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1
Q

What are the precautions for methoxyflurane?

A

Renal disease

Diabetes

Caution if pt unable to self-administer

Use in post-delivery phase of labour and with PPH; may induce uterine atonia

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2
Q

Dose of glucagon for 18kg pt:

A

<20kg = 0.5IU IM

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3
Q

What are the four types of shock, and a cause of each?

A

Hypovolaemic shock: haemorrhage or non-haemorrhagic (burns, dehydration)

Cardiogenic shock: caused by heart not pumping effectively (AMI, dysrhythmias)

Distributive shock: caused by excessive vasodilation and impaired fluid distribution resulting in third spacing (sepsis, anaphylaxis, burns, spinal cord or brain injury, Addisonian crisis)

Obstructive shock: physical obstruction of great blood vessels (PE, cardiac tamponade, tension pneumothorax)

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4
Q

What is the dose of IMI morphine? + calculate dose and volume for paediatric patient

A

0.1mg/kg

Repeat 1x, after 30-45 mins if required.

Do not exceed 20mg.

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5
Q

What is the dose and volume of IV morphine for a 5yo who has already had fentanyl?

A

Up to 0.05mg/kg

Half dose because post-fentanyl

5x2+9= 19kg

19 x 0.05mg = 0.95mg/2 = 0.475mg

Can round to 20kg to make calculations easy

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6
Q

What are the contraindications of paracetamol?

A

Known or suspected allergy

Previous paracetamol in last 4hrs (oral)

Previous paracetamol in last 6hrs (IV)

Children who do not have sufficient gag reflex to swallow measured dose.

Not to be given to children <1 month

Diagnosed liver failure.

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7
Q

What are the contraindications for aspirin?

A

Known or suspected allergy

Known or suspected active bleed

Known bleeding tendency

Chest pain associated with psychostimulant use

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8
Q

What is the management of seizures during pregnancy?

A

IV magnesium sulphate as first line agent: 2.5g over 30-60secs

ICP: follow initial IV dose with springfusor infusion

High flow oxygen therapy

Treat symptomatically as per appropriate CMG

Urgent transport and early notification to ED (not birth suite)

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9
Q

Name 4 signs and symptoms of ACS:

A

Chest pain/pressure/fullness/discomfort

Pain/discomfort in one or both arms, jaw, neck, back or stomach

SOB

Dizziness/light-headedness

Nausea

Sweating/clamminess

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10
Q

3 adverse effects of adrenaline:

A

Tachycardia

Tachyarrhythmias

Hypertension

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11
Q

Indications for pelvic binder + demonstrate application:

A

Patients suspected of having a pelvic fracture, particularly if hypotensive

Patients with significant ALOC where pelvic fracture cannot be excluded

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12
Q

What is the dose of ceftriaxone for 6yo and how do you administer it?

A

Weight: 21kg

Dose = 50mg/kg to total of 2g

50 x 21 = 1.05g

2x 1g vials, reconstituted with 10mL, administer 10mL + 0.5mL of 2nd 10mL IV preferred

If administering IM – reconstitute 2x 1g vials with 3mL

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13
Q

What are the 3 steps in the “stepwise” approach to pain management and give an example of each?

A

Non-pharmacological: splinting, positioning, reassurance

Enteral/Inhalation: methoxyflurane, paracetamol, ibuprofen, GTN

Parenteral: morphine, ketamine, IV paracetamol, midazolam, fentanyl

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14
Q

What signs and symptoms indicate organophosphate poisoning

A

Salivation

Lacrimation

Urination

Defecation

GI Upset

Emesis

Bradycardia

Bronchospasm

Bronchorrhea

Miosis (pin point pupils)

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15
Q

Actions of Ibuprofen:

A

Analgesic

Anti-pyretic

Anti-inflammatory

Inhibits prostaglandin synthesis via inhibition of COX-1 and COX-2

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16
Q

Adverse effects of Droperidol:

A

May lower seizure threshold

ECG Changes – prolonged QT and torsades de pointes

Extrapyramidal effects

Neuroleptic malignant syndrome

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17
Q

What should you do if you have made a medications error?

