5001 Practice Exam Questions Flashcards
How much IV fluid would you give to a 63 year old male patient in PEA arrest secondary to anaphylaxis that weighs 84kg?
20ml/kg
= 1680mls
What does IMIST AMBO stand for?
Identification Mechanism/medical issue Injuries/information Signs and symptoms Treatment
Allergies
Medications
Background information
Other information
What is the time interval between defibrillation and IV adrenaline doses in the adult normothermic cardiac arrest patient?
2min and 4 min
According to the PSA a patient with the following observations would be considered to have what perfusion status? HR 53, BP 90/50, cool, pale and clammy skin and GCS 15
Borderline Perfusion
What are the six metrics of high performance CPR?
- rate of 100-120 compressions per minute
- 5cm depth of the chest
- allow for full recoil
- 50:50 compression release duty cycle
- Minimise interruptions to CPR
- Change operator every 2 minutes
When does the BVM provide oxygen?
When the bag is squeezed and it automatically refills when it is released
When verifying a death, how long do you need to listen for heart sounds?
2 minutes
What are the 4 main differences in the paediatric respiratory system that needs to be taken into consideration when assessing and managing paediatric patients?
- paediatric patients have enlarged tonsils
- airway is softer so ensure neutral head positioning
- Padding may be required under the shoulders to maintain neutral alignment
You attend a child in cardiac arrest, according to AV paediatric weight calculations what is the calculated weight of a 9 year old?
weight = age x 2 + 8 answer = 26kgs
Discuss the role of PEEP in optimising ventilation in the patient who has achieved ROSC post medical cardiac arrest. What is the aim of applying PEEP and what might be some benefits and side effects of this intervention on the patient?
Benefits
- PEEP splints, recruits and oxygenates the alveoli.
- Optimised oxygenation by preventing alveolar collapse
Side effects can cause - hypovolaemia/hypotension - worsen tension pneumothorax - elevate ICP - no pulse = no peep
The _____ is the outermost layer of the brain cells. Thinking and voluntary movements begin in this region of the brain
Cortex
What is the normal conduction pathway through the heart?
SA node, AV node, Bundle of His, Purkinje fibres
Explain in detail the pathophysiology of the tension pneumothorax and how this relates to the signs or symptoms of the patient?
- A tension pneumothorax is an accumulation of air in the pleural space that cannot escape. This accumulation raises intra thoracic pressure leading to collapse of the affected lung and subsequent restriction of function of the other structures of the heart, opposite lung and diaphragm. Increase ITP causes decreased venous return and cardiac output. If not treated results in PEA
Explain the procedure undertaken to perform chest decompression in the pre-hospital setting using the ARDS decompression needle
- SMART Ambo
- Second intercostal space
- Midclavicular line (avoiding medial placement)
- Above third rib (avoiding neurovascular bundle)
- Right angles to the skin
- Tilt the bevel towards the spine
- Bilat chest decompression do the right then the left (mediastinal shift secondary to right sided TPT can displace the heart to the left side, creating the potential for accidental puncture of the heart if the left side were decompressed first)
- If you hit a haemopneumo - take needle out and apply pressure
On the ECG the T wave represents…
Ventricular repolarisation
The calculated joules for a 9 year old in VF cardiac arrest is
weight = age x 2 + 8 Weight = 9 x 2 + 8 = 26kg
weight x 4 joules
26 x 4 = 104 joules
What is the normal range for ETCO2?
35-45mmHg
You are assessing a patient in ACS. The patient will not open his eyes until you apply sternal pressure. He also moves to grab your hand when you do this. The patient is making gurgling and grunting noises. What is the patients GCS?
GCS 9
According to the AV pharmacology sheet within the CPG. How is adrenaline metabolised?
By monoamine oxidase and other enzymes in the blood, liver and around the nerve endings, excreted by the kidneys
Where is the mitral valve located within the heart?
Between the left atrium and the left ventricle
List 4 possible stroke mimics that you may consider when assessing a patient that has an ACS
- hypo/hyperglycaemia
- seizures
- migraine
- sepsis
- intoxication
- brain tumour
- Vertigo
- SDH
- Syncope
- Electrolyte disturbance
- MS
What size SGA should be inserted in a patient that weighs 80kg?
Size 4
List the ECG criteria that needs to be met for diagnosis of VT
- regular, broad complex tachycardia
- rate >100
- rhythm vegular
- P waves: nil discernible
- PR interval: nil discernible
- QRS duration: > 0.12
To avoid damage to the soft palate at what age should an OPA not be rotated 180 degrees when being inserted into an airway?
less than 8
In regards to defibrillation safety when using the toll defib. What are two environmental safety considerations that must be adhered to within the ambulance setting?
- Do not use the defibrillator around flammable agents, oxygen rich atmospheres or anaesthetics
- Do not use the defibrillator on or near water or on metal surfaces
You attend a 35 year old male patient who is complaining of lower back pain and states he hurt his back at work a few weeks ago. You and your partner decide to use the “treat and refer” guideline for lower back pain and refer him to his GP for follow up. What analgesia can you offer this patient?
Paracetamol
The _____ is located between the spinal cord and the rest of the brain. Basic functions controlled in this area of the brain are breathing and sleep.
Brain stem
Is history of mental health problems a yellow clinical flag?
No
The mottled purple-red discolouration of the dependent parts of the body after death, related to the pooling of blood in those regions is known as
Post mortem lividity
What does the chain of survival include?
- Early recognition, early CPR, early defib, early advanced care
Upon achieving ROSC in the medical cardiac arrest patient, the three overall main goals or ALS care are?
- 12 lead ECG
- consider PHT as per STEMI management
- VT/VF arrest or suspected cardiac cause or post PHT: transport to PCI centre
- Suspected non-cardiac cause: transport to closest appropriate hospital with notification
You attend a patient that is unconscious and hypoventilating. The patient has truisms and you need to insert a NPA to assist with ventilation of this patient. What are two precautions to insertion of NPA and explain why
- BOS #
- Facial #’s
- TBI
