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4th Year > Acute Care and Anaesthetics > Flashcards

Acute Care and Anaesthetics Flashcards

1
Q

Where is the needle inserted in an emergency pleural decompression?

A

Second intercostal space, mid-clavicular line

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2
Q

What is a recognised risk of epidural in labour?

A

Headache

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3
Q

On admission to A&E, the patient is aggressive, using inappropriate words, localising to a painful stimulus, and opening their eyes to voice. What is the GCS score?

A

11

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4
Q

Which drug is administered when patients become unresponsive, snoring and hypoxic on a benzodiazepine?

A

Flumazenil

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5
Q

Which of the following medication is most important to stop in the days prior to surgery?
A- amlodipine
B- clopidogrel
C - metformin
D - simvastatin
E - salbutamol inhaler

A

B - clopidogrel (antiplatelet)

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6
Q

A 20-year-old male returns from theatre following a laparoscopic appendicectomy. He has no other medical history. He is drowsy following anaesthesia and not managed to eat or drink yet. Estimated blood loss was 100ml. He had 500ml 0.9% saline administered in theatre.
What is the most appropriate fluid regimen for this patient?

A. IV 500ml 0.9% saline stat
B. IV 0.9% saline 500ml with 40mmol/L K+ at 100ml/hr
C. IV 5% dextrose 500ml at 83ml/hr
D. IV 0.9% saline 500ml at 100ml/hr
E. IV 5% albumin 500ml over 125ml/hr

A

D - IV 0.9% saline 500ml at 100ml/hr

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7
Q

A 78-year-old man collapsed on a medical ward. He is found to be in cardiac arrest. There is blood on the floor and around his head. You’re the FY1 on the ward and first doctor on scene. Nurses are doing CPR and ask you to manage his airways while the rest of the arrest team arrives.
What is an appropriate action to do?
A - Insert a laryngeal mask airway and attempt to ventilate the patient
B - Hand ventilate with an ambu-bag
C - Open his airway with a head tilt and chin lift and apply 15L oxygen
D - Attempt to intubate the patient
E - Avoid inserting an oropharyngeal airway as he might have a head injury

A

A - Insert a laryngeal mask airway and attempt to ventilate the patient

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8
Q

A 70-year-old man collapsed suddenly following a myocardial infarction. He has no pulse, no breathing effort and is unresponsive. No bystander CPR is performed. What would the ABG likely demonstrate?

A

A mixed respiratory and metabolic acidosis

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9
Q

What is the most appropriate immediate treatment of anaphylaxis in an adult?

A

Intramuscular adrenaline, 0.5mg

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10
Q

A 48-year-old woman is 18 hours post hysterectomy and bilateral salpingoopherectomy for ovarian cancer. She had a general anaesthesia and a spinal anaesthetic with 1mg of intrathecal diamorphine. She has a morphine PCA for post-op analgesia. On nursing review, she is drowsy, difficult to rouse and with a respiratory rate of 5 breaths per minutes.
What is an appropriate treatment option? 1 vial naloxone = 400 micrograms

A - Refer to ICU for intubation and ventilation
B - 400 micrograms bolus of naloxone and reassess
C - 40 micrograms increments of naloxone titrated to effect
D - 4mg bolus of naloxone and reassess
E - 2222 call for a medical emergency

A

C - 40 micrograms increments of naloxone titrated to effect

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11
Q

How do you choose the size of an oropharyngeal airway?

A

Measure between the patient’s incisor teeth and the angle of the mandible.

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12
Q

Order the cannulas from biggest to smallest

A

Orange
Grey
Green
Pink
Blue

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13
Q

What blood tests are useful in an acute situation?

A

FBC
U&Es
Blood glucose

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14
Q

What fluid do you give in hypotensive patients with no history or signs of bleeding?

A

500ml 0.9% Saline

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15
Q

What monitoring should be use in the assessment of circulation?

A

ECG
Blood pressure

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16
Q

What is the pupillary response consistent with a 3rd nerve palsy?

A

One large pupil, both reactive

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17
Q

What is the pupillary response consistent with a raised ICP?

A

One large pupil, both reactive

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18
Q

What is the pupillary response consistent with Horner’s syndrome?

A

One small pupil, both reactive

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19
Q

What is the pupillary response consistent with atropine medication?

A

Unreactive, dilated pupils

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20
Q

What is the pupillary response consistent with brain stem death?

A

Unreactive, dilated pupils

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21
Q

What is the pupillary response consistent with opioid overdose?

A

Bilateral pin point pupils, both reactive

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22
Q

What do you test for in disability?

A

ACVPU
Pupillary response
Glucose

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23
Q

How is hypoglycaemia treated in ABCDE?

A

100mI of 10% Glucose/Dextrose

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24
Q

What is assessed in exposure (E)?

A

Temperature
Assess for any obvious injuries

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25
Q

How do you choose the size of a nasopharyngeal airway?

