Acute and critical care

Question 1

What basic airway manoeuvres can be done if the airway is compromised?

Answer 1

Head tilt, chin lift and jaw thrust

Question 2

How do you assess airway?

Answer 2

Is there any signs of airway compromise - cyanosis, use of accessory muscles

Is there any abnormal airway nosies - stridor, snoring, gurgling

Inspect the mouth - is there any obstructing the airway such as secretions or foreign object

Question 3

When do you put the crash call out?

Answer 3

If the patient loses consciousness/there are no signs of life

Question 4

How do you assess breathing?

Answer 4

Review respiratory rate and oxygen saturations, inspection of breathing effort, assess tracheal deviation

Question 5

What investigations would you do in breathing?

Answer 5

ABG if hypoxic
CXR if suspecting lung pathology

Question 6

What interventions can be done in breathing?

Answer 6

Patient position - sit them upright if conscious
Oxygen - 15L via non-rebreathe mask unless COPD where you consider venturi mask
Others based on clinical findings - bronchodilators, antibiotics, steroids

Question 7

How do you assess circulation?

Answer 7

Review heart rate and blood pressure, review fluid balance (urine output, recent fluids, check ankles and sacrum for oedema, JVP), temperature and capillary refill time, auscultate the heart

Question 8

What investigations might you want to do for circulation?

Answer 8

IV cannula (at least 1 wide bore), FBC, U+E, LFTs, VBG/ABG, ECG, blood cultures if suspecting sepsis

Question 9

What interventions might you do for someone in circulation?

Answer 9

If hypovolaemic patients require fluid resuscitation - 500ml bolus followed by assessing for fluid overload

If haemorrhage they may require transfusion of red cells, platelets and fresh frozen plasma

Question 10

How do you assess disability?

Answer 10

ACVPU, pupils, blood glucose (+ketones)

Question 11

What interventions might you be required to do in disability?

Answer 11

Maintain the airway if GCS<8 or they are unresponsive/only responding to pain, correct hypoglycaemia

Question 12

How to you assess exposure?

Answer 12

Ask if they have any pain anywhere, inspect skin for rashes, bruising, signs of infection, palpate abdomen, inspect calves, review any drains/lines, body temperature, assess for sepsis

Question 13

How do you do the A-E assessment in trauma?

Answer 13

CABCDE (control catastrophic haemorrhage before doing the A-E assessment)

Question 14

How do you control bleeding in step wise approach?

Answer 14

Clear any clots obscuring the bleeding source –> direct pressure –> more direct pressure –> indirect pressure by occluding proximal arteries –> tourniquet –> haemostatic agents

Question 15

In burns patients how might the airway be managed?

Answer 15

Always consider early intubation as direct thermal injury in the upper airway causes oedema which may progress to complete airway obstruction within minutes

Question 16

What is a flail chest?

Answer 16

Fracture of 2 or more ribs in 2 or more places which leads to floating sections of ribs and leads to ventilatory failure

Question 17

What are the signs of a bleeding patient?

Answer 17

Sweaty, anxious, pallor, tachycardia, tachypnoea, >CRT, narrow pulse pressure, hypotension

Question 18

What interventions can be done in someone with pelvic fracture?

Answer 18

Pelvic binder should be used in any haemodynamically unstable blunt trauma patients (assume there is a pelvic fracture)

Question 19

What is permissive hypotension?

Answer 19

Maintain lower than normal target BP to avoid disruption of unstable clot by higher pressure and worsening of bleeds

Question 20

What’s the difference between a spinal and epidural anaesthesia?

Answer 20

Spinal = through ligaments and dura, single bolus, rapid onset, effective in lumbar region
Epidural = between ligaments and dura, continuous infusion, slower onset, large dose required, effective in thoracic and lumbar region

Question 21

Why is adrenaline used in local anaesthetic?

Answer 21

Causes vasoconstriction which reduces bleeding and prolonged anaesthetic effect due to reduced absorption

Question 22

Name some local anaesthetics and their uses

Answer 22

Lidocaine - immediate onset, minor ops

Bupivacaine - 10 minute onset, regional/spinal

Question 23

What is used for short and long term sedation?

Answer 23

Short term = IV midazolam
Long term = IV propofol and alfentanil

Question 24

Which type of NIV is used for what time of respiratory failure?

Answer 24

CPAP for type 1 and BiPAP for type 2

Question 25

What are the causes of type 1 respiratory failure?

Answer 25

Alveolar collapse e.g. pneumonia, LV heart failure

Question 26

How does CPAP work?

Answer 26

Holds open the alveoli and fluid is forced out of the lungs

Question 27

What is the main cause of type 2 respiratory failure?

Answer 27

COPD

Question 28

How does BiPAP work?

Answer 28

BiPAP adds inspiratory pressure to further expand the lungs to improve ventilation as well as preventing alveolar collapse

Question 29

What is the function of anticholingeric medications for cardiovascular support?

Answer 29

They inhibit the parasympathetic nervous system and increase heart rate - used to treat bradycardias e.g. atropine

Question 30

What is the function of beta-adrenoreceptor agonists for cardiovascular support?

Answer 30

Stimulates myocardial cells and increases heart rate and contractility e.g. dobutamine

Question 31

What is the function of alpha agonists for cardiovascular support?

Answer 31

Stimulate alpha receptors which are found in peripheral vessels –> vasoconstriction –> increased BP

e.g. metaraminol, noradrenaline

Question 32

When is a combined alpha and beta agonist used?

Answer 32

When both BP and HR are low e.g. ephedrine or adrenaline

Question 33

What is an example of a serotonin receptor antagonist antiemetic and what are its uses?

Answer 33

Ondansetron

Useful in drug related N+V, gut infection, radiotherapy/chemotherapy

Question 34

What is an example of a dopamine receptor antagonist antiemetic and what are its uses?

Answer 34

Metoclopramide, domperidone, prochlorperazine, haloperidol

Useful in drug related N+V and decreased gut motility e.g. opioids

Contraindicated in GI obstruction

Haloperidol is used in metabolic causes of N+V e.g. hypercalcaemia

Prochlorperazine is primarily used in vertigo

Question 35

What is an example of a histamine receptor antagonists antiemetic and what are its uses?

Answer 35

Cyclizine, promethazine

Useful in motion sickness, vertigo

Cyclizine is 1st line in most cases and used in N+V associated with bowel obstruction

Question 36

What muscle relaxant is used in rapid sequence induction?

Answer 36

Suxamethonium

Question 37

What is used to measure carbon monoxide levels in the blood?

Answer 37

Carboxyhaemoglobin (measured using ABG and co-oximetry)

Question 38

What kind of airway can prevent aspiration?

Answer 38

Tracheal tube is the only airway that can prevent aspiration

Question 39

How long do you need to fast for before surgery (clear fluids and solids)?

Answer 39

2 hours for clear liquids, 6 hours for solids

Question 40

When does someone require a CT head following a fall?

Answer 40

GSC <12 on initial assessment, GSC <15 at 2 hours post injury, suspected skull fracture (panda eyes, CSF leak from ear or nose, battle’s sign), seizure, focal neurological deficit, more than 1 episode of vomiting

Question 41

What are the symptoms of carbon monoxide poisoning?

Answer 41

N+V, cherry red skin, tachycardia, 100% oxygen saturations on pulse oximetry

Question 42

What dose of adrenaline is given in anaphylaxis?

Answer 42

0.5mg IM