MCQs Flashcards
(261 cards)
1
Q
Ratio of blood products
A
2 RBCs : 1 unit FFP
Once on 4th unit RBC -> platelets
2
Q
What blood to ask for in major haemorrhage
A
1 unit O-ve
1 unit type specific
Rest fully crossmatched
3
Q
priorities in TBI
A
hyperoxaemia
maintain normal PaCO2
MABP > 90
neurosurgery consult
4
Q
Fluids in resuscitation
A
crystalloids (hartmann’s/saline)
No more than 1L
5
Q
Hypothermia level which increases bleeding x 2
A
35 degrees celsius
6
Q
1st marker haemorrhage shock
A
pulse pressure (vasoconstriction - increases diastolic pulse pressure - pulse pressure decreases)
7
Q
chest drain size pneumothorax
A
28
8
Q
chest drain size haemothorax
A
32
9
Q
very distressed child
A
intranasal diamorphine 0.1mg/kg
10
Q
dermatomal/myotomal changes in C5 - where is the injury likely to include to
A
C3 (2 above)
11
Q
diaphragmatic supply
A
C3, C4, C5
keeps diaphragm alive
12
Q
Low BP + low HR + warm
A
neurogenic shock
13
Q
GCS - M total
A
6
14
Q
GCS - V total
A
5
15
Q
GCS - E total
A
4
16
Q
M6
A
obeys command
17
Q
M5
A
localises to pain
18
Q
M4
A
withdraws from pain
19
Q
M3
A
abnormal flexion
20
Q
M2
A
abnormal extension
21
Q
V5
A
normal
22
Q
V4
A
confused
23
Q
V3
A
inappropriate words
24
Q
V2
A
sounds
25
E4
opens spontaneously
26
E3
opens to voice
27
E2
opens to pain
28
pain control chest drain
xylocaine - to muscular & nerve level as well as skin
29
needle decompression/finger thoracotamy/chest drain insertion site
5th ICS (nipple level/breast fold), anterior to midaxillary line, above rib
30
2nd rib at
manubrium
31
Inspection for B
skin colour, use of accessory muscles, chest wall equally rising, obvious external injuries, seesaw pattern, neck veins
32
Inspection from end of bed C
GCS, skin colour, pain/discomfort/agitation, sweating,
33
Inspection for A
foreign bodies, obvious fractures, blood/vomit, dentures
34
temperature for warmed fluids
39 degrees
35
Areas of major haemorrhage
```
chest
abdo
pelvis
retroperitoneum
long bones/limb amputation (on the floor)
```
36
TXA Dosing
1g within 3 hours
| 1g over 8 hours
37
immediately when walk into scenario
C-spine control
then: ask nurse for oxygen, observations, IV access & bloods
collar & blocks & tape
38
MIST
M – Mechanism of injury/illness
I – Injuries (sustained or suspected)
S – Signs, including observations and monitoring
T – Treatment given
39
Bloods in trauma patient
VBG, FBC, U&Es, coagulation, G&S, crossmatch, glucose, pregnant test,
40
Exposure examination
perineum, rectum & vagina, log roll for back, MSK
41
larynx/trachea injury
neck injuries
may cause obstruction due to swelling/bleeding
urgent definitive airway - may need early surgical airway
42
3Ps of indications for definitive airway
Provide - immediate - most qualified in room
Protect - urgent - most qualified in dept
Puff - soon - most qualified in hospital
43
triad of symptoms laryngeal trauma
hoarseness, subcut emphysema, palpable fracture
| - early definitive airway
44
triad of symptoms laryngeal trauma
hoarseness, subcut emphysema, palpable fracture
| - early definitive airway
45
B examination pattern
look, feel (incl percuss), listen (incl HS)
46
how to measure NPA
diameter same as little finger, usually right nostril, follow curve of NPA
47
paralytic for drug assisted intubation
1-2mg/kg/ succinylcholine IV
48
needle size for needle cricothryoidotomy
adults 12-14G (orange)
paed 16-18G (grey-green)
can use for 20 mins, 1sec on 4 sec off
49
tube size for surgical cicothyroidotomy
5-7 in adult
| not recommended for children < 12
50
pulse oximetry accuracy decreased by
profound anaemia/hypothermia
51
sats of >95% correlate with PaO2 of
>70mmHg or 9.3kPa
52
shock =
loss of end organ perfusion
53
best treatment for haemorrhage shock
stop the bleeding!!!!