A

Corner of the mouth to the tragus

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26
Q

When are nasopharyngeal airways contraindicated?

A

In patient with a base of skull fracture

27
Q

What is the normal resp rate?

A

12-18

28
Q

What is a flail chest?

A

Flail chest is a traumatic disorder that happens when three or more ribs located next to each other are fractured in two or more places.

29
Q

What are the 4 H’s?

A

Hyper/hypothermia
Hypovolaemia
Hypoxia
Hyper/hypokalaemia

30
Q

What are the 4 T’s?

A

Toxins
Thrombosis
Tamponade
Tension pneumothorax

31
Q

What additional step should be carried out in C (circulation) in a trauma patient?

A

On the floor and four more
- floor
- chest
- abdomen
- long bones

Abdominal examination

32
Q

What drug is given in trauma patients to help stop the bleeding?

A

Tranexamic acid

33
Q

What level is a pelvic binder put on?

A

Level of the greater trochanter

34
Q

What GCS level indicates that a patient may not be able to maintain their own airway?

A

8 or less

35
Q

What are the three components of GCS?

A

Eye movement (4)
Verbal response (5)
Motor response (6)

36
Q

Describe the scoring of eye movement in GCS

A

4 = spontaneously
3 = to verbal command
2 = to pain
1 = no eye opening

37
Q

Describe the scoring of verbal response in GCS

A

5 = alert/orientated
4 = confused
3 = inappropriate words
2 = inappropriate sounds
1 = no verbal response

38
Q

Describe the scoring of motor response in GCS

A

6 = obeys commands
5 = localises pain
4 = withdrawal from pain
3 = flexion to pain
2 = extension to pain
1 = no motor response

39
Q

What is given in prolonged seizures?

A

Lorazepam (or other benzodiazepines)

40
Q

What are shockable rhythms?

A

Pulseless ventricular tachycardia
Ventricular fibrillation

41
Q

What are non-shockable rhythms?

A

Asystole
Pulseless electrical activity (PEA)

42
Q

What drugs are given after 3 shocks in cardiac arrest?

A

Amiodarone 300mg IV
Adrenaline 1mg IV

43
Q

When is the first dose of adrenaline given in cardiac arrest?

A

During the 2–min period of CPR after delivery of the third shock.

44
Q

How often is adrenaline given in cardiac arrest?

A

Every 3-5 minutes or after alternative 2-minute loops of CPR

45
Q

When can a second dose of amiodarone be administered in cardiac arrest?

A

If VF/pVT persists, or recurs, a further dose of 150 mg amiodarone may be given after a total of five defibrillation attempts.

46
Q

What is the treatment of symptomatic sinus bradycardia?

A

Atropine 500mcg IV until max of 3 mg

47
Q

What are some side effects of atropine?

A

Blurred vision, dry mouth, urinary retention and confusion

48
Q

Action of atropine?

A

Blocks vagus nerve
Increases sinus node automaticity
Increases atrioventricular conduction

49
Q

If atropine doesn’t resolve symptomatic sinus bradycardia, what is the next step?

A

Transcutaneous pacing

50
Q

What is the treatment of ventricular tachycardia?

A

Electrical Synchronised DC Shock

51
Q

What is first line in symptomatic sinus tachycardia?

A

Vagal manoeuvres

52
Q

What is second line to vagal manoeuvres in symptomatic sinus tachycardia?

A

Adenosine 6 mg bolus rapid IV injection

53
Q

Side effect of adenosine

A

Nausea

54
Q

What happens to PaCO2 levels in hyperventilation?

A

CO2 levels drop

55
Q

What is a high PaCO2 suggestive of in a blood gas?

A

Respiratory acidosis

56
Q

What is a low PaCO2 suggestive of in a blood gas?

A

Respiratory alkalosis

57
Q

What does a negative base excess (blood gas) suggest?

A

Metabolic acidosis

58
Q

What does a positive base excess (blood gas) suggest?

A

Metabolic alkalosis

59
Q

How does the body compensate for metabolic alkalosis?

A

Increasing PaCO2 through hypoventilating

60
Q

How does the body compensate for metabolic acidosis?

A

Reduces PaCO2 through hyperventilating

61
Q

What is raised urea and creatinine indicative of?

A

Dehydration
Pre-renal failure due to hypovolaemia

62
Q

What type of antacid is ranitidine?

A

H2-receptor antagonist

63
Q

Why are antacids important in anaesthetics?

A

Reduce gastric acid reflux
Reduces aspiration risk at induction of anaesthesia

64
Q

Describe the mechanism of benzodiazapines

A

Benzodiazepines bind to the GABA receptor in the CNS. They increase the receptor affinity for GABA. Ion movement across the cell membrane is increased. This hyperpolarises the cell membrane and reduces the firing of neurons.

4th Year (15 decks)

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