Acute Care and Anaesthetics Flashcards
Where is the needle inserted in an emergency pleural decompression?
Second intercostal space, mid-clavicular line
What is a recognised risk of epidural in labour?
Headache
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?
11
Which drug is administered when patients become unresponsive, snoring and hypoxic on a benzodiazepine?
Flumazenil
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
B - clopidogrel (antiplatelet)
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
D - IV 0.9% saline 500ml at 100ml/hr
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 - Insert a laryngeal mask airway and attempt to ventilate the patient
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 mixed respiratory and metabolic acidosis
What is the most appropriate immediate treatment of anaphylaxis in an adult?
Intramuscular adrenaline, 0.5mg
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
C - 40 micrograms increments of naloxone titrated to effect
How do you choose the size of an oropharyngeal airway?
Measure between the patient’s incisor teeth and the angle of the mandible.
Order the cannulas from biggest to smallest
Orange
Grey
Green
Pink
Blue
What blood tests are useful in an acute situation?
FBC
U&Es
Blood glucose
What fluid do you give in hypotensive patients with no history or signs of bleeding?
500ml 0.9% Saline
What monitoring should be use in the assessment of circulation?
ECG
Blood pressure
What is the pupillary response consistent with a 3rd nerve palsy?
One large pupil, both reactive
What is the pupillary response consistent with a raised ICP?
One large pupil, both reactive
What is the pupillary response consistent with Horner’s syndrome?
One small pupil, both reactive
What is the pupillary response consistent with atropine medication?
Unreactive, dilated pupils
What is the pupillary response consistent with brain stem death?
Unreactive, dilated pupils
What is the pupillary response consistent with opioid overdose?
Bilateral pin point pupils, both reactive
What do you test for in disability?
ACVPU
Pupillary response
Glucose
How is hypoglycaemia treated in ABCDE?
100mI of 10% Glucose/Dextrose
What is assessed in exposure (E)?
Temperature
Assess for any obvious injuries
How do you choose the size of a nasopharyngeal airway?
Corner of the mouth to the tragus
When are nasopharyngeal airways contraindicated?
In patient with a base of skull fracture
What is the normal resp rate?
12-18
What is a flail chest?
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.
What are the 4 H’s?
Hyper/hypothermia
Hypovolaemia
Hypoxia
Hyper/hypokalaemia
What are the 4 T’s?
Toxins
Thrombosis
Tamponade
Tension pneumothorax
What additional step should be carried out in C (circulation) in a trauma patient?
On the floor and four more
- floor
- chest
- abdomen
- long bones
Abdominal examination
What drug is given in trauma patients to help stop the bleeding?
Tranexamic acid
What level is a pelvic binder put on?
Level of the greater trochanter
What GCS level indicates that a patient may not be able to maintain their own airway?
8 or less
What are the three components of GCS?
Eye movement (4)
Verbal response (5)
Motor response (6)
Describe the scoring of eye movement in GCS
4 = spontaneously
3 = to verbal command
2 = to pain
1 = no eye opening
Describe the scoring of verbal response in GCS
5 = alert/orientated
4 = confused
3 = inappropriate words
2 = inappropriate sounds
1 = no verbal response
Describe the scoring of motor response in GCS
6 = obeys commands
5 = localises pain
4 = withdrawal from pain
3 = flexion to pain
2 = extension to pain
1 = no motor response
What is given in prolonged seizures?
Lorazepam (or other benzodiazepines)
What are shockable rhythms?
Pulseless ventricular tachycardia
Ventricular fibrillation
What are non-shockable rhythms?
Asystole
Pulseless electrical activity (PEA)
What drugs are given after 3 shocks in cardiac arrest?
Amiodarone 300mg IV
Adrenaline 1mg IV
When is the first dose of adrenaline given in cardiac arrest?
During the 2–min period of CPR after delivery of the third shock.
How often is adrenaline given in cardiac arrest?
Every 3-5 minutes or after alternative 2-minute loops of CPR
When can a second dose of amiodarone be administered in cardiac arrest?
If VF/pVT persists, or recurs, a further dose of 150 mg amiodarone may be given after a total of five defibrillation attempts.
What is the treatment of symptomatic sinus bradycardia?
Atropine 500mcg IV until max of 3 mg
What are some side effects of atropine?
Blurred vision, dry mouth, urinary retention and confusion
Action of atropine?
Blocks vagus nerve
Increases sinus node automaticity
Increases atrioventricular conduction
If atropine doesn’t resolve symptomatic sinus bradycardia, what is the next step?
Transcutaneous pacing
What is the treatment of ventricular tachycardia?
Electrical Synchronised DC Shock
What is first line in symptomatic sinus tachycardia?
Vagal manoeuvres
What is second line to vagal manoeuvres in symptomatic sinus tachycardia?
Adenosine 6 mg bolus rapid IV injection
Side effect of adenosine
Nausea
What happens to PaCO2 levels in hyperventilation?
CO2 levels drop
What is a high PaCO2 suggestive of in a blood gas?
Respiratory acidosis
What is a low PaCO2 suggestive of in a blood gas?
Respiratory alkalosis
What does a negative base excess (blood gas) suggest?
Metabolic acidosis
What does a positive base excess (blood gas) suggest?
Metabolic alkalosis
How does the body compensate for metabolic alkalosis?
Increasing PaCO2 through hypoventilating
How does the body compensate for metabolic acidosis?
Reduces PaCO2 through hyperventilating
What is raised urea and creatinine indicative of?
Dehydration
Pre-renal failure due to hypovolaemia
What type of antacid is ranitidine?
H2-receptor antagonist
Why are antacids important in anaesthetics?
Reduce gastric acid reflux
Reduces aspiration risk at induction of anaesthesia
Describe the mechanism of benzodiazapines
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.
