Emergency

Question 1

What are signs of shock?

Answer 1

hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness.

Question 2

What are the first steps in any emergency?

Answer 2

ABCDE

Question 3

What is the CPR ratio in adults?

Answer 3

30:2

Question 4

What are shockable rhythms?

Answer 4

VF Pulseless VT

Question 5

What are non-shockable rhythms?

Answer 5

Asystole PEA - pulseless electrical activity

Question 6

After shocking a collapsed patient how long do you then carry on CPR before another shock?

Answer 6

2 minutes, then reassess rhythm

Question 7

What reversible causes could have caused a cardiac arrest collapse? 4 Hs, 4Ts

Answer 7

Reversible Causes: Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Thrombosis - coronary or pulmonary Tamponade - cardiac Toxins Tension pneumothorax

Question 8

What is a precordial thump? Is it useful?

Answer 8

Single blow to sternum A single precordial thump has a very low success rate for cardioversion of a shockable rhythm and is only likely to succeed if given within the first few seconds of the onset of a shockable rhythm.

Question 9

What are the steps in adult BLS?

Answer 9

Check safety Unresponsive? Shout for help Open airway Not Breathing? Call 999 30 chest compressions 2 rescue breaths 30:2

Question 10

What rate should chest compressions be given in?

Answer 10

100-120 a minute

Question 11

When do you continue resuscitation until?

Answer 11

• qualified help arrives and takes over, - the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally, OR - you become exhausted.

Question 12

What compression depth should be achieved in an adult?

Answer 12

5-6 cm

Question 13

If a person is choking, what suggests severe airway restriction?

Answer 13

Response to question ‘Are you choking?’  Victim unable to speak  Victim may respond by nodding Other signs  Victim unable to breathe  Breathing sounds wheezy  Attempts at coughing are silent  Victim may be unconscious

Question 14

Describe what the algorithm is of an adult choking.

Answer 14

Question 15

Describe how to give 5 black blows for Choking

Answer 15

Stand to the side and slightly behind the victim.

Support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway.

Give up to five sharp blows between the shoulder blades with the heel of your other hand.

Question 16

Describe how you would give 5 abdo thrusts in an adult choking

Answer 16

Stand behind the victim and put both arms round the upper part of his abdomen. o Lean the victim forwards.

Clench your fist and place it between the umbilicus (navel) and the bottom end of the sternum (breastbone).

Grasp this hand with your other hand and pull sharply inwards and upwards.

Question 17

How likely, when a shocking someone in VT, is it for a normal rhythm to return?

Answer 17

If a patient in a shockable cardiac arrest rhythm is defibrillated within the first 90 seconds of the arrest there is a high (80%) chance that the rhythm will be terminated and replaced by one which will return cardiac output.

However with each passing minute the patients’ chance of survival drops by 10%

Question 18

What drug should be given when dealing with a cardiac arrest collapse?

Answer 18

1 mg IV adrenaline

Question 19

Is survival likely from a non-shockable rhythm cardiac arrest?

Answer 19

Survival following cardiac arrest with asystole or PEA is unlikely unless a reversible cause can be found and treated effectively.

Question 20

How often should IV adrenaline be given in an arrest situation?

Answer 20

Every 3-5 minutes

Question 21

What is the algorhythm for peadiatrics BLS?

Answer 21

Unresponsive?

Shout for help

Open airway

Not breathing?

999

5 rescue breaths

No sign of life?

15 chest compressions

Continue 15:2

Question 22

In a peadiatric situation and you are alone, when should you go for help?

Answer 22

Do CPR for one minute before going for help

Question 23

How deep should your chest compressions be in a peadiatric situation?

Answer 23

1/3 body depth

2 fingers in infant under 1

one hand in small child

Question 24

How long should you listen for normal breathing for in a peadiatric case?

Answer 24

no more than 10seconds

Question 25

What position should an infants head be in when giving rescue breaths?

Answer 25

Neural position

Question 26

Where should you apply chest compressions in a child or infant?

Answer 26

1 fingersbreadth above the xiphiod sternum

Question 27

What defines a newborn, neonate, infant and child?

Answer 27

A newborn is a child just after birth. A neonate is a child in the first 28 days of life. An infant is a child under 1 year. A child is between 1 year and puberty.

Question 28

What are general signs of choking (esp. in a child)

Answer 28

Witnessed episode Coughing or choking Sudden onset Recent history of playing with or eating small objects

Question 29

What signifies ineffective coughing in a child who has choked?