54
tachycardia in infant is
> 160
55
tachycardia in 1-5 year old
>140
56
tachycardia in 5-15
>120
57
tachycardia in adults
> 100
58
types of shock
```
haemorrhage
cardiogenic incl cardiac tamponade/air embolus/MI
tension pneumothorax
neurogenic
septic
```
59
normal adult blood volume is
7% of body weight (70kg = 5L) (78ml/kg)
60
normal child blood volume is
8-9% of body weight (70-80ml/kg)
61
class 1 haemorrhage approx blood loss
15% (750ml)
62
class 1 haemorrhage signs
```
normal HR
normal BP
normal pulse pressure
normal RR
normal UO
normal GCS
base deficit 0 to -2
```
63
class 1 haemorrhage management
monitor
64
class 2 haemorrhage approx blood loss
15-30% (750-1.5L)
65
class 2 haemorrhage signs
```
normal/high HR
norma BP
low pulse pressure
normal RR
normal UO (20-30ml/hour)
normal GCS
base deficit -2 to -6
```
66
class 2 haemorrhage management
IV fluid bolus challenge (500ml-1L)
- responder - fine leave
- transient responder/responder - blood transfusion/major haemorrhage
67
class 3 haemorrhage approx blood loss
31-40% (1.5L-2L)
68
best assessment of fluid ressusc in adults
urine output of 0.5ml/kg/hour
69
most important principle for head injury
avoid hypotension
70
pads urine output target > 1 year
1ml/kg/hour
71
succinylcholine onset of action
paralysis < 1 min
duration < 5 mins
can cause severe hyperkalaemia
72
starling's law
muscle fibre length related to contractile properties of myocardial muscle
73
class 3 haemorrhage signs
```
high HR
normal/low BP
low pulse pressure
normal/high RR
low urine output
low GCS
base deficit -6 to -10
```
74
class 3 haemorrhage management
control the bleeding
| major haemorrhage protocol
75
class 4 haemorrhage approx blood loss
> 40% (>2L)
76
class 4 haemorrhage signs
```
high HR
low BP
low pulse pressure
high RR
low UO
low GCS
base deficit > -10
```
77
class 4 haemorrhage management
control the bleeding
major haemorrhage protocol
anticipate arrest
78
blood loss in tibia/humeral fracture
750ml
79
blood loss in femur fracture
1.5L
80
blood loss in pelvic fracture
2L or more
81
remember gastric decompression!!
can cause unexplained hypotension & cardiac dysrhtymia
82
pads < 40kg fluid resuscitation
20ml/kg (bolus with 10ml/kg initially)
83
urine output target in < 1 year
2ml/kg/hour
84
minimum size of need for IV access
18G (green)
| - aim have grey (16G) or orange (14G) which are bigger
85
massive transfusion =
> 10 units within 24 hours or > 4 units in 1 hour
86
Ohm's law
BP is proportional to cardiac output and systemic vascular resistance
BP (V) = CO (I) x SVR (R)
87
tracheobronchial tree injury presentation
```
LIFE THREATENING
haemoptysis
cervical subcut emphysema
tension pneumothorax
cyanosis
```
88
method for CXRs
```
identify patient name, DOB, date of XR, & technically ok
outside in
- foreign bodies
- soft tissues
- pleura
- diaphragm
- lungs
- heart
- mediastinum
```
89
method for pelvic XRs
3 Os - pelvic & ischial
3 joints - pubic symphysis, SIJs & hips
3 lines - schentoins, pubic symphysis, trace bone outlines
90
tracheobronchial tree injury diagnosis confirmation
bronchoscopy
91
how to confirm diaphragm rupture
pass NG tube and re XR - will not go below if ruptured
92
tracheobronchial tree injury management
immediate airway - may require intubation of only the uninjured bronchus
93
open pneumothorax (sucking chest wound) management
dressing attached on 3 sides
94
massive haemothroax =
> 1.5L in one side of chest (if drained immediately/200ml for 2-4 4 hours -> thoracotomy)
- ensure IV access
95
kussmaul's sign
rise in venous pressure with inspiration when breathing spontaneously - consider tamponade
96
cardiac tamponade management
thoracotomy/sternotomy
| - needle pericardioscentesis is temporising measure
97
VF give
epinephrine 1mg
98
causes fo cardiac arrest in trauma
```
severe hypoxia
