🚑

Question 1

STEMI management - PCI

Answer 1

Aspirin- 300mg
GTN- 400mcg- assuming not inferior with right sided involvement
Fentanyl

Ticagrelor - 180mg
Or
Clopidogrel - 600mg (8 x 75mg)
Heparin - 5000 IU

Question 2

Atropine
Drug class?
Pharmacology?
Indications?

Answer 2

Drug class- Anticholinergic
Pharm - inhibits the action of the parasympathetic nervous system. Blocks vagus nerve on the heart, increases SA node rate, blocks exocrine gland activity
Indications
- bradycardia
- envenomation
- Hypersalivation (post ketamine)
- organophosphate toxicity

Question 3

Indications for calcium gluconate?

Answer 3

• suspected hyperkalaemic cardiac arrest
• severe hyperkalaemia
• verapamil and diltiazem toxicity
• hydrofluoric acid inhalation
• following pre-hospital blood infusion

Question 4

What is verapamil and diltiazem?
Drug class?
Used for?

Answer 4

Calcium channel blockers
- blocks calcium’s action on muscle in heart and arteries

Hypertension
Antiarrhythmias
Angina

Question 5

Atropine
Presentation?
Adult doses?
Paediatrics dose?

Answer 5

Presentation - 1.2mg/1ml

Adult
Bradycardia/hypersalivation - 600mcg
Repeated after 2 min - max 1.2mg
Organophosphate/envenomation- 1.2 mg repeated 5 min with no max

Paed
20mcg/kg

Question 6

Gamma-aminobutyric acid (GABA)
Primary function?

Answer 6

• primary inhibitory neurotransmitter for the CNS
• blocks signals to the CNS

Question 7

Atelectasis?

Answer 7

Collapse of all or part of the lung

Question 8

Nexus criteria?

Answer 8

No midline tenderness
No evidence of intoxication
No ALOC
No docs neurology deficit
No distracting injury

Question 9

COAST score?

Answer 9

Entrapment
Systolic blood pressure
Temperature
Chest injuries
Abdominal injuries

Question 10

Classes of anti-arrhythmic drugs

Answer 10

1. Sodium channel blockers
2. Beta blockers
3. Potassium channel blockers
4. Calcium channel blockers
5. Unknown

Question 11

Reversible causes of cardiac arrest
5Hs 4Ts

Answer 11

Hypoxia
Hyper/hypothermia
Hypovolaemia
Hydrogen ions -acidosis
Hyper/hypokalaemia

Thrombus
Toxins
Tamponade
Tension pneumothorax

Question 12

Clopidogrel
Drug class?
Pharmacology?
Presentation?
Dose?

Answer 12

• antiplatelet
• potent platelet aggregation inhibitor, inhibits ADP binding to platelet
• 75mg tablets
• 600 mg PCI & 300mg Thrombolysis

Question 13

Dexmethasone
Drug class?
Presentation?
Pharmacology?
Dose?

Answer 13

• corticosteroid
• 8mg/2ml
• long acting corticosteroid that produces anti-inflammatory and immunosuppressive effects.— vasoconstriction in upper airways followed by systemic ani-inflammatory response.
• 0.3mg/kg rounded to nearest 0.5ml

Question 14

Enoxaparin
Drug class?
Pharmacology?
Presentation? Dose?
Indication

Answer 14

• Anticoagulant
• binds to antithrombin 3 leads to inhibition of thrombin generation + factor Xa
• 60mg/0.6ml & 100mg/1ml
• pts with STEMI who have received tenecteplase - prehospital thrombolysis

Question 15

Tranexamic Acid
Drug class?
Pharmacology?
Presentation?
Indication?
Dose?

Answer 15

• Antifibrinolytic
• competitive inhibitor of plasminogen activation - displaces plasminogen from fibrin which inhibits fibrinolysis
• 1g/10ml
• recent traumatic injuries COAST >3 & management of Primary PPH
• 1g slow push over 10min
• paed - 15mg/kg - consult

Question 16

Contusion?

Answer 16

Bruise

Question 17

Burns
First degree?
Second degree?
Third degree?

Answer 17

First- top superficial layer of skin only (dermis)
Second- multiple layers (dermis + epidermis) - increased pain plus blistering
Third degree - all layers + subcut tissue and muscle

Question 18

Heat stroke?

Answer 18

Failure of the body’s thermoregulatory mechanisms.
>39.5 degrees C
Massive cell damage - reduces function of motor senses in the brain- inability to recruit motor units for muscular activity

Question 19

Heat stress/exhaustion

Answer 19

Exercise- energy transformation and production releases heat- heat is absorbed into water- water is released through sweat- sweat produces layer of water on skin and also excreted heat created by energy expenditure- losing salts- reduced internal fluids leads to increased cardiac drive - body’s is unable to reduce temp - malaise/fatigue/headaches/nausea/vomiting/diarrhoea/cramps- able to respond to questions, may be confused

Question 20

Brugada
- pathophysiology
- ECG

Answer 20

• total loss of function of the Na+ channel
  ECG
• coved ST elevation v1-3
• saddle back ST elevation

Question 21

Sick sinus syndrome
Clinical findings
ECG

Answer 21

Clinical finding- dizzy, fatigue, pre-syncopal, syncopal episode, palpitations
ECG
- sinus arrest
- Bradycadia-tachycardia syndrome