A

nil answer

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18
Q

What medications can you administer through an IO?

A

nil answer

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19
Q

Demonstrate insertion of OPA in paediatric

Application of CAT

Demonstrate COACHED

Demonstrate application of traction splint

Demonstrate CPAP application

Demonstrate Valsalva manoeuvre

Demonstrate 12-Lead ECG application/discuss the landmarks

A

Discuss. nil answer

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20
Q

Demonstrate and discuss 15-Lead ECG:

A

Indicated for suspected posterior MI

Reciprocal changes in V3, V4

V4 moves to V4R: 5th intercostal, right midclavicular line

V5 moves to V8: Posterior 5th intercostal space, mid scapular

V6 moves to V9: 5th intercostal space, left paraspinal border

Mark movements on ECG once printed

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21
Q

Treatment of 4y/o with BGL 22mmol/L:

A

Aim is to bring BGL down: ideally done with insulin, but no access = fluids

Fluid replacement as per CMG 14 for dehydration: up to 10mL/kg to maintain BP >90mmHg (adults).

Normal BP for 4YO = 70-110mmHg, consider other indicators of perfusion.

4yo = 17kg = up to 170mL NS

Symptomatic management

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22
Q

Mechanism behind autonomic dysreflexia:

A

Cutaneous or visceral noxious stimuli below level of injury

Afferent signals travel up the spinal cord, triggering sympathetic response.

In an intact autonomic NS, increased BP activates baroreceptors, leading to parasympathetic response - slows HR and causes vasodilation

Normal parasympathetic compensatory response unable to travel below the level of injury, resulting in the characteristic symptoms of AD.

Diffuse vasoconstriction and consequent rise in BP below level of injury while normal parasympathetic response occurs above level of injury (bradycardia and vasodilation).

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23
Q

What is the dose of ketamine for an agitated pt and what should be considered when administering this?

A

200mg IMI initial dose

100mg IMI initial dose if >65 years or with general debility

Repeat 1mg/kg IMI (after 5 mins if require)

Must have ICP back-up attend

In the shocked patient, consider a smaller dose than full dose and onset of action will be prolonged

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24
Q

Explain effect of CPAP on respiratory function:

A

Provides constant, fixed positive end expiratory pressure throughout inspiration and expiration which maintains adequate functional residual capacity within the alveoli to prevent alveoli collapsing, thus reducing gas trapping.