tension pneumothorax
profound hypovolaemia
cardiac tamponade
cardiac herniation
severe myocardial contusion
severe brain injury
```
99
IO sizing
paeds - pink
bigger paed (>40kg) - blue
yellow - adult
100
warfarin reversal
FFP
Vit K
prothombin complex concentrate
factor VIIa
101
herparin/LMWH reversal
protamine sulfate
102
dabigatran reversal
idarucizumab
103
DPL positive
GI contents, food, oil, >10cc blood in haemodynamically unstable
104
indications for laoporotomy
```
abdo trauma + HD unstable
GSW transversing peritoneum
evisceration
bleeding from stomach, rectum & GU tract following penetrating trauma
free air/rupture diaphragm
CT findings
```
105
common diaphragm injury
5-10 cm in length & involves posterolateral left hemidaphram
106
open book pelvic fracture commonly in
petrol pessary - abrupt stop on motorcycle
107
pelvic binder can stay on for
max 12 hours
108
can stay on spinal board for max
2 hours
109
monro-kellie doctrine
explains ICP (box has limited space)
110
pulse pressure
systolic - diastolic
| normal > 40mmg
111
MABP
diastolic x 2 + systolic
| divided by 3
112
cerebral pulse pressure =
MAP - ICP
| - MAP of 50-150mmhg is auto regulated for constant cerebral blood flow
113
severe brain injury
GCS 3-8
114
moderate brain injury
GCS 9-12
115
mild brain injury
GCS 13-15
116
admission indications for mild brain injury
no ct available but is required, CT abnormal, skull fracture, CSF leak
focal neurological deficit
GCS does not return to normal within 2 hours
117
neurosurgery consultation for
moderate & severe brain injury
118
CT head for
moderate & severe brain injury
mild with - GCS < 15 at 2 hours after, skull fracture suspected, vomiting (> 2), age > 65, anticoagulants, LOC (>5mins), dangerous mechanism, amnesia before impact
119
severe brain injury management
```
frequent examination
PaCO2 35-40
mannitol if signs of herniation
neurosurgery
consider levetiracetam for seizures
```
120
seizure in TBI
acute - phenytoin loading 1g IV (no faster than 50mg/min)
| maintenance - phenytoin 100mg/8hours
121
management of moderate BI
```
CT
admit
observe with frequent GCS for 12-24 hours
neurosurgery
consider repeat CT at 24 hours
```
122
mannitol dose
1g/kg over 5 mins if signs of herniation
| 0.25-1g/kg for raised ICP
123
burr hole
10-15mm drill hole in skull - use if neurosurgeons not readily available
124
C5 dermatome
badge patch
125
C6 dermatome
thumb
126
C7 dermatome
middle finger
127
C8 dermatome
little finger
128
T4 dermatome
nipple
129
T8 dermatome
xiphisternum
130
T10 dermatome
umbilicus
131
T12 dermatome
symphysis pubis
132
L4 dermatome
medial aspect of calf
133
L5 dermatome
webspace between 1st & 2nd toe
134
S1 dermatome
lateral border of foot
135
S3 dermatome
ischial tuberosity area
136
S4 & S4 dermatome
perianal region
137
C5 myotome
elbow flexion
138
C6 myotome
wrist extension
139
C7 myotome
elbow extension
140
C8 myotome
finger flexors
141
T1 myotome
finger abductors
142
L2 myotome
hip flexors
143
L3 myotome
knee extension
144
L4 myotome
ankle dorsiflexion
145
L5 myotome
big toe dorsiflexion
146
S1 myotome
ankle plantar flexion
147
S2, 3, 4
anal tone
148
injury to what spinal level can cause impairment of sympathetic pathways
T6 and above (neurogenic shock)
149
assessment of spine
look, feel, patient move
150
corticospinal tract
anterior & lateral segments of cord
| motor power on same side
151
spinothalamic tract
anterolateral cord
pain & temperature on opposite side
- test by pinprick
152
dorsal columns
posteromedial aspect
position and light touch on same side
- vibration & proprioception
153
area of greatest flexion & extension in c-spine
C5-C6 (most vulnerable)
154
image neck if
age > 65
dangerous mechanism
pareasthesia
unable to rotate neck through 45 degrees with no pain
155
do not image neck if
```
sitting in ED
