Katrina

Question 1

1. The goal of treating a patient with TBI is to? (4) Read this question carefully!

Answer 1

• Recognise TBI and
• Minimise or prevent secondary injury and
• Treat other life threatening injuries if present and
• Transport the patient direct to a hospital with the capacity to provide the recuscitation and treatment needs of the patient whenever reasonably feasible

Question 2

2. 4 common forms of Secondary Injury are?

Answer 2

• Hypotension
• Hypoxia
• Hypercarbia
• Hypocarbia

Question 3

3. Paracetamol is indicated for ? or in addition to ? Can you use it if the patient is febrile? Explain

Answer 3

• Is indicated for mild pain
• Or in addition to other measures for moderate pain
• Can be used if the patient is febrile with a temperature greater than 39 degrees and the fever is causing discomfort

Question 4

4. You would suspect airway burns if there is ? (6)

Answer 4

• Burns around the lips
• Loss of nasal hair
• Visible swelling or burns in the mouth
• Hoarse voice
• Stridor
• Black sputum

Question 5

5. You have called Clinical Help Desk and they have confirmed you can use IM adrenaline,
   What dose do you administer, where, and what adverse effect can it have on your patient?

Answer 5

•0.3 – 0.5mg of IM adrenaline to lateral thigh (Preferred site) or if this site is not suitable the lateral upper arm
•Common Adverse effects are 
	tachycardia
	tachydysrhymias 
	myocardial ischaemia 
	ventricular ectopy
	hypertension
	nausea
	vomiting
	tremor
	headache
	anxiety

Question 6

6. Patients may receive treatment for hypoglycaemia and have a recommendation made to them that they do not need immediate referral to a doctor, provided all the following criteria are met ? (10)

Answer 6

• It is an isolated single episode (check the history of their glucose meter if they have one) and
• There is a clear and easily treatable cause (e.g a missed meal) and
• It is not due to overdose (including accidental) of insulin or oral hypoglycaemics
• It is not complicated by seizure or injury and
• They fully recover and can safely mobilise and
• Their blood glucose is > 3.5mmol/L 10 or more minutes after their last glucose administration and
• They are given a complex carbohydrate to eat and
• They have an adult who can stay with them for the next 4 hours and
• They are instructed to measure their glucose hourly for the next 4 hours and
• They are instructed to see their GP for a review of their treatment

Question 7

7. Using clinical criteria death may be determined when? (5)

Answer 7

• There must be no clinical signs of breathing ( the chest and abdomen must be uncovered and the patient examined for signs of breathing over 1 full minute)and
• There must be no palpable pulse at a central site ( carotid or femoral)and
• The pupils must be dilated and unreactive to light and
• After 10 minutes all of the above examinations must be repeated and there must be no signs of breathing, no palpable pulse and no pupillary reaction to light and
• A 3 lead ECG must then be taken showing asystole

Question 8

8. The combination of sympathetic nervous system stimulation and organ dysfunction produce the signs of shock, list 7.

Answer 8

• Tachycardia
• Cold and clammy skin
• Prolonged capillary refill
• Tachypnoea
• Narrowed pulse pressure
• Hypotension
• Confusion or falling level of consciousness

Question 9

9. Oxygen administration should usually only be given if the patient has ? (7)

Answer 9

• An SpO2 < 94% on air (exception CORD)or
• Airway obstruction or
• Respiratory distress (exception CORD) or
• Shock
• Inability to obey commands from TBI or
• Smoke inhalation or
• Carbon monoxide poisoning

Question 10

10. What 3 things does the application of PEEP achieve?

Answer 10

• Helps expand collapsed alveoli, improving oxygenation and ventilation
• Splints medium sized airways open during exhalation improving ventilation
• Reduces the preload of the left ventricle by increasing the afterload of the right ventricle. This reduces the amount of fluid entering the lungs by reducing the pressure within lung blood vessels

Question 11

11. List 3 Contraindications and 4 Relative Contraindications for GTN administration.

Answer 11

•3 contraindications
	Pulse rate >150bpm or
	Pulse rate < 40bpm or
	Systolic blood pressure <100 mmHg
•4 relative Contraindication
	Right ventricular infarct or
	Poor perfusion or
	Dysrythmia is present or
	The patient has taken a drug for erectile dysfunction in the last 24 hours