Increases volume of air available gas exchange, thus decreasing V/Q mismatch

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25
3 examples of when the cease resuscitation policy would not apply:
Episodes of sustained cardiac output (>4 mins) during resuscitation Sustained or recurrent VF/VT Cardiac arrest in advanced pregnancy (>22 weeks) Significant hypothermia (<33 degrees) Apparent reversible cause Persistent narrow complex PEA Difficult patient situation
26
When should pts with GI bleed be transported to TCH?
Pts with significant GI bleed as indicated by GI bleed + signs of shock (tachypnoea, ALOC, cap refill >2sec, pallor, diaphoresis, tachycardia, hypotension) should be transported directly to TCH.
27
When is PEEP contraindicated?
Suspected pneumothorax
28
A pt presents with significant blood vessel injury (post trauma) and is hypotensive. What should you monitor for throughout treatment?
Monitor for tachypnoea, ALOC, and skin findings such as cap refill, pallor, and diaphoresis which may indicate worsening state of shock. Reassess haemorrhage control measures (torniquets, pelvic binders, packed wounds, wounds with pressure applied) to ensure bleeding has ceased (or slowed) Reassess neurovascular obs as required/as relevant.
29
What are the contraindications for ondansetron?
Known hypersensitivity
30
What are the contraindications for LMA insertion?
Active vomiting (excl. passive regurgitation) Gag reflex (incl. ketamine sedation only) Epiglottitis Facial fractures where you cannot visualise the landmarks
31
Dose of adrenaline for paediatric asthma:
0.01mg/kg up to 0.5mg IM Max. 3 doses, with 5 mins between each
32
Management of cord prolapse:
Urgent transport without delay + early prenotification Assess if the cord is pulsating Pulsating: Minimal handling to prevent vasospasm Position in exaggerated sims (left lateral with hip raised) Gently place cord back into vagina If unable to place into vagina, support with warm, moist dressings Non-pulsating: Minimal handling to prevent vasospasm Position in exaggerated sims Using fingers, gently apply pressure on foetal presenting part to alleviate compression of cord. May also position mother in knees-to-chest, head down – not ideal for transport
33
Dose of prochlorperazine for a 10y/o (30kg) child:
Not used in anyone aged <18yrs
34
Why is GTN precautioned in RVI? What precautionary action should you take?
Poor RV contractility = preload sensitivity and dependence on preload to maintain BP. Nitrates cause systemic vasodilation; venous dilation decreases preload, while arterial dilation decreases systemic vascular resistance, and therefore, afterload. Have fluids running and use nitrates with caution.
35
What is the management for an open sucking chest wound?
Cover wound with commercial chest seal if available If signs of tensioning, peel back seal and “burp” the wound to encourage air to escape In absence of commercial chest seal, use 3-sided dressing (defib pads with cables removed, sterile packaging and tape etc. Have a low threshold for decompression – Have ICP back-up coming
36
Where should the umbilical cord be clamped and cut if necessary?
Following normal delivery, once the cord has stopped pulsating: clamp three times, 10cm from neonate, 15cm from neonate, and third clamp close to the mother’s perineum. Cut between the 1st and 2nd clamps. If cord is around neck, and cannot be delivered through the cord and the cord cannot be slipped over the neonates head; clamp in two places and carefully cut the cord.
37
What should you do if you suspect a child has been involved in a non-accidental injury?
Provide care to patient as required including transport to hospital if needed If the child is at immediate risk, request AFP attendance Contact DOO to arrange temporary release from duties to complete report. Contact CYPS via phone or complete the online report form
38
What is the dose of MDI salbutamol for an adult with asthma?
Mild-Moderate: 4-12 puffs, repeat after 20-30mins Severe: 12 puffs, repeat after 20 mins Life-threatening: 12 puffs, repeat after 10 mins
39
What temperature range is considered mild hypothermia and what is the management?
32-35 degrees More rapid warming acceptable Warm oral fluids (sweet if possible)
40
What are the contraindications for fentanyl administration?
Bilateral bleeding or occluded nostrils ALOC Children <1yo Known allergy or previous reaction to fentanyl
41
What size LMA would be appropriate for a 25kg pt?
Size 2.5
42
Discuss the management of a complete foreign body upper airway obstruction in a conscious pt:
5 back blows If fails: 5 chest thrusts (if possible, position with head down to utilise gravity If fails: repeat the sequence above If fails: urgent transport and 100% oxygen
43
What time frame should crush be considered?
