Practice exams Flashcards
Three potential advantages to parents being present during resuscitation?
Disadvantages?
Advantages
-Parents can see that all efforts have been made
-Improves ability to accept death and deal with grief
-Reduces risk of litigation
-Improves professional behaviour of staff
-Opportunity to say good-bye
Disadvantages
* Needs designated staff member to support family
* Potential for parental interference
* Distress for parents seeing invasive procedures and other intervention
* Increase stress for staff providing resuscitative care
List six (6) factors that should be considered prior to terminating resuscitation
- Downtime prior to commencement of resuscitation (eg presence of rigor mortis)
- Have all reversible causes been identified and treated
- Underlying severe comorbidity or terminal disease
- Severe biochemical derangement (pH< 6.8, K >10)
- Has there been any response to treatment during resuscitation
- Duration of resuscitation with no evidence of cardiac output
- Persistently low end tidal pCO2 (less than 10-15mmHg)
- Has a senior clinician been involved in managing the arrest (phone or in person)
- Is there team agreement the further resuscitation is futile
Paracetamol toxicity?
Risk assessment
-> 200mg/kg or > 10g
-Survival guaranteed if NAC commenced within 8 hours
-Still treat with established hepatic injury as decreases morbidity (cerebral oedema and inotropic requirements) and mortality
-If present after 8 hours are commenced on NAC immediately while awaiting paracetamol and ALT levels (ALT < 50 normal)
-If double the nomogram line should have increased dose of NAC, double dose second bag
Stage 1 < 24 hours
-Nausea and vomiting or asymptomatic
Stage 2, 24-72 hours
-RUQ tenderness, hepatoxicity
-Transaminases may exceed 10, 000
-INR elevation
-Hypoglycaemia, hyperbilirubinaemia
Stage 3, 72-96 hours
-Fulminant hepatic failure with jaundice and encephalopathy
-Death can occur, associated with worsening lactic acidosis, progressive renal failure, severe coagulopathy and cerebral oedema
Stage 4, 4 days to 2 weeks
-Recovery phase
Decontamination
-Activated charcoal if present within 2 hours
-Also for massive ingestions > 500mg/kg if present within 4 hours
Patients fulminant hepatic failure require management in ICU and transfer to liver transplant service
Criteria include
-INR > 3 at 48h
-Oliguria or Cr > 200micromol/L
-Acidosis with pH < 7.3
-SBP < 80 or lactate > 3
-Hypoglycaemia
-Severe thrombocytopenia
-Encephalopathy
What are the Ellis classification of dental injuries how are they treated?
Ways to minimise pain with local anaesthetic?
Smaller diameter needle
Slow speed of infiltration
Smallest volume necessary
Warming solution
List four (4) risk factors for developing re-expansion pulmonary oedema
- Large Ptx
- Drainage of large volume >1.5L
- Young patient
- Lung collapse >7/7
- Application of negative pressure (suction)
The patient states he is a Jehovah’s Witness and presents a written Advanced Care Directive stating that
he will not consent to treatment with blood products under any circumstances.
List three (3) criteria that must be fulfilled for this Directive to be valid
- Written voluntarily / without coercion
- Written when patient was competent/had capacity
- Relevant to the current situation
You deem the best course of action is to focus on end of life comfort care.
Outline your approach to this situation with the daughter.
Private environment
- Explanation of rationale of change of focus to comfort, maintaining dignity
- Include pt if possible
- Establish pt’s previous wishes, enquire about ACD
- Stakeholders/family/priest/cultural rep
- Engage treating teams
- Social worker
Palliative care medications?
What are the four (4) cardinal signs of flexor tenosynovitis?
- Tenderness along the course of the flexor tendon
- Symmetrical oedema of the finger (“sausage digit”)
- Finger slightly flexed at rest
- Pain along the tendon on passive extension
Define cultural competency in health practice
Cultural competency is a set of attitudes, skills and knowledge that allow an individual to
interact effectively in cross-cultural situations
How can cultural competency be incorporated into practice?
- Treating the patient with their specific cultural context in mind
- Ensuring that the patient feels safe
- Approaching those of other ethnicities with a mixture of empathy, respect, self-reflection and
curiosity, ensuring that the patient does not feel judged based on their cultural background - Being aware of how our own culture impacts on our health practice
- Knowledge of different ethnicities and their health statuses
- Knowledge of different cultures and their beliefs and experiences around health
- Continuing to improve your skills in these areas
What is the insulin rate for children < 5 with DKA?
0.05 units/kg/hr
Define Emergency Department overcrowding?
Situation where ED function is impeded primarily because the number of patients waiting to be seen,
undergoing assessment and treatment, or waiting to leave exceeds the physical and/or staffing
capacity of the ED
Other than access block, list six causes for ED overcrowding
- increased patient number (eg- a seasonal component like winters)
- increased patient complexity
- increased unnecessary patient evaluation/investigation
- delays in referral
- delays in-inpatient unit assessment
- delays in other services eg radiology, pathology, allied health (max 2 marks)
- ED staff factors eg-skills, numbers
- ED structure eg design/size
Define access block
Inability to access appropriate beds in a timely manner for emergency patients who require
inpatient admission quantified as the proportion of patients admitted, transferred to other
hospitals, or who die in the ED who have a total ED time (arrival at triage to discharge from the ED) of
more than 8 hours
List three broad recommendations made by ACEM (Australasian College for Emergency Medicine) to
ensure more effective and efficient patient care in Emergency Department.
- demand reduction eg increased access to outpatient clinics, easier referral pathways
- removing barriers to patient flow eg pull model, minimize investigations in ED
- reducing hospital occupancy eg improved discharge planning, HITH options post discharge
Complete the table labelling parts of the under water seal unit?
Suggested pressures for patients with chest drain who require suction?
Suggested pressures for other patients who require suction -20cmH2O/15 mmHg
What are two methods for measuring blood pressure in patients with an LVAD?
- NIBP is performed with a manual sphygmomanometer and Doppler ultrasound over
brachial or radial artery - Invasive mean arterial pressure can be obtained by placement of an ultrasoundguided
arterial line
List four initial first aid or topical measures that can be used to control anterior epistaxis?
Sit with head forward to prevent swallowing/ aspiration of bloodAdvise patient to spit out and
not swallow blood
Suction blood/ clots from the nares or ask patient to blow nose Topical Vasoconstrictors -
adrenaline/ co-phenylcaine / oxymetazoline
Continuous pressure to the anterior nares (cartilaginous part) for 15-20 minutes
Cautery with silver nitrate - do don’t apply to both sides of the septum
List three factors on physical examination that suggests a posterior source of epistaxis?
Failure to visualize blood anteriorlyBleeding from both nares
Visualisation of blood in the posterior pharynx
Despite insertion of an appropriately sized Rapid Rhino, the bleeding remains uncontrolled.
Management of life threatening bleeding on dabigatran?
Dialysis - Consider on setting of impaired renal function or dabigatran present inexcess as
indicated by aPTT > 80 seconds or a dabigatran level> 500 mg/ml
Reversal agent - ldarucizumab (Praxbind) 2.5g to 5g. Only indicated if thrombin time prolonged
TXA 15mg/kg IV
List four possible factors in this man that would make his wound high risk and necessitate the need to
treat with antibiotics
- *>8hour delay in review
- puncture wound that can’t be adequately debrided
- wound on hand
- involving deep tissues- bones, joints, tendons
- pt immune compromised or alcoholic, liver disease or DM
- open #
