Tuesday Teaching Extras

Question 1

four differentials?

Answer 1

• Ruptured AAA
• epidrual abscess with shock
• perforated DU
• Aortic dissection
• renal colic
• lumbar back pain

Question 2

in a ruptured AAA what are pros and cons of US V CT

Answer 2

US

Pro - fast and no radiation
Con - user dependent, not as reliable, low sen and spe

CT
Pro - high sensitibity and specificy, allows surgical planning, rules out other things
cons - radiation, time consuming, danger of going in scanner

Question 3

what criteria is used by ambos to decide whether to bypass a hospital to go to trauma centre

Answer 3

MIS

Mechanism
eg over 60km
fatality in same accident
state of vehicle
children

Injuries
penetrating
severe burns
head injury with coma

Signs
shock
resp distress

Question 4

advantages and disadvantages of trauma bypass

Answer 4

Advantages
* reduces mortality
* concentrate resources
* staff retention

Disadvantages
* deskilling of staff
* over triage of injuries
* longer transit times
* harder for family to accesss

Question 5

what makes a psych patient high risk for retrieval?

what drugs can you use to ease transfer?

Answer 5

• threats of violence
• active thought disorder
• medication non compliance
• intoxicated
• history of violence
• evidence of self harm
• previous assault

Diazepam 10mg oral prn
Ketamine 20mg aliquots prn, or infusion 50-250mg/hr (0.6-3mg/kg/hr)
Droperidol 10mg IM

Question 6

doses of sodium bicarb and hypertonic saline

Answer 6

Sodium Bicarb 8.4 %
* 50-100ml in arrest or hyperK
* 1-2ml/kg in TCA if seizing

Hypertonic saline 3%
* 100ml bolus to raise rapidly in seizures (2-3mmol)
* Acute - 1-2ml/kg/hr in acute low Na aim for 1-5mmol/l/hr
* Chronic - 10mmol/day
* 3ml/Kg ICH

Question 7

insulin treatment for
hyperK
Calcium channel OD

Answer 7

hyper k - 10 units in 50% dextrose 50ml
Ca - 1unit/kg + 50% dextrose 50ml
Then 0.5units/kg/hr and dextrose 50% 50ml/hr

Question 8

Adrenaline dose for newborns

Answer 8

Question 9

How do you calculate osmolar gap

What is normal

What causes high?

Answer 9

Measured osmolality - calculated osmolality

Calculated osmolality = 2 x na + urea + glucose + ethanol

Normal is less than 10

High:
* mannitol
* methanol
* ethylene glyco.
* Drugs - IV lorazepam/phenytoin

Question 10

what can you not give in quetiapine OD

Answer 10

Adrenaline

Question 11

complications of SCA

Answer 11

• Infections
• Priapism
• Vaso occlusive criss
• Acute chest syndrome
• Acute splenic sequestration

Question 12

What is TTP in child?

Answer 12

HUS

Question 13

hunter criteria

Answer 13

Question 14

drugs you can put in tube and dose

Answer 14

NAVEL - 2-3x normal dose
Naloxone
Atropine
Vasopressin
Adrenaline
Lidocaine

Question 15

Chain of survival

Answer 15

Question 16

hypoxia post intubation

Answer 16

Question 17

CVP pressure sepsis target

Answer 17

8-12mmhg

Question 18

ways to incresse electrical impedence in shock

Answer 18

shave, dont place over jewellwet, over ecg pads, over lines, ensue gel, ensure good cover

Question 19

when do you use dual sequential defib?

Answer 19

refractory VF

Question 20

how long does high dose insulin take to work?
When do you use

Answer 20

1 hour
Any tox with cardio suppression eg bets blocker, calcium channel blocker

Question 21

causes of pacemaker failire

Answer 21

output failure - battery, wire fracture, lead displacement
capture failure - wire fracture, lead displacement, wire fibrosis, electrolyte derangement, MI (dead tissue)

Question 22

fluid components

Answer 22

Question 23

dex dose kids
midaz dose

Answer 23

10% 2-5ml/kg
0.15mg/kg

Question 24

age weight tube size kids

Answer 24

1 - 10 - 4
5 - 20 - 5
10 - 30 - 6

Question 25

adrenaline infusion dose anaphylacxis

Answer 25

1ml of 1:1000 in litre 5ml/kg/hr

Question 26

contraindications for ED thoractomy

Answer 26

* Penetrating injury + no signs of life and CPR > 10min * Blunt injury + no signs of life > 5 minutes * Multiple severe blunt trauma * Non-survivable head injury No signs of life on scene

Question 27

when to stop ED thoractomy

Answer 27

no cardiac activity, no tampanade found, SBP under 70 after 30 mins of management

Question 28

principles of damage control resus

Answer 28

1) recognition 2))haenostatic resus – stop triad, 1:1:1 blood 3)Rapid movement to theature eg scoopr and run and wllow permissive hypotension

Question 29

steps in thracotomy

Answer 29

intubated and have had bilateral thoracostomies (in the 4th or 5th Using a 10-blade scalpel, connect the bilateral thoracostomies. Make your incision count; cut through the skin and subcutaneous tissue down to the intercostal muscles. Try and remain in a single intercostal space. You may need to extend the incision laterally, but if you do so, remember to not go straight down to the bed, but extend up into the axillae. Using heavy scissors, cut through the intercostal muscles towards the sternum and through Now that you are through the sternum, lift up the chest wall (clamshell) and expose the thoracic organs. Place your rib-spreader .

Question 30

Trauma scores

Answer 30

ISS TS RTS GCS

Question 31

infusion doses for dissection

Answer 31

GTN - 50mcg/min fent - 100mcg/hr labetalol - 20mg/hr hydralazine 3ml/hr

Question 32

eye movements

Answer 32

Question 33

drawbacks GCS

Answer 33

* not in tox * not in kids * inter user variability * need to be skilled * not a good indicator of mortalirt between 7-9 * only designed for head injury

Question 34

cord syndromes

Answer 34

Question 35

steps after clam shell

Answer 35

* Open the pericardium to relieve tamponade * Identify and repair any cardiac injuries * Perform internal cardiac compressions * Cross-clamp the aorta if needed * In the presence of major lung injury, collapse and compress the lung

Question 36

deep sulcus sign

Answer 36

pneumothorax

Question 37

co2 for all head stuff

Answer 37

35-40

Question 38

signs of tampanade

Answer 38

becks triad tachy chest pain pulsus paradoxus

Question 39

NB for all trauma

Answer 39

Abx and ADT

Question 40

when do you not do permissive hypotension

Answer 40

head injury

Question 41

Clinical Irikandji

Answer 41

Question 42

Irikanji treatment

Answer 42

Vinegar Do not apply a pressure immobilisation bandage (PIB) To emergency department Administer IV fentanyl (0.5–1.0 microgram/kg/dose) repeated every 10 minutes until appropriate analgesia is achieved. Control hypertension refractory to opioid analgesia with an intravenous infusion of glyceryl trinitrate (50 mg in 100 mL starting at 6 mL/minute; 1–4 microgram/kg/minute in children) titrated to achieve a systolic blood pressure <160 mmHg Manage pain refractory to opioids with IV magnesium (0.2 mmol/kg up to 10 mmol in adults) administered over 5–15 minutes. Seek expert advice

Question 43

Venlafaxine

Answer 43

SNRI AND SSRI Serotonin syndrome and seizures