emergencies

Question 1

why do we do needle decompression

Answer 1

in an emergency setting to buy you some time before inserting a chest drain

Question 2

needle decompression

Answer 2

done in 2nd intercostal space mid clav

Question 3

chets drain

Answer 3

done in 5th itercostal mid axiallary

Question 4

so where is the first rib

Answer 4

you wont be able to feel it as its bascially under the clavicle so the first rib you feel is the 2nd rib

Question 5

why is a atnesion penumothorax a emergency

Answer 5

as the mediastinal shift occurs it causes a sn obstructive shock compressing the vana cava and not alloweing blood to reach the heart

Question 6

so what are the 3 signs that would alert you to a tension pneumor

Answer 6

1. TACHY + HYPO (SIGNS OF SHCOK)
2. ABSENT BREATH SOUNDS
3. DYSPNEAC

JVP AND TRACHEAL SHIFT ARE MUCH LATER SIGNS

Question 7

which do you treat with a 3 way dressing

Answer 7

OPEN

Question 8

PRIMARY PNEUMO

Answer 8

HAPPNES WITHOUT ANY CHEST PROBLEMS UNDERLYING DISEASE

Question 9

how to avoid hitting the nerves and vessels

Answer 9

when in the space always go over the bottom rib as the bundle is underneth the top rib!

e.g 2nd intecostal space is between 2nd and 3rd rib so lie the needle over the 3rd rib .

Question 10

DESCRIBE RECOVERY POSTION

Question 11

MNEUMOIC FOR ALTERNED MENTAL STATUS

Answer 11

A- ALCOHOL, ACIDOSIS, AMMONIA , ARRYTHMIAS
E- EPILESY
I- INFECTIONS
O - OVERODES, OXYGEN, OPIATES
UR-UREMIA

Question 13

Non shockable tx

Answer 13

Cprand adrenaline (amiodorone later on)

Question 14

Non shcoabkle rtyhme

Answer 14

Pea
Asytole

Question 15

Shockable rhythms

Answer 15

Vtach (plus less)
V fib

Question 16

Why is torsdades dangerous

Answer 16

Can lead to v fib

Question 17

What do you use to shock in a cardiac arrest

Answer 17

De fib

Question 18

Causes of carriac arrest

Answer 18

5 h
4 t

Question 19

How do you recognise a cardiac arrest

Answer 19

Absent breathing or agonal
No central pulse
So don’t just rely on peripheral ? Ask ababa

Question 20

What’s a Farida arrest call number

Answer 20

2222

Question 21

How long do you do cpr for

Answer 21

2 mins then check for a rhythm

Question 22

What is something imprortanf before you shock someone

Answer 22

Remove oxygen
Tell people to stand clear

Question 23

What is the joules for cardiac arrest

Answer 23

Not specified in guideline

Range from 120~ 360

Question 24

Algorithm for shockable Rythm

Answer 24

ABCDE
Secure airway
Give oxygen

Shock
Resume cpr for 2 mins

After 3 rounds of shocks 300mg amiodorone and 1mg adrenaline IV or IO

Then repeat adrenaline every 3~5 mins I.e every other cycle

After 5 shocks give 150 mg amiodorone

Question 25

Algorith, for non shockable

Answer 25

ABCDE Secure Oxygen Cpr Adrenaline 1mg iv or io T Keep giving every 3-5 mins or every other cycle Cannot shock or give Amod wrong unless rhythm changes to a shockable one

Question 26

Every time you do a Rythm check what should you do

Answer 26

Always stop compressions and pause a little

Question 27

Every time you do a Rythm check what should you do

Answer 27

Always stop compressions and pause a little

Question 28

What’s the definition of septic shock

Answer 28

1. Despite aggressive resuscitation cannot maintain a MAP above 65 so need vasopresssor 2. Lactate more than 2 despite fluids

Question 29

What kind of vasopressor do we give in septic shock

Answer 29

Noradrenaline first line

Question 30

News parameters how many

Answer 30

6

Question 31

What’s are the cut offs for news

Answer 31

1. 5 or more 3 or more in 1 section

Question 32

In terms of news of o2 says what to always remember

Answer 32

To add 2 to the score of a patient if they are receiving supplemental oxygen

Question 33

What’s more important in terms of bp for a deteririoting patient

Answer 33

Hypo Because hyper can be due to pain or distress

Question 34

What is a news score we are very worried about

Answer 34

7 plus

Question 35

Traffic light system news

Answer 35

Less than 5 5/6 moderate or a single 3 7+ severe

Question 36

DKA

Answer 36

Triad Hypergycelmia Ketonemia more than3 Acidosis <7.2 or bicarbonate <15 Nb! Hyperglycaemia may not always be present in DKA (euglycemic dka)

Question 37

What is DKA associated with

Answer 37

Type 1 but it can happen in type 2 very rare Young kids

Question 38

DKA happens commonly

Answer 38

In children

Question 39

Signs of DKA

Answer 39

Fruity breath Tacky Hypo Abdomen pain Vomitting Dehydrated Kussmail breathing Altered mental status

Question 40

Protocol for DKA

Answer 40

1. Start fluids 2. Them start insulin infusion 0.1 units per kg per hour 1 hour after starting fluids Theee is a a risk of hypokalemia so think about adding potassium

Question 41

To what level would you consider adding glucose in DKA

Answer 41

Once the glucose falls below 14

Question 42

malignant hypertension whats the main thing we are worried about here

Answer 42

>180/120 encephlopathy as leads to edema of brain

Question 43

what are the signs of end organ failure in hypertension

Answer 43

1. headache 2. vision- retinal hemorrgage, papilledema 3. kidney 4. encephalopathy seizure 5. heart

Question 44

what are we aiming the drop for and why in malignant hypertension 1st line

Answer 44

around 160/100 otherise can cause a stroke ischemic ca channel blocker