomas
4. Fistulas
5. Multiple IV in the same limb
103
What are the indications for the insertion of a urinary cath 4
1. Drainage: E.g. obstetrics, chronic urinary retention and palliation of chronic urinary incontinence
2. Installing medications or contrast
3. Sterile urine sample
4. Fluid balance monitoring
103
What are the 2 indications for a blood culture
1. Check antibiotic effectiveness
2. To check for presents of microbes in a sick patient
103
What are 4 possible complications of blood cultures
1. Contamination of the specimen leading to unnecessary antibiotics
2. Localised skin infections
3. Bleeding from the puncture site and possible haematoma
4. Needle stick injuries
104
What are the 2 contraindications of urinary cath
1. Urethral abnormalities
2. Allergies to latex
105
How long should a catherter stay in for
1. Latex: 1-14 days
2. Silicon: 6 weeks to 3months
106
What is Paraphimosis
This is a serious urological condition in which the fore skin becomes wrapped back on the penis causing inflammation and necrosis
107
What gauge of cannula is used for adult resus
14-16g
108
What gauge of canula is normally used on adults
18-22g
109
What gauge of cannula is used on infants
22-24
110
How do you locate the ventrogluteal IM postition
Place the palm of your hand on the greater trochanter of the the femur then point your index finger to the anterior iliac spine and the middle finger to the iliac crest and inject between the 2
111
112
What is the vastus lateralis used for
It is used in toddler and infants
113
What are the 3 possible IM sites
1. Ventrogluteal
2. Vastus lateralis
3. Deltoid
114
What are the contraindications of a subcutaneous injection 2
1. Infection at the site
2. More than 2 ml need to be administered
115
What are the risks with sub cut injections 5
1. Bleeding or bruising
2. Lipohypertrophy
3. Infection
4. Needle stick injuries
5. Vasovagal response
116
What are the contraindications of LP 3
1. Coagulopathy
2. Localised skin infection
3. Raised intracranial pressure
117
What is the best site for an LP
L4-5
118
Where does the spinal cord terminate
T12-L1
119
What are the risks in an LP 6
1. Haematoma causing spinal nerve compression
2. Post dural puncture headache
3. Introduction of an infection
4. Spinal nerve damage
5. Brain herniation
6. Intraspinal tumors
120
What is the stain used to diagnose cryptococcal infection
India ink
121
How is Entrovirus and HSV diagnosed in an LP
On PCR
122
What causes decreased glucose on a spinal tap
Infection
123
What cause a cloudy or turbid appearance of spinal fluid and how do you distinguish between them
Bacterial meningitis and fungal meningitis, Bacteria will have much higher cell counts than that of fungal infections
124
What is the possible cause of a severely elevated protein conc.
Guillain barre syndrome
125
WHat would indicate MS on LP
The presents of oligoclonic IgG bands
126
What are the 2 forms of non absorbable sutures
Nylon and silk
127
What are the 3 types of absorbable sutures and what are they composed of
1. Chromic: Composed of twisted strands of bovine interstial serosa collegen
2. Vicryl: Composed of polyglycolic acids coated in n lysin
3. Monocryl: Composed of copolymer glycolide
128
Which are the 2 monofilaments
1. Monocryl and nylon
129
What is the needle size that can be used on the scalp
4 or 5
130
What is the needle size that is used on the face
6
131
What is the needle size that is used on the truck and limbs
4 and 5
132
What is the needle size that is used on the hands
5
133
What is the needle size that is used on the soles of feet
3 or 4
134
What is the needle size that is used on the penis
5
135
What needle point is used for skin closure and subcut
Tapered
136
What is the needle type that is used for muscle and fascia
Blunt tip
137
What needle tip is used for soft tissue closure
Cutting edge
138
What is the benefit of lignocaine with adrenaline
It vasoconstricts arterioles
1. Decreases the absorption rate thus limiting toxic effects and keeps area numb for longer
2. Decreases bleeding
139
What is the max dose of lignocane and with adreniline
Normal: 3mg/kg
Adrenaline: 7mg/kg
140
What are the 5 contraindications for suturing the skin
1. If an animal bite or human bite
2. Loss of skin placing the skin under high tension
3. Infected or contaminated wound
4. Damage to the underlying structure
5. The wound is older than 8 hours and a vascular wound that is older than 24 hours
141
What are the possible complications of suturing a wound closed 4
1. Infection
2. Failure to heal
3. Scaring or keloid formation
4. Allergy to the suture or the anastertic or antiseptic
142
What are the 6 types of wounds
1. Puncture
2. Laceration: There is tearing of the soft tissue due to a blunt or irregular edge
3. Incision: This is where there is a clean cut that is made leading to clean wound edges
4. Abrasion: This is where there is scraping of the skin on a rough surface
5. Crush: This is when there is blunt force from a heavy object
6. Degloving: This is when the skin and sub cut tissue are separated from the underlying tissue
143
What are the major complications of tournequet application 3
1. Irrevocable ischemia and necrosis: This can be prevented by releasing the tourniquet every hour for 5 mins
2. Venous congestion
3. Toxic shock on releasing the tourniquet
144
What can be done to prevent pressure sores in a non mobile patient
If they have no sensation then you flip them every 2 hours between side and the back, if sensation is intact then every 4 hours
145
What are 4 prevention strategies for pressure sores
1. Position limbs to avoid bony prominences
2. Use protective devices e.g. sheep skins
3. Check pressure points twice daily
4. Position the patient so that areas that are threating to form pressure sores dont have pressure on them
146
What is the treatment of pressure sores
1. Apply clean sterile dressings and prevent infection
2. Areas that are dead should be removed
3. Deep pressure sores should get skin grafts
147
Which type of wound is at high risk for tetanus 7
1. Wounds that are older than 6 hours
2. More than 1 cm deep
3. Star shaped
4. Dead tissue present
5. Contaminated with dirt or rust
6. Gunshots
7. Burns and frostbite
148
Who should get the tetnus vaccine
If your wound is at high risk and you had one 5 yo or more
If not high risk but more than 10 yo
149
When should sutures on the scalp be removed
8-10 days
150
When should sutures on the face be removed
5
151
When should sutures on the chest and abdomen be removed
8-10
152
When should sutures on the back be removed
2 weeks
153
When should sutures on the feet be removed
2-4weeks