ambulatory at arrival
delayed onset of neck pain
no midline cervical tenderness
able to rotate neck through 45 degrees
no dangers mechanism
young
no neurology
```
156
screen for carotid/vertebral artery injury
in c1-c3 fracture
157
temporal lobe herniation would compress
```
oculomotor nerve (CNIII)
- pupillary dilation (unopposed sympathetic)
```
158
uncle herniation
corticospinal tract compression - weakness in opposite side of body
159
basilar skull fracture
raccoon eyes
battle's sign
CSF leak from nose/ear
dysfunction of CNs 7 & 8 - facial paralysis/hearing loss
160
BP targets in brain injury
50-69years old systolic >100
| 15-59 years old & > 70 years systolic >110
161
low PaCO2 in BI
cerebral vasoconstriction
162
disproportionately greater loss of motor strength in arms & fingers compared to legs & feet
hyperextension injury in C-spine stenosis
central cord syndrome
163
paraplegia & bilateral loss of pain & temperature
anterior cord syndrome
164
brown-sequard syndrome
ipsilateral motor loss (corticospinal) & proprioception (dorsal)
contralateral loss of pain & temp (spinothalamic)
165
metabolic acidosis, high potassium, low calcium, DIC
rhabdo
166
ABPI
SBP of injured leg divided by SBP of uninjured arm
| < 0.9 is abnormal
167
open fracture wound < 1cm minimal contamination
cefazolin
| if anaphylactic clindamycin
168
open fracture wound 1-10cm, commuinuted fracture§
cefazolin
| if anaphylactic clindamycin
169
open fracture severe soft tissue damage, substantial contamination
cefazolin (if anaphylactic clindamycin) + gentamicin (2.5mg/kg in child, 5mg/kg in adult)
170
open fracture contaminated with farmyard, soil, standing water
tazocin (piperacillin + tazobactam)
171
nerve at risk in elbow injury
ulnar
| - index & little finger abduction, little finger sensation
172
nerve at risk in wrist fracture/dislocation
median distal
| - thenar contraction with opposition, sensation to tip of index finger
173
nerve at risks in supracondylar fracture of humerus
median, anterior interosseous
| - index finger flexion
174
Nerve at risk in distal humeral fracture/anterior shoulder dislocation
musculocutaenous
| - elbow flexion, sensation of lateral forearm
175
nerve at risk in anterior shoulder dislocation/proximal humeral fracture
axillary
| - motor to deltoid, sensation to lateral shoulder
176
nerve at risk in pubic rami fracture
femoral
| - knee extension, sensation to anterior knee
177
nerve at risk in obturator ring fractures
obturator
| - hip adduction, medial thigh sensation
178
nerve at risk in knee dislocation
posteror tibial
| - toe flexion, sensory to sole of foot
179
nerve at risk in fibular neck fracture/knee dislocation
superficial peroneal
| - ankle eversion, sensory to lateral dorsal of foot
180
nerve at risk in fibular neck fracture/compartment syndrome
deep peroneal
| - ankle/toe dorsiflexion, sensation to dorsal 1st & 2nd toe web space
181
nerve at risk in posterior hip dislocation
sciatic nerve
| - ankle dorsiflexion/plantar flexion, sensation to foot
182
nerves at risk in acetabular fracture
superior gluteal
- hip abduction, sensory to upper buttocks
inferior gluteal
- hip extension, sensory to lower buttocks
183
acid or alkali burn worse
alkali
184
carboxyhemoglobin < 20%
asymptomatic
185
carboxyhemoglobin 20-30%
headache & nausea
186
carboxyhemoglobin 30-40%
confusion
187
carboxyhemoglobin 40-60%
coma
188
carboxyhemoglobin >60%
death
189
treatment of carboxyhemoglobin poisoning
100% oxygen (decreases T12 from 4 Horus to 40mins) & intubate
190
fluids in shock in burns
2ml/kg/% of body surface area burned in first 24 hours
- give 1/2 in first 8 hours
- remaining in subsequent 16 hours
3ml/kg/% body surface burned in paeds
191
fluids in electrical injury
4ml/kg/body surface burned
192
repercussion syndrome
acidosis, hyperkalaemia, local swelling