Question 12

12. Describe the components of the Paediatric Triangle.

Answer 12

1

Question 13

13. What skills are in your Scope of Practice list 2 Primary Care and 11 EMT skills.

Answer 13

•Primary care skills
	Entonox
	Methoxyflurane
•Emergency medical technician skills
	Nasopharyngeal  airway
	Laryngeal mask airway
	PEEP valve
	GTN Spray
	Nebulised adrenaline
	Nebulised ipratropium
	Nebulised salbutamol
	Oral loratidine
	Oral ondasetron
	IM Glucagon
	Tourniquet

Question 14

14. One sentence answer….What is Asthma?

Answer 14

•Asthma is reversible bronchoconstriction caused by bronchospasm, mucus plugging and oedema

Question 15

15. Explain the setting of PEEP in Cardiogenic Pulmonary Oedema, and what are you trying to achieve with its use?

Answer 15

2

Question 16

16. Do we still use a Pre-cordial thump in cardiac arrest, when? How is this delivered?

Answer 16

3

Question 17

17. In the attachment what is this rhythm? And what is your treatment for it?

Answer 17

4

Question 18

18. To have Septic Shock a patient must have ? and ?. Describe each component.

Answer 18

•To have septic shock the patient must have both an infection and shock

•To have an infection, the patient must have:
A temperature < 36 degrees or > 38 degrees and
an identified or highly suspected site of infection
•Examples of sites of infection include
a)Urosepsis – particularly pyelonephritis
b)Pneumonia
c)Blood e.g. meninogococcemia
d)cellulitis

•To have shock, the patient must have:
Tachycardia (unless beta blocked)
Tachypnoea (greater than 20/min for adults)
Hypotension or very poor perfusion. The patient does not have to be hypotensive but there must be clear signs of shock, including signs of very poor perfusion for the provisional diagnosis to be septic shock
•Additional signs and/or symptoms associated with septic shock may include
a)decreased urine output
b)Confusion
c)Diarrhoea
d)Nausea and vomiting
e)Aching muscles or joint
f)Petechial spots

Question 19

19. What is the most common diving emergency? Explain the pathophysiology behind this.

Answer 19

• The most common diving emergency is decompression sickness or ‘the bends’. This occurs when gases (predominantly nitrogen) that are dissolved in body fluids form bubbles
• When a person has been diving at depth, the increased ambient pressure results in an increase in the amount of gas dissolved in body fluids. As the diver ascends these dissolved gases come out of body fluids and are ‘breathed out’ through the lungs. If the amount of dissolved gases is very high and the ascent is to rapid, the gases leaving body fluids can form bubbles

Question 20

20. Define Postpartum Haemorrhage.

Answer 20

•Abnormal bleeding (>500ml) following the delivery of a baby

Question 21

21. How do you differentiate between angina, unstable angina and MI?

Answer 21

5

Question 22

22. Describe the position of lead placement V1 - V6 for a 12 Lead ECG?

Answer 22

6

Question 23

23. Name some common causes of Hypovolaemic Shock?

Answer 23

• Penetrating truncal trauma
• Leaking abdominal aortic aneurysm
• Peripheral penetrating trauma
• Postpartum haemorrhage
• Ectopic pregnancy
• Blunt trauma
• Fluid loss (e.g. diarrhea, hyperglycemia)
• Peripheral blood loss that has been fully controlled
• Gastrointestinal bleeding
• Antepartum haemorrhage
• Hyperthermia

Question 24

24. List some conditions that can cause shortness of breath? (make it a big list!)

Answer 24

7

Question 25

25. Name the types of shock?

Answer 25

•Hypovolemic
Is due to inadequate intra-vascular volume
•Anaphylactic
Is due to mediators released in response to an allergic reaction
•Septic
Is due to a systemic inflammatory state in response to an infection
•Spinal
Is due to loss of sympathetic nervous system outflow following spinal cord injury
•Hypoadrenal
Is due to inadequate levels of circulating cortisol. Patients with congenital adrenal hypoplasia are at risk of this particularly if they have trauma or illness.
•Obstructive
Is due to pulmonary embolism causing inadequate right ventricular function or tension pneumothorax causing inadequate right ventricular filling
•Cardiogenic
Is due to inadequate cardiac output as a result of a heart problem

Question 26

26. What are the stages of shock?

Answer 26

8

Question 27

27. What are the different types of diabetes?

Answer 27

9