Random Bits I Still Don't Know

Question 1

What echo signs would you be looking for in an MI

Answer 1

regional wall motion abnormalities
signs of complications: papillary muscle rupture, septal wall rupture, pericardial effusion
signs of old infarct: wall thinning

Question 2

What echo signs would you be looking for in a PE

Answer 2

dilated RV
underfilled D shaped LV
tricuscpid regug
septal flattening

Question 3

What echo signs would you be looking for in a tamponade

Answer 3

swinging heart
diastolic collapse of RA +/- RV later in disease process
IVC plethora: reduced IVC collapse on inspiration

Question 4

What echo signs can exclude a pneumothorax

Answer 4

lung sliding
A and B lines
lung pulse (rhythmic motion of visceral along parietal pleura with each cardiac contraction)

Question 5

What echo signs would indicate a pneumothorax

Answer 5

lung point - the point at which visceral pleura is no longer associated with parietal pleura

Question 6

What are A and B lines on an echo

Answer 6

A - horizontal reflective lines which are artefact. Generated by pleural layers

B - They extend radially from the pleura and indicate that the parietal and visceral pleura are in apposition and therefore no pneuomothorax

Question 7

What echo signs would indicate hypovolaemia

Answer 7

small hyperkinetic LV
kissing ventricles: LV is obliterated at the end of systole
small IVC with exaggerated collapse on inspiration

Question 8

What ECG features would make you suspect a RV infarct and how could this be confirmed

Answer 8

ST elevation in V1 +/- depression in V2

confirm with ST elevation in V4R

Question 9

Why is giving nitrates to inferior STEMI’s bad

Answer 9

With poor RV contractility the heart is preload sensitive so giving nitrates (reduces preload) lead to profound hypotension

Question 10

What ECG features would make you suspect a posterior infarct and how would you confirm it

Answer 10

reciprocal changes (ST depression, upright T) in V1-V3
dominant R in V2
confirm: ST elevation in V7-V9

Question 11

What could lead to a AV block following MI

Answer 11

ischaemia of the AVN following RCA infarct (AVN artery arises from RCA)

Question 12

MOA of reteplase, aspirin, clopidogrel and LMWH

Answer 12

reteplase: recombinant TPA
aspirin: reduced thromboxane A2 so reduced binding to TXA2
clopidogrel: inhibit ADP binding to P2Y12 receptors
LMWH: indirect factor Xa inhibitor and direct thrombin inhibitor

Question 13

elevated R in aVR =

Answer 13

Na channel blockers!!

Question 14

causes of bidirectional VT

Answer 14

CPVT

severe digoxin toxicity

Question 15

How far are you inserting an ET tube

Answer 15

small adult: 21cm
big adult: 22-23cm
child: age/2 + 12

Question 16

what can be used to better look for epsilon waves

Answer 16

fontain bipolar precordial leads

Question 17

define deffered consent

Answer 17

patient is randomised according to criteria that have been made clear in ethical review then request for patient/their representatives informed consent is done at a later stage

Question 18

what is exception to informed consent with prior community consult

Answer 18

researchers consult with members of the community in which the research will be carried out prior to the research being done

Question 19

what is transthoracic impedance and what effects it

Answer 19

the bodies resistance to current flow

inter-electrode distance, skin-electrode interface, ventilation

Question 20

What benefits does TTM have on a cellular level

Answer 20

stops MPTP opening
preserves mitochondrial function
lower metabolic demand from tissues

Question 21

Give an example of a hallogenated volatile anaesthetic and a depolarising neuromuscular relaxant

Answer 21

halogenated volated anaesthetic: halothane

depolarising neuromuscular relaxant: succinylcholine

Question 22

What extra tests are needed for ROLE in hypostasis, rigor mortis, submersion

Answer 22

no heart sounds
asystole on ECG for 20 seconds
bilaterally absent pupil response
no pulse

Question 23

False positive ETCO2 can be caused by:

Answer 23

exposure to acidotic fluid eg stomach contents or adrenaline

fizzy drinks or vigorous BM ventilation can give false +ve if tube in oesophagus

Question 24

False negative ETCO2 can be caused by

Answer 24

low pulmonary flow - PE

Question 25

describe cerebral performance categories 1-5

Answer 25

1: conscious, can work, may have minor deficit 2: conscious, can work in a sheltered environment 3: conscious, dependant on others for ADLs 4: coma, vegetative state, unaware, sleep wake cycles, may open eyes 5: brain dead

Question 26

What does the cormack-Lehane intubation classification classifiy

Answer 26

views seen on direct laryngoscopy to determine how difficult intubation is likely to be

Question 27

calculation for mean arterial pressure

Answer 27

1/3 systolic + 2/3 diastolic

Question 28

NPA size for majority of adults

Answer 28

green 6mm | orange 7mm

Question 29

NPA insertion method

Answer 29

advance along septum horizontally with the bevel towards the septum

Question 30

OPA sizes

Answer 30

``` green = size 2 orange = size 3 red = size 4 ```

Question 31

how do you calculate the weight of a child

Answer 31

(age + 4) x 2 | (months/2) +4

Question 32

how do you calculate ET tube depth insertion for paediatrics

Answer 32

3 x tube size or | (age/2) + 12

Question 33

If adrenaline is needed to maintain BP post ROSC, how much is given

Answer 33

50 micrograms

Question 34

When should you feel for a pulse during ALS

Answer 34

only when an organised rhythm (narrow or regular) is seen at the end of a 2 minute cycle

Question 35

lactate range

Answer 35

0.5-2.2

Question 36

when would you measure lactate

Answer 36

post resuscitation - MABP should be targeted to achieve a normal or decreasing lactate

Question 37

what are the 3 classifications of a newborn according to their initial assessment

Answer 37

1: vigorous breathing, HR > 100, crying, good tone 2: breathing inadequate, HR <100, normal-reduced tone 3: breathing inadequate, undetectable HR, floppy, pale

Question 38

How would you treat a newborn categorised as 2 on initial assessment

Answer 38

dry and wrap and baby should improve with mask inflation

Question 39

How would you treat a newborn categorised as 3 on initial assessment

Answer 39

dry and wrap, immediate airway control, lung inflation and ventilation. May need chest compressions

Question 40

What would make you suspect a RV infarct

Answer 40

Patients with inferior infarct + clinical shock + clear lung fields

Question 41

paeds adrenaline dose

Answer 41

0.1mg/kg of 1:10,000

Question 42

GRADE

Answer 42

grading of recomendations, assessment, development and evaluation

Question 43

SEERS

Answer 43

scientific evidence evaluation and review system

Question 44

COSTR

Answer 44

consensus on science with treatment recommendations