193
RR in infant
normal 30-40
194
RR in older child
normal 15-20
195
needle decompression in paeds
just above 3rd rib in midclavicular line - caution when using 14-18G needles
- chest drain same as adult but tunnel along rib
196
< 1 normal HR
< 160
197
< 1 normal BP
> 60
198
< 1 normal RR
< 60
199
< 1 normal UO
2ml/kg/hr
200
1-2 yr normal HR
<150
201
1-2yr normal BP
> 70
202
1-2yr normal RR
> 40
203
1-2yr normal UO
1.5ml/kg/hr
204
3-5yr normal HR
< 140
205
3-5yr normal BP
> 75
206
3-5yr normal RR
< 35
207
3-5yr normal UO
1.0 ml/kg/hr
208
6-12yr normal HR
<120
209
6-12yr normal BP
> 80
210
6-12yr normal RR
< 30
211
6-12yr normal UO
1.0ml/kg/hour
212
> 13 normal HR
< 100
213
> 13 normal BP
> 90
214
> 13 normal RR
< 30
215
> 13 normal UO
0.5 ml/kg/hr
216
weight estimation paeds
(2 x age in years) + 10
217
blood volume in infant
80ml/kg
218
blood volume in child 1-3 yrs
75ml/kg
219
blood volume in > 3 yrs
70ml/kg
220
IO needle infant
18G
221
IO needle > 3 yrs
15G
222
damage control resuscitation in paeds
1. 10ml/kg bolus crystalloid
response - fine
nonresponder/transient - 10-20ml/kg pRBCs + 10-20ml/kg FFPs
223
V5 in < 4yrs
appropriate words, social smile, fixes & follows
224
V4 in < 4yrs
cries but consolable
225
V3 in < 4 yrs
persistently irritable
226
V2 in < 4yrs
restless, agitated
227
child tracks movement & holds head steady at
3 months
228
child rolls over at
6 months
229
child sits without support at
7 months
230
child stands whilst cruising at
9 months
| - should be saying mama/dada at 8 months
231
child crawls at
10 months
232
child stands without support for a few seconds at
11 months
233
low normal PaCO2 in pregnancy (3.5-4.0)
impending resp failure
234
examination mandatory in pregnancy
vaginal
235
displace uterus to prevent vena cava compression
to the left
| 15-30 degrees
236
normal fibrinogen in pregnancy
?early DIC (usually x2)
237
3 vital signs of the eye
vision, pupils, intraocular pressure
238
normal eye pressure
8-21mmHg
239
anterior examination of eye
periorbita, extra ocular muscles, lids, lashes, lacrimal sacs, conjunctiva, sclera, cornea, iris, anterior chamber and lens
240
posterior examination of eye
red reflex, optic nerve, retina
241
decreased vision, elevated eye pressure, asymmetrical eye bulge, resistance to retropulsion and "rock hard eye" (tight eyelids agains globe)
retrobulbar haemorrhage with compartment syndrome
| - need canthotomy & catalysis (call ophthalmologist)
242
chemical burn to eye
1L of saline, connected to Morgan lens. rinse for 30 mins (or after each 1L) and assess pH for normal (7)
243
test to locate small leaks of aqueous fluid from anterior chamber
seidel test
244
mild hypothermia
32-35
245
moderate hypothermia
30-32
246
severe hypothermia
< 30
247
mild hypothermia in injury
36
248
moderate hypothermia in injury
32-36
249
severe hypothermia in injury
< 32
250
cardiac irritability occurs at what body temp
33
251
VF occurs at what temp
below 28
252
asystole occurs at what temp
below 25
253
mild & moderate hypothermia management
mostly passive warming
254
severe hypothermia management
active warming - warm fluid lavage, haemodialysis, bypass
255
you are not dead until
you're warm and dead
256
heat exhaustion occurs at
39
257
heat stroke occurs at
```
> 40
involves CNS (dizziness/confusion/seizures)
and systemic inflammatory response (rhabdo, encephalopathy, ARDS)
```
258
2 types of heat stroke
```
classic
nonexertional (heat waves, typically affecting young & old)
```
259
exertion heat stroke
young, fit & healthy
| strenuous exercise
260
management of heat injuries
```
A-E
100% O2
consider definitive airway
ABG, renal & urea nitrogen levels
CXR
remember hypoglycaemia, hyperkalaemia, acidosis
seizures - benzos
```
261
goal temp decrease in heat stroke
decrease to < 39 in 30 mins