Development of crush syndrome is time and pressure dependent Even if force not sufficient to mangle muscle tissue, muscle death may occur within an hour
44
What is the dose of normal saline for a 70kg patient with anaphylaxis?
Up to 20mL/kg with aim to maintain SBP >90mmHg
45
When is an OPA contraindicated?
Patients who have a gag reflex
46
When should a CAT be applied?
Uncontrolled, life-threatening haemorrhage of a limb
47
Once bleeding has ceased, should the CAT be released?
CAT should remain in situ until it can be released in theatre at hospital
48
What is the dose of aspirin for a pt taking warfarin?
150mg (half of 300mg tablet) Does not apply to any other anti-platelet therapy
49
When should CPAP be applied?
Conscious patients who are able to follow instructions with: Respiratory distress (increased HR, decreased SpO2, using accessory muscles) APO, severe asthma, COPD exacerbation CO Poisoning, smoke inhalation, near drowning, anaphylaxis
50
How many doses of ondansetron may be administered to a pt with nausea?
Adult: single dose only Paediatric: IV/IM weight-based dose can be repeated 1x if required after 10 mins Paediatric: PO single dose only
51
Contraindications of oral glucose gel?
Impaired or absent swallow/gag reflex
52
Can 3 paramedics travel in the back of an ambulance travelling P1?
No – it would not be appropriate for 3 paramedics to travel in the back of an ambulance travelling P1 due to lack of restraints.
53
What is the recommended flow rate for a nebuliser mask?
8L/min
54
When should a traction splint be applied?
Patient with suspected mid-shaft femur fracture
55
Calculate dose of Glucose 10% for a 5y/o:
Up to 2.5mL/kg 5yo weight = 2x5 + 9 = 19kg Max. dose = 47.5mL
56
What is the landmark for IO insertion and locate it?
Proximal tibia, 2cm medial to the tibial tuberosity Located distal aspect of patella, 2cm distally, then medial to locate flat aspect of bone Distal tibia, 3cm superior to the medial malleolus
57
What are three complications of IV access? 
Extravasation Thrombophlebitis Haematoma formation Venous air embolism Dislodgement
58
When should a BP not be performed on am arm and why?
Pts who have had mastectomies are at risk of lymphoedema if BP taken on the same arm as surgery Avoid taking BP on fistula arms of dialysis patients.
59
Calculate GCS for a patient who opens eyes to voice, localises to pain, and is confused:
Eyes: 3, Verbal: 4, Motor: 5 GCS: 12
60
What colour represents deceased pt in triage tag system?
Black
61
What are for the indications for fundal massage?
Placenta delivered Significant vaginal haemorrhage (>500mL) Fundus not firm (uterus spongey/soft on palpation) May be performed if placenta insitu in case of torrential haemorrhage with signs of haemodynamic compromise – THIS IS A LAST RESORT
62
What is maximum PEEP that can be applied to an adult patient post drowning?
15cm H2O, only if desaturating with 10cm H2O
63
What is the dose of adrenaline and how many repeats for anaphylaxis?
Adult: 0.5mg IM, repeat up to 3x, 5 mins between each Paediatric: 0.01mg/kg (up to 0.5mg) IM, repeat up to 3x, 5 mins between each
64
What are two medical causes of upper airway swelling?
Anaphylaxis Croup/epiglottitis Oral/pharyngeal infection
65
What is the management of upper airway swelling for am 8kg child?
Nebulised adrenaline: 0.5mL/kg 1:1000, make up to 5mL with saline, single dose 8kg x 0.5 = 4mL + 1mL NS
66
What is the most common type of diabetes seen in children?
Type 1 Diabetes Mellitus
67
What is Cushing’s Triad?
A set of signs indicative of increased ICP Consists of bradycardia, irregular respirations, and widened pulse pressure reflected by increasing SBP
68
How should suspected decompression illness be postured? Why?
Posture supine, do not sit pt up If unconscious, position left lateral Supine positioning has been shown to increase rate of inert gas elimination as well as decreasing likelihood of arterial bubbles travelling to the brain.
69
What is the correct size for a BP cuff?
A BP cuff should cover approx. 2/3 upper arm Alternatively, in children, the BP cuff should cover 40% of the upper arm
70
What are the contraindications for morphine?
Respiratory depression BP <70mmHg systolic Acute asthma attacks
71
Why should PEEP be avoided in a patient with TBI?
PEEP should be avoided in patients with TBI (or other intracranial pathology) due to the risk of hypotension and decreased cardiac output; the goals of management for head injury are to maintain adequate perfusion and oxygenation of the brain.
72
What are the lateral leads on an ECG?
V5, V6, I, aVL
73
What are the contraindications for NPA insertion?
Resistance during insertion/unable to insert easily.
74
When should transport of the deceased person be considered?
