Acute Care

Question 1

What measurement do you make to determine the size of the oropharengeal airway?

Answer 1

Incisor teeth to mandibular angle

Question 2

What are the 4 Hs and the 4 Ts?

Answer 2

• Hypoxia
• Hypokalaemia/hyperkalaemia,
• Hypothermia/hyperthermia
• Hypovolaemia
• Tension pneumothorax
• Tamponade
• Thrombosis
• Toxins

Question 3

How do you diagnose cardiac tamponade?

Answer 3

• Cardiac echo (gold standard)
• Look for Beck’s triad = low blood pressure, jugular-venous distension, and muffled heart sounds (quick)
• Look for trauma and rule it out if there is none (probably what you’re actually going to do)

Question 4

How do you treat hyperkalaemia?

Answer 4

• 10mls 10% calcium gluconate – protects myocardium. GIVE FIRST
• Insulin (actrapid 10units)
• 50mls 50% dextrose
• Salbutamol nebuliser (only if the patient is breathing) – Moves K+ back into the cells

Question 5

What does one large pupil and one normal pupil, both reactive, indicate?

Answer 5

3rd nerve palsy/raised ICP

Question 6

What can cause nonreactive, dilated pupils apart from brainstem death?

Answer 6

Atropine

Question 7

How much glucose should be given in unconscious hypoglycemia?

Answer 7

100ml of 10% dextrose

Question 8

What are the 2 shockable rhythms?

Answer 8

VF and pulseless VT

Question 9

What are the 2 drugs given during CPR?

Answer 9

• Adrenaline (every 3-5 minutes)

- Amioderone (after 3 shocks)

Question 10

What drug is used for bradycardia?

Answer 10

Atropine

Question 11

What drug is used for tachycardia?

Answer 11

Adenosine

Question 12

Give examples of vasovagal manoeuvres

Answer 12

• Carotid massage
• Blow into syringe
• Cough
• Hold breath and bear down
• Dunk head into ice water

Question 13

Which vessel is likely the cause of a extradural haemorrhage?

Answer 13

Middle meningeal artery

Question 14

Which vessels are likely the cause of a subdural haemorrhage?

Answer 14

Bridging veins

Question 15

What is Cushing’s reflex and what does it mean?

Answer 15

Triad of low HR, high BP and irregular respiration - means that the physiology of the body is failing and is a very bad sign

Question 16

What are the 4 eye scores in GCS?

Answer 16

4 - spontaneous opening
3 - open to voice
2 - open to pain
1 - no eye opening

Question 17

What are the 5 voice scores in GCS?

Answer 17

5 - orientated 
4 - confused
3 - single/inappropriate words
2 - sounds
1 - silent

Question 18

What are the 6 motor scores in GCS?

Answer 18

6 - obeys commands
5 - localizes to pain
4 - withdraws from pain
3 - decorticate (flexion)
2 - decerebrate (extension)
1 - no movement

Question 19

What are the signs of a base of skull fracture?

Answer 19

• External bleeding
• Epistaxis with no nasal trauma
• CSF rhinorrhoea/otorrhoea
• Panda eyes (bilateral bruising with no trauma or swelling)
• Battle sign (mastoid bruising)
• Subconjunctival haemorrhage without posterior border

Question 20

What are the urgent indications for a head CT?

Answer 20

• GCS 12 or less
• Focal neurology
• Coagulopathy and GCS <15

Question 21

What are the indications for a non-urgent head CT?

Answer 21

Head injury with:

• failure to improve GCS 13 after observation
• Persisting confusion/vomiting
• Signs of base of skill fracture
• Persisting severe headache

Question 22

What kind of head injury might indicate a skull fracture?

Answer 22

A high energy injury to a small area causing a boggy haematoma

Question 23

How much adrenaline should be given in anaphalaxis?

Answer 23

500mcg (1/2 ml)

Question 24

How much dextrose should be given in hypoglycemia

Answer 24

200ml 10% IV