Acute Care - ABCDE and Trauma

Question 1

what can cause a metabolic acidosis with a raised anion gap?

Answer 1

poisoning
e.g salicylate
methanol

DKA

Question 2

what is the ABG progression with salicylic acid?

Answer 2

resp alkalosis (due to hypoventilation)
met acidosis

Question 3

what is the ABG with DKA?

Answer 3

met acidosis

Question 4

for c, in cABCDE, what are the floor and 4 places to check?

Answer 4

chest
abdo (feel)
pelvis
long bones (pulses)

Question 5

what should be given to all pts to try stop bleeding?

Answer 5

tranxemic acid (antifibrinolytic)

Question 6

in A, what should be done?

Answer 6

look (mouth and chest moving)
listen
feel

Question 7

what is the difference between stridor and wheeze?

Answer 7

stridor is inspiratory

wheeze is expiratory

Question 8

what can be changed in A?

Answer 8

suction
head tilt chin lift
protect C spine
nasopharyngeal 
oropharyngeal (guedell)
laryngeal (igel)

Question 9

how are guedell airways measured?

Answer 9

mandible to incisors

Question 10

in B, what should be done?

Answer 10

look for hypoxia signs
sP02
RR
chest movements
trachea
chest expansion
auscultate
percuss

Question 11

what can be changed in B?

Answer 11

oxygen (15L/min in a non rebreather)
nebuliser
ABG
CXR

Question 12

what should be done in C?

Answer 12

pulse
CRT
HR 
BP
feel calves
abdo exam
pelvic binder/Kendrick splint

Question 13

what can be changed in C?

Answer 13

fluids
ECG
IV
access (grey)
G+S/crossmatch

Question 14

what can be done in D?

Answer 14

AVPU
GCS
pupils
BM
temperature
recovery position

Question 15

what can be changed in D?

Answer 15

give glucose/insulin

warm

Question 16

what should be done in E?

Answer 16

expose patient
temperature
fluid balance
SEWS

Question 17

what scan can be done in E?

Answer 17

FAST SCAN 
(US for fluid in
RUQ
LF
pericardium
rectovesical/uterine pouch)

Question 18

what is a tension pneumothorax?

Answer 18

one way valve between lung and pleural cavity

lung collapses

Question 19

signs of a tension pneumothorax?

Answer 19

tracheal deviation
reduced breath sounds
hyper resonant percussion

Question 20

Tx for tension pneumothorax?

Answer 20

large bore cannula to 2nd ICS

Question 21

what is a haemothorax? signs?

Answer 21

blood collecting in the pleural cavity

dull percussion
low BP
tachycardic

Question 22

Tx for haemothorax?

Answer 22

fluids
blood
chest drain
thoracotomy

Question 23

what happens in a flail chest?

Answer 23

several rib # create an area of the chest that moves paradoxically

Question 24

what is an open pneumothorax?

Answer 24

chest wound
sucks in air to the pleural space

can progress to tension pneumothorax

Question 25

what can cause distributive shock?

Answer 25

anaphylaxis
burns
neurogenic

Question 26

what happens in distributive shock?

Answer 26

excessive systemic vasodilation and leakage of fluid from the capillaries to tissue

Question 27

what happens in cardiogenic shock?

Answer 27

heart fails to pump enough blood round the body

Question 28

what happens in obstructive shock?

Answer 28

inability to produce a CO despite normal myocardial function and intravascular volume

Question 29

what is the triangle of safety in the axilla?

Answer 29

pec major
lat dorsi
5th ICS

Question 30

when inserting a chest drain, should you aim superior or inferior? why?

Answer 30

inferior

NVB runs alongside inferior aspect of the rib

Question 31

what is cushing’s response?

Answer 31

when ICP raises

HR + RR drop
BP rises

Question 32

difference between a G+S and a crossmatch?

Answer 32

G+S - blood type (better acutely as faster)

crossmatch - full Abs and issues blood