Knowledge Flash Cards

Question 1

Considerations when giving GTN?

Answer 1

Adequate blood pressure
Rate and rhythm appropriate (Preload dependant)
No PDE-5 inhibitor use

Question 2

Chest pain differentials

Answer 2

PE
Aortic dissection
Tension pneumothorax
Myocarditis
Respiratory

Question 3

STEMI Criteria

Answer 3

Persistent STE in >2 contiguous leads.
Normal QRS or RBBB

Stable Pt.
<60min from PCI

All age and gender 1mm in all lead other than V2 - V3.
In V2 - V3:
Male
<40 - 2.5mm
>40 - 2mm
Female any age
1.5mm

Question 4

Indications for Opiates in Chest Pain and dose

Answer 4

Continue SL GTN
Consider clinical support
Pt has severe pain and stable GCS
SBP >100
IV Fentanyl 25-50mcg, repeat 5 min PRN, total max dose 300mcg

Question 5

Indications/goals for fluids in Sepsis

Answer 5

qSOFA +2 - Hypotensive Altered GCS Tachypnoea
Adults with suspected sepsis and SBP<100 or MAP <65
Rapid IV saline 250mL alliquots up to max of 20mL per Kg
Aim to achieve SBP>100 or MAP >65
Paeds
10mL per kg up to 20mL per kg

Question 6

Severe/life threatening croup indication and treatment

Answer 6

Barking cough
Marked stridor - insp or expir or audible at rest
Agitated or reduced consciousness
Severe accessory muscle use

Neb adrenaline
<6mths 2.5mg, add saline to make 5ml
>6mths 5mg
Repeat PRN

Redipred 1mg/kg max 50mg

Question 7

Concepts of damage control resuscitation

Answer 7

Haemorrhage control
Temperature control
Minimise movement
Targeted fluid resus - obeys verbal command or radial pulse
TXA
Rapid transport with in 20mins

Question 8

Lethal Triad

Answer 8

Coagulopathy
Hypothermia
Acidosis

Question 9

Causes of post partum haemorrhage

Answer 9

Tone
Tissue
Trauma
Thrombus

Question 10

Treatment of PPH

Answer 10

Assessment of fundus
- massage fundus
- assessment of external trauma - direct pressure
- promote bladder emptying
- skin to skin contact/ breast feeding

• 2 x large bore IV access
• <3hrs IV TXA
  If not responding to verbal commands
  IV saline 250mL bolus up to 20mL/kg

External aortic compression

Question 11

Cell cycle of death

Answer 11

Swelling or bleeding
Decreased perfusion
Increased hypoxia
Anaerobic respiration - 2 ATP production
Na/K pump failure - Na retained
Cell swelling

Question 12

Fluid goals in TBI

Answer 12

Trigger point - GCS 12 or trending down. MAP <90 or SBP <110

End goal - MAP >90 or SBP >110

Question 13

When can you give a second dose of midazolam?

Answer 13

5 minutes post first dose

Question 14

Indications for midazolam

Answer 14

Seizure continuous for five minutes or multiple seizure not fully regaining consciousness.

Exceptions to five minutes
Risk of aspiration
Risk of harm to self or others
Hypoxia

Head injury or pregnancy

Question 15

Intranasal fentanyl dose and preparation

Answer 15

450mg/1.5mL
0.1mL=30mcg

The MAD requires 0.1mL to prime so initial dose 0.4mL.

Adult: initial dose 180mcg. 90mcg (0.3mL) per nostril. Max cumulative dose 400mcg. So 2 doses of 180mcg.

Question 16

Paediatric Cardiac arrest drugs & jules

Answer 16

Adrenaline - 10mcg/kg IV max 1mg
Diluted to 1:10000
Amiodarone - 5mg/kg
4 jules/kg

Question 17

Sedatives for Challenging behaviours

Answer 17

SAT Score +1 - 1-2mg lorazepam >16yrs
SAT Score +2 - 5-10mg IM droperidol 18-64yrs. Total max 20mg

Question 18

3 for Mum
3 for Baby

Answer 18

3 for mum - Fundal assessment, Observations, Assess vagina for bleeding/trauma
3 for baby - Dry stimulate/skin to skin, Cord care, APGAR

Question 19

What does ECOLOGY stand for?

Answer 19

Expected delivery date
Contractions
Obstetric Hx
Loss/show
Observations
Gynaecological hx
Y Use - drug use

Question 20

What does MRSOPA stand for?

Answer 20

M - Adjust mask
R - Reposition head
S - Suction mouth then nose
O - Open mouth
If still no air movement
P - increase pressure
A - Artificial airway (iGel)

Question 21

What is a placental abruption?

Answer 21

Separation of the placenta from uterine wall. Present or concealed

Question 22

Physiological changes in pregnancy?

Answer 22

HR increase 10 - 20 BPM. 80 - 95BPM considered normal.
Sustained HR >100BPM may indicate hypovolaemia.
BP - Decreases 5 - 15mmHg during 2nd trimester.
Hypercoagulable state - DVT, PE, DIC (during trauma, placental abruption)
Diaphragm displacement upwards - Decreasing lung expansion, Decreased O2 reserve, Increased RR and Minute volume.

Question 23

Indication/regime for fluids in anaphylaxis?

Answer 23

SBP <100 post administrative of adrenaline.
10mL/kg

Question 24

What is an Ante-partum haemorrhage?

Answer 24

Bleeding if 15mL or more from the birth canal after 20 wks

Question 25

Two main causes of ante-partum haemorrhage?

Answer 25

Placenta praevia Placental abruption

Question 26

Dose for NEB salbutamol in COPD

Answer 26

5mg salbutamol run over 6 minutes

Question 27

Symptoms of airway burns

Answer 27

Harsh cough Stridor Burns to the face head and neck swelling Inflamed oropharynx. Singed nasal hair, eyebrows or eyelashes Soot in the saliva, sputum, nose or mouth

Question 28

Fluid indications/goals for burns

Answer 28

Signs of poor central perfusion: 10mL/kg up to 20mL/kg (max 250mL aliquots)

Question 29

TXA indications

Answer 29

Blunt or penetrating trauma: HR >120 or BP <90 SBP Less than 3 hrs since incident Post-partum haemorrhage: <3hrs from birth Medical cause of bleeding consult CMO

Question 30

Crush syndrome may result…

Answer 30

Anticipate crush syndrome when releasing compressive force from patients who have had a prolonged crush (>60mins) affecting a body surface >18% with significant muscle mass

Question 31

Crush Syndrome treatment

Answer 31

Pre compression release: Prepare to treat traumatic injuries Prepare for cardiac arrest. Allocate roles and set up equipment. Large bore IV access x2 Fluid - 20mL/kg Post compression release: Minimise scene time Fluid - 10mL/kg up to 20mL/kg If signs of Hyperkalaemia consult ECP for salbutamol neb

Question 32

Fluids indication/dose in burns

Answer 32

Signs of poor central perfusion 10mL/kg Consult for further