Respiratory Failure, Falls, Head injury

Question 1

What is respiratory failure?

Answer 1

Acute impairment in gas exchange between the lungs & blood causing hypoxia with/without hypercapnia

Question 2

What are the causes of acute respiratory failure?

Answer 2

Acute exacerbation of asthma
PE
Pulmonary oedema
ARDS
Pneumonia
Acute epiglottitis
HypoV (blood loss, dehydration)
Shock
Severe anaemia
R to L cardiac shunting

Question 3

How does acute respiratory failure present?

Answer 3

Dyspnoea
Tachypnoea
Confusion
Accessory breathing muscle use
Stridor
Inability to speak
Retraction of intercostal spaces
Cyanosis

Question 4

How is acute respiratory failure investigated?

Answer 4

Sats

ABG

Question 5

How is acute respiratory failure treated?

Answer 5

ACUTE:
Airway clearance
O2
Tx underlying cause
ET tube, mechanical ventilation, RSI

Question 6

What factors increase the risk of someone falling?

Answer 6

Impaired motor function
Impaired sensory function
Cognitive impairment
Orthostatic hypotension
Polypharmacy: >5 meds
Substance abuse
Environmental hazards

Question 7

After a fall, what factors would warrant immediate investigation?

Answer 7

Change in alertness/consciousness
Brady/tachycardia
Head injury
Pain suggesting potential fracture

Question 8

When taking a Hx on a fall what should be asked?

Answer 8

Location
Activity at time of fall
Injuries
Sx post-fall
Sx related to change in position
Medications & reviews
Falls RFs

Question 9

What is the criteria for a CT head in adults within 1hour of a head injury?

Answer 9

GCS <13 initially
GCS <15 at 2hours
?Open/depressed skull #
Signs of basal skull #
Post-traumatic seizure
Focal neuro deficit

Question 10

What is the criteria for a CT head in a child within 1hour of a head injury?

Answer 10

Suspicion of non-accidental injury
Post-traumatic seizure
GCS <14 initially or <1yo GCS <15
GCS <15 at 2hours
Focal neuro deficit
?Open/depressed skull #
Signs of basal skull #
<1yo: Bruise/swelling/laceration >5cm on head

Question 11

What RFs in a child with a head injury warrant a CT head within 1 hour?

Answer 11

> 1 of:

• LOC >5mins
• Abnormal drowsiness
• > 3 episodes of vomiting
• Dangerous mechanism of injury
• Amnesia >5mins

Question 12

What are the indications for a CT cervical spine in 1hour?

Answer 12

GCS <13 initially
Intubated
Xray inadequate
Xray suspicious 
Definitive diagnosis needed urgently (surgery)

Question 13

If there has been a LOC or amnesia since a head injury should a CT head be done?

Answer 13

CT within 8hours if any of:
>65yo
Bleeding/clotting disorder
Warfarin therapy
Dangerous mechanism
>30mins retrograde amnesia

Question 14

What are the primary & secondary causes of a head injury?

Answer 14

PRIMARY: Occurs at time of trauma, causes axonal shearing
SECONDARY: Occurs later usually due to preventable & reversible factors: Hypoxia, hypoV, infection

Question 15

How is ↑ICP treated?

Answer 15

16mg Dexamethasone

Question 16

What are the indications for C-Spine immobilisation?

Answer 16

GCS <15
Neck pain/tenderness
Focal neuro deficit
Paraesthesia in extremities
?suspicion of C-Spine injury

Question 17

What is the Canadian C-Spine Rule?

Answer 17

ANY 1 high risk factor:
- >65yo
-Dangerous mechanism
-Numbness/tingling in extremities
ANY 1 low risk factor which allows safe assessment of RoM:
-Simple rear end MVC
-No neck pain at scene 
-No pain during midline C-Spine palpation

Question 18

When can a C-Spine collar be removed using the canadian C-Spine Rule?

Answer 18

No high risk factors
1 low risk factor allowing safe assessment of RoM
Patient voluntarily able to actively rotate neck 45 degrees L&R