Person is in public place and police have requested ACTAS provide transport Resuscitation is ceased while a patient is being transported to hospital or after being loaded in the ambulance. Deceased persons are to be transported to FMC and are not to be transported under UDD conditions.
75
State management of a patient in rapid AF (160bpm):
Establish diagnostic criteria: AF or atrial flutter with rapid rate (>150/min in adults, >180/min in paeds) + recent onset (no evidence of pre-existing AF) Management dependent on symptoms No significant compromise: monitor Hypotension: no LVF – treat with IV fluids Ischaemic chest pain: treat as appropriate Pulmonary oedema: treat as appropriate Apparently secondary to acute cerebral event: no LVF – IV fluids ICP - can manage with amiodarone in certain circumstances.
76
STEMI identified on 12-Lead ECG – what should you do next?
Transmit STEMI to TCH cardiology and be prepared for phone call from registrar Do not delay transport for treatment Prenotify receiving hospital (TCH) Aspirin GTN Antiemetic Analgesia (morphine) Oxygen only if SpO2 <94% or shocked Fluids as per CMG 14 if hypotensive ICP for heparin: do not extend scene time waiting for ICP
77
What is the dose of midazolam for a 45kg fitting pt?
0.1mg/kg 45 x 0.1 = max. 4.5mg IMI Repeat 1x after 10 mins if still seizing
78
What are the adverse effects of GTN?
Hypotension Headache Flushing Occasionally bradycardia
79
Name two potential calls to dialysis patients:
Bleeding Hypotensive episode Haemolysis Venous air embolism Chest pain
80
How would you draw up to adrenaline dose for a 7kg child in cardiac arrest? 
Dose = 0.01mg/kg = 7 x 0.01 = 0.07mg or 70mcg Use 1:10,000 preparation (100mcg/1mL): draw up 0.7mL
81
What are the indications for GTN?
Relieve ischaemic chest pain Relieve acute pulmonary oedema Management of autonomic dysreflexia
82
When performing CPR on a pregnant woman, what should be considered?
Gravid uterus will compress IVC and abdominal aorta when supine = prop patient left lateral if possible. May need to manually displace uterus to the left. Early consideration of transport to definitive care if advanced pregnancy (>22weeks) to allow for emergency caesarean section
83
What are the contraindications for CPAP?
Unconscious Hypoxia due to trauma Cardiac/respiratory arrest Facial trauma Pneumothorax Note: ALOC may receive CPAP if responding to voice and cooperative
84
What are the actions of salbutamol?
Beta 2 receptor agonist causing bronchodilation Smooth muscle relaxation Moves K+ from extracellular to intracellular space
85
Differentiate between minor heat syndromes and heat stroke:
Minor Heat Syndromes: Normal or transient disturbance in mentation Sweating Core temp <40 Heat stroke: ALOC and/or abnormal neurological signs No sweating: hot, dry skin Core temp >40
86
What is the management of heat stroke? 
Prompt transport Rapid, active cooling – aggressive as possible IV resuscitation – cool fluids if possible 12-Lead ECG and ICP back-up for management of arrhythmias Check BGL Aggressively manage seizures and shivering
87
What are the actions of GTN?
Arterial and venous vasodilation Dilation of collateral coronary vessels
88
Can a patient with a dislocated prosthetic hip be transported to Calvary hospital?
Yes
89
Explain the rule of 9’s:
The rule of 9’s is a method of estimating total body surface area affected by burns in adult patients. It assigns 9% to different sections of the body to allow for a more structured estimation of burns. 9% to head 9% to front and back of chest 9% to front and back of abdomen 9% to each arm 9% to front and back of each leg 1% to genitals
90
How long is a baby considered a newborn?
First 24hrs of life
91
What is your management of a pt with HR 42 and BP 75/30?
IV normal saline, up to 20mL/kg to increase and maintain SBP >90mmHg If caused by TBI, aim for SBP >100mmHg ICP back-up: atropine, adrenaline infusion, or external pacing
92
What size gastric tube would you place in a size 3 LMA?
14FG
93
What are the actions of adrenaline?
Alpha: peripheral vasoconstriction Beta 1: increased rate of sinus node, increased myocardial contractility, increased AV conduction, increased myocardial irritability Beta 2: bronchodilation, vasodilation of skeletal muscle
94
What is the maximum dose of methoxyflurane per week?
15mL/week
95
How much normal saline would an adult trauma receive?
Up to 20mL/kg unless TBI, then aim for SBP >100mmHg, no limit on volume of fluid
96
What colour triage tag does a walking patient receive?
Green
97
What size LMA would a 6kg child receive?
1.5
98
What are the contraindications of Magill forceps?
Epiglottitis Conscious patient
99
What is the weight of an 11y/o?
33kg
100
What is the dose of glucagon for a child weighing 22kg?
>20kg = 1IU IM

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