Acute Care

Question 1

Motor findings for GCS

Answer 1

1. None
2. Extends to pain
3. Flexion to pain
4. Withdraws form pain
5. Localises to pain
6. Obeys commands

Question 2

Verbal findings for GCS

Answer 2

1. None
2. Sounds
3. Words
4. Confused
5. Orientated

Question 3

Eye findings for GCS

Answer 3

1. None
2. To pain
3. To speech
4. Spontaneous

Question 4

Max GCS

Answer 4

15

Question 5

Min GCS

Answer 5

3

Question 6

CPR of < 1 year old

Answer 6

Dry baby first

3 chest compressions : 1 breath

Question 7

CPR of child

Answer 7

5 rescue breaths

15 chest compressions : 2 breaths

Question 8

CPR of adult

Answer 8

30 chest compressions : 2 breaths

- check for femoral and brachial pulse

Question 9

Shockable rhythms

Answer 9

Ventricular Fibrillation (VF)
Ventricular Tachycardia (VT)

Question 10

Non-shockable rhythms

Answer 10

Asystole

Pulseless Electrical Activity (PEA)

Question 11

Management for VT/VF

Answer 11

Defibrillation: 3 shocks first
1mg of adrenaline (repeat every 3-5 mins)

• witnessed: 3 stacked shocks
• un-witnessed: 1 shock + CPR (2mins) x 3

Question 12

Management of Asystole/PEA

Answer 12

1mg of adrenaline ASAP (repeat every 3-5mins)

CPR

Question 13

Reversible causes of cardiac arrest

Answer 13

5Hs + 4Ts

Hypoxia
Hypovolaemia
Hypothermia
Hypoglycaemia/calcaemia/kalaemia
Hyperkalaemia

Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins

Question 14

Management of hypothermia

Answer 14

Bring to 30 degrees

CPR + 3 x shocks

Question 15

Specifics of chest compression in all children

Answer 15

100-120 compressions per min

1/3 depth of sternum

Question 16

Acute fluid management for children

Answer 16

IV bolus of 20ml/kg 0.9% NaCl in < 10 mins

Question 17

When to give fluids in burns

Answer 17

Adults: > 15% surface area burn
Children: > 10% surface area burn

Question 18

Parkland formula for fluid resus in burns

Answer 18

Surface area (%) x weight (kg) x 4ml 
First 50% given in first 8 hours

Question 19

What fluid to use in burn management

Answer 19

Crystalloid fluid (Hartman’s/Ringer’s)

Question 20

Superior fluid to be used in resuscitation

Answer 20

Crystalloid

Question 21

Risk of using colloid fluid

Answer 21

Risk of anaphylaxis

Question 22

Signs of too much fluid

Answer 22

Increased JVP
Ascites
Lung crackles
Tachypnoea

Question 23

Signs of too little fluid (negative fluid balance)

Answer 23

Tachycardia
Hypotension
Oliguria
Sunken eyes
Decreased skin turgor

Question 24

Risk of using large volumes of 0.9% NaCl

Answer 24

Hyperchloraemic metabolic acidosis

Question 25

Maintenance fluid management for children

Answer 25

0.45% NaCl + 5% Dextrose 100ml/kg for first 10kg 50ml/kg for next 10kg 20ml/kg for next 10kg

Question 26

Contraindications for Hartmann's fluid

Answer 26

Don't use in hyperkalaemia as it contains potassium

Question 27

Daily requirements of maintenance fluid management in adults

Answer 27

``` Water: 25-30ml/kg/day Potassium: 1mmol/kg/day Sodium: 1mmol/kg/day Chloride: 1mmol/kg/day Glucose: 50-100g/day ```

Question 28

Maintenance fluid management for adults (70kg man)

Answer 28

1L normal saline + 40ml potassium or 1L 5% dextrose + 40ml potassium

Question 29

Contents of 1L bag of normal (0.9%) NaCl saline solution

Answer 29

1L water 154 mmol sodium 154 mmol chloride

Question 30

Contents of 1L bag of 5% dextrose solution

Answer 30

1L water | 50g glucose

Question 31

Total fluid in 70kg male

Answer 31

42L (100%)

Question 32

Total intracellular fluid

Answer 32

28L (60-65%)

Question 33

Total extracellular fluid

Answer 33

14L (35-40%)

Question 34

Extracellular fluid is made up of

Answer 34

Interstitial Fluid = 10L (24%) Plasma = 3L (5%) Transcellular fluid = 1L (3%)

Question 35

5 types of shock

Answer 35

``` Septic Anaphylactic Neurogenic Cardiogenic Haemorrhagic ```

Question 36

Types of shock that cause cold peripheries

Answer 36

Cardiogenic | Haemorrhagic

Question 37

Types of shock that cause warm peripheries

Answer 37

Distributive shocks: - Septic - Anaphylactic - Neurogenic

Question 38

Decreased SVR Increased HR Normal/increased CO Decreased BP

Answer 38

Septic shock

Question 39

Temp < 36 or > 38 Hr > 90 RR > 20 WBC < 4000 or > 12,000

Answer 39

Septic shock

Question 40

Septic shock can lead to

Answer 40

Systemic inflammatory response syndrome (SIRS) | Multi organ failure

Question 41

Neutropenic sepsis

Answer 41

Sepsis with neutrophil count < 1 x 10(9)/L

Question 42

Why may you test a clotting screen in sepsis

Answer 42

To test for DIC

Question 43

Management for Sepsis

Answer 43

BUFALO - "Sepsis Six" ``` Blood cultures Urine output Fluids (IV) Antibiotics Lactate Oxygen ```

Question 44

What is Starling's law?

Answer 44

Reduced preload = reduced cardiac output = reduced peripheral tissue perfusion

Question 45

Shock occurring following a spinal cord transection | - often trauma/ RTA

Answer 45

Neurogenic shock

Question 46

Pathophysiology of neurogenic shock

Answer 46

Increased parasympathetic tone Decreased sympathetic tone = reduced peripheral vascular resistance mediated by vasodilation = hypotension + bradycardia

Question 47

``` Increased SVR Increased HR Decreased CO Decreased BP Hx of IHD ```

Answer 47

Cardiogenic shock

Question 48

``` Increased SVR Increased HR Decreased CO Decreased BP Recent Hx of Blood loss ```

Answer 48

Haemorrhagic "Hypovolaemic"

Question 49

Volume of blood in average 70kg male

Answer 49

5L - 7% of body weight in adult - 9% of body weight in children - less in elderly

Question 50

4 Classifications of Haemorrhagic shock

Answer 50

I: <750ml loss II: 750-1500ml loss III: 1500-2000ml loss IV: >2000ml

Question 51

Secure airway at what GCS

Answer 51

= 8

Question 52

igels (supra glottic airway) are used to intubate in

Answer 52

emergencies, especially cardiac | - cannot protect against aspiration

Question 53

Trachea tube is used to intubate when

Answer 53

there is risk of aspiration

Question 54

Guedel (oral airway) is used to

Answer 54

maintain airway