Answer 29

Unable to vocalise Quiet or silent cough Unable to breathe Cyanosis Decreasing level of consciousness

Question 30

What reassures you that a child has an effective cough after choking/

Answer 30

Crying or verbal response to questions Loud cough Able to take a breath before coughing Fully responsive

Question 31

What is the Paediatric Choking Treatment Algorithm ?

Answer 31

Question 32

Should you use abdominal thrusts in a choking infant?

Answer 32

NO

Question 33

How do you give chest thrusts to infants?

Answer 33

Turn the infant into a head-downwards supine position. This is achieved safely by placing your free arm along the infant’s back and encircling the occiput with your hand. Support the infant down your arm, which is placed down (or across) your thigh. Identify the landmark for chest compression (lower sternum approximately a finger’s breadth above the xiphisternum). Deliver up to 5 chest thrusts. These are similar to chest compressions, but sharper in nature and delivered at a slower rate. The aim is to relieve the obstruction with each thrust rather than to give all 5.

Question 34

How is the airway measured for a gudel/oropharengeal airway?

Answer 34

The oropharyngeal airway is measured from the edge of the mouth to the tragus.

Question 35

If a patient is unresponsive and can't protect their airway what can you use?

Answer 35

An endotracheal tube

Question 36

How can you ensure you have inserted the endotracheal tube correctly?

Answer 36

capnograph

Question 37

What are the AVPU parameters?

Answer 37

AVPU Assessment :- A - Alert V - Responding to Voice P - Responding to Pain U - Unresponsive

Question 38

What are the steps in the Glasgow Coma Scale GCS?

Answer 38

Eye Opening Response 4 - Spontaneous 3 - To Speech 2 - To Pain 1 - No Eye Opening Best Verbal Response 5 - Orientated 4 - Confused Conversation 3 - Inappropriate Words 2 - Incomprehensible Sounds 1 - No Response Best Motor Response 6 - Obeys commands 5 - Appropriate localising response to pain 4 - Withdrawal response 3 - Abnormal flexion response (Decorticate Rigidity) 2 - Extension response (Decerebrate rigidity) 1 - No Response

Question 39

How much of an adult body is water?

Answer 39

45-80% around 45 L

Question 40

Of the total body's water content, how much is intracellular and how much extracellular?

Answer 40

2/3 intra - 30L 1/3 intra - 15L

Question 41

Of the intracellular fluid, how much is interstitial fluid and how much intravascular?

Answer 41

10L - intersitial 5L intravascular

Question 42

What fluids are seen as isotonic?

Answer 42

Normal saline (150 mmol NA/l) Hartmann's solution (131 mmol NA/l)

Question 43

IV infusion of an isotonic solution maininly increases the volume of what compartment?

Answer 43

ECF - extraceullar fluid

Question 44

Where will IV infusion of dextrose solution be distributed?

Answer 44

Between ECF and ICF - as glucose in it is metabolised, so leaves just water, which reduces the ECF osmolality, so fluid leaves it to the ICF until balence is regained

Question 45

What are symptoms of hypovolaemia?

Answer 45

Lethargy, weakness Postural dizziness Thirst Dry mouth Reduced urine output Feeling cold Shivering Panting Altered mental state

Question 46

What are clinical signs of hypovolaemia?

Answer 46

Colour – pallor Peripheral temperature – cool Peripheral perfusion – delayed capillary refill time greater than 2 secs Dry mucous membranes Dry furrowed tongue Sunken eyes Reduced skin turgor Pulse - tachycardia - or postural rise in pulse rate greater than 30 bpm on standing BP - reduced - or postural fall in BP greater than 20mmHg on standing JVP - low or absent

Question 47

What investigations may confirm hypovolaemia

Answer 47

Urea, creatinine, sodium Haemoglobin, haematocrit Urinary sodium, osmolarity ECG, CXR, ABG Central venous pressure monitoring

Question 48

What are causes of shock?

Answer 48

Hypovolaemia Cardiogenic (MI, PE) Septicaemia Anaphylaxis Neurogenic (spinal injury - loss of sympathetic tone - vasodilation) Tension pneumothorax Addisonian crisis

Question 49

What amount of fluid would you give initially in shock?

Answer 49

Rapid bolus 1-2l in adults 20mls/kg in a child

Question 50

What type of fluid would you use initially in shock?

Answer 50

Isotonic crystalloids - hartmanns, normal saline If pt is bleeding - blood if available, other fluids while waiting