amk teach

Question 1

70yr old man falls unconscious. PMH of AF and high BP what should you do first

Answer 1

check the airway and secure it
A-E
airway, breathing, cardiovascular, disability, exposure

Question 2

when is an airway not patent

Answer 2

secretions, aspirated or if GCS below 8

if patient can speak airway is patent
consider suction , airway opening manoeuvres such as head tilt or naso or oropharyngeal

treat cause if knows such as foreign body or anaphylaxis( if suscpeted treat dont move on to ABCDE)

Question 3

breathing what would you do to investigate

Answer 3

resp rate
pulse oximetry
calves ( dvt and pe)
tests such as ABG and CXR

mx
15L 02 via non rebreathe mask - less for COPD
treat any evident cause - pneumothorax, asthma, copd, exacerbation, opiate, OD and PE

Question 4

breathing what would you do to investigate

Answer 4

resp rate
pulse oximetry
calves ( dvt and pe)
tests such as ABG and CXR

mx
15L 02 via non rebreathe mask - less for COPD
treat any evident cause - pneumothorax, asthma, copd, exacerbation, opiate, OD and PE

Question 5

how to assess circulation

Answer 5

capillary refill time - central
pulse - rate rhythm and volume
BP
temperature
auscultation and JVP

tests
wide bore cannula - take blood and VBG
3 lead cardiac monitoring
ECG
catheter for fluid monitoring

treat cause and reassess after any intervention

Question 6

disability what do you check

Answer 6

DEFG - dont ever forget glucose
GCS
pupils reactivity and symmetry
pain assessment
tests - CT brain

Question 7

what comes under e

Answer 7

exposure - exposre the body lookign for rashes and injuries
examine abdomen
focused exam of any relevant systems

Question 8

40yr old female brought in by ambo with 1.5hr of SOB and dry cough, BMI is 35, calves huge, positive for covid what is this dx

Answer 8

PE

Question 9

PE is a blockage in pulmonary circulation - can be fat , air amniotic fluid but most commonly VTE
sx

Answer 9

pleuritic chest pain - worse on inspiration
breathlessness
cough hemoptysis etc

wells score for risk
ECG, echo and CXR

Question 10

score of 4 or less then d dimer psotive what do you give

Answer 10

LMWH - enoxaparin

Question 11

score 5 or more what do you do

Answer 11

give LMWH and CTPA when psottivle

Question 12

if CTPA is negative what do you do

Answer 12

stop heaprin

Question 13

if ctpa is postive

Answer 13

anticogaultion for 3-6 months

Question 14

INR for someone with PE

Answer 14

2-3

Question 15

if score of 4 or less and d dimer negative what do you do

Answer 15

seek another diagnosis

Question 16

massive pe signs and tx for this

Answer 16

SBP under 90 , for over 15mins , pulselessnesss or bradycardia
thrombolysis immediately with alteplase

Question 17

sub-massive pe causing RV dysfunction , myocardial necrosis or saddle PE - tx for this

Answer 17

give unfractionated heparin over 72hr and reconsider thrombolysis

Question 18

25yr man 2hr history of SOB , hyperresonnant R chest , L sided tracheal deviation and sats dont improve with O2. His ecg shows arrhythmia. First step management after A-e?

Answer 18

right sided decompression 2nd intercostal space mid clavicular line

Question 19

pneumothorax is air in the pleural space caused by trauma, iatrogenic such as biopsy, infection asthma or another lung pathology, spontaneous. what are the three types.

Answer 19

closed - air cant move out
open - air can move in and out of pleural space
tension - air keeps coming in pushing mediastinum to the other side

Question 20

Ix and management of Pneumothoarx

Answer 20

CXR and measure the distance between the lung edge adn the inside of the chest wall at the hilum

Question 21

if no SOB and under 2cm air what happens

Answer 21

no treatment

Question 22

if SOB and over 2cm of air what to do

Answer 22

aspriation and reassess
if aspriation fails twice due chest drain

Question 23

if unstable

Question 24

if aspiration fails twice and you cannot get rid of cause what to do

Answer 24

chest train in 5th intercostal space , midaxiallary line and anterior axillary line - lat dorsi adn pec major in trangel of safety

Question 25

72 male follow a fall, confused and tired, trouble urinating GP prescribed abx. 8/15 on NEWS. blood coagulates before you can even take if from his cannula what is dx

Answer 25

sepsis

Question 26

sepsis is systemic inflammation due to infection. what is septic shock

Answer 26

severe sepsis reuslts in organ hypoperfusion adn failure. systolic BP less than 90 ,
hyperlactatemia over 4

Question 27

rf for sepsis

Answer 27

old or young, diabetes or chronic c
chemo, immuno, steroids
preg or peri-partum
indwelling devices eg catheters or central lines

Question 28

signs of sepsis

Answer 28

hypoxia
oliguria
AKI
thrombocytopenia
coagulation dysfucntions
hypotension
hyperlactatemia over 2

Question 29

montior sepsis throuhg NEWS score , temp, hr , rr, o2, bp, consciousness - immunosuppressed patietns may get normal score despite being v unwelll due to

Answer 29

neutropenic sepsis

Question 30

sepsis 6

Answer 30

BUFALO
blood cultures
urine output
fluids
antibiotics
lactate
oxygen

CXR if suspect penumonia

Question 31

what is neutropenic sepsis

Answer 31

sepsis in patients with low neutrophil count
reusult of chemo or TB drugs
treat anyoen on these drugs or weird , temp - treat with borad spec abx immediately usually piperacilin and tazocin but check guidliens

Question 32

what drugs cause neutropenic sepsis

Answer 32

antipyschotics
immunosuppresant and drugs for rheumatoid arthritis
chemo

Question 33

15yr old with 15min SOB and stridor. allergic to tomatoes what step first

Answer 33

a- adrenaline 0.5mg IM
B - 15L o2 non rebreather mask with salbutamol 5mg if wheeze
c - Iv access add fluids 500ml - 1L stat may need to titrate up to 4-8L
hydrocortisone 200mg IV
chlorpheniramine 10mg IV

admit for over 6hr monitor

take mast cell tryptase to confrim theyve had an anaphylactic shock

Question 34

what confrims an anaphylactic shock after attack

Answer 34

mast cell tryptase

Question 35

how often can you repeat with `IM adrenaline

Answer 35

every 5 min

Question 36

if not gettign bettwer move to

Answer 36

IV adrenaline

Question 37

heavy periods at 40 , fatigued, Hb is 40 , onyl eats biscuits and tea. next best step in management. and how many units of blood would she need

Answer 37

blood transfusion - 3 units

Question 38

when do consider a blood transfusion

Answer 38

acute blood loss, very low HB or coagulapathy