Anesthesiology

Question 1

Bone immobilization should always follow the?

Answer 1

* Pott’s rule:*

-If a long bone is broken, the immobilizing dressing should involve the given bone and two adjacent joints
-If a joint is damaged, the immobilizing dressing should involve the given joint and both bones forming it

Question 2

Antipyretics MOA

Answer 2

cause the hypothalamus to override a prostaglandin-induced increase in temperature.

Question 3

Antipyretics: example

Answer 3

-salicylates (eg, sodium salicylate and acetylsalicylic acid),
-ibuprofen, nonsteroidal anti-inflammatory drugs (NSAIDs),
-para-aminophenol derivative acetaminophen

Question 4

Hypovolemic shock is a

Answer 4

generalized state of ischemia in the body when the body’s cells do not receive enough oxygen as a result of blood loss or transfer to other cavities in the body.

Question 5

Hypovolemic shock resulting from blood loss is called

Answer 5

hemorrhagic shock

Question 6

An orthostatic drop in blood pressure of _____mmHg and a concomitant increase in heart rate of ______ indicates what ?

Answer 6

An orthostatic drop in blood pressure of** ≥10 mmHg** and a concomitant increase in heart rate of** ≥20/min** indicates hypovolemia.

Question 7

Loss of blood up to ____ is usually accompanied by ___.

Answer 7

Loss of blood up to 1500 ml is usually accompanied by** anxiety.**

Question 8

The loss of half of total blood volume (_______ml) is associated with _______ disturbances of _______.

Answer 8

** (2000–2500 ml)** is associated with quantitative disturbances of** consciousness.**

Question 9

Assuming an adult’s blood volume of 5 liters, the loss of **750ml of blood **is ____% of the circulating blood

Answer 9

Assuming an adult’s blood volume of 5 liters, the loss of **750ml of blood **is **15% **of the circulating bloodv

Question 10

ATLS guidelines that break down the shock according to the percentage of

Class 1 shock loss of less than 15% of blood

Answer 10

• no symptoms

Question 11

ATLS guidelines that break down the shock according to the percentage of

Class 2 shock loss of 15%-30% of blood

Answer 11

• increase in heart rate

Question 12

ATLS guidelines that break down the shock according to the percentage of

Class 3 shock loss of 31%-40% of blood

Answer 12

• increase in heart rate and decrease in pressure, moderate increase in respiratory rate and decrease in diuresis.

Question 13

ATLS guidelines that break down the shock according to the percentage of

Class 4 shock loss of more than 40% of blood

Answer 13

• a significant increase in heart rate and a decrease in pressure, an increase in respiratory rate, a significant decrease in diuresis.

Question 14

Hypothermia is a condition in which the internal body temperature falls below ___ ° C.

Answer 14

**35 ° C. **

Question 15

Classification of hypothermia distinguishes 5 stages of this condition

1 ° - mild hypothermia -

Answer 15

32-35 ° C

Question 16

Classification of hypothermia distinguishes 5 stages of this condition

2 ° - Moderate hypothermia -

Answer 16

28-32 ° C

Question 17

Classification of hypothermia distinguishes 5 stages of this condition

3 ° - Severe hypothermia -

Answer 17

24-28 ° C

Question 18

Classification of hypothermia distinguishes 5 stages of this condition

4 ° - Cardiac arrest or hypoperfusion state

Answer 18

<24 ° C

Question 19

Classification of hypothermia distinguishes 5 stages of this condition

5 ° - Death due to irreversible cooling of the body

Answer 19

<13.7 ° C

Question 20

Cooling the body reduces ?

Answer 20

Oxygen demand (6% for every 1 ° drop in core body temperature).

Question 21

Hypothermia reduces ?

Answer 21

body’s sensitivity to medication .

Question 22

in case of hypothermia are warming the patient and performing chest compressions in a ratio of 30: 2. After reaching the body temperature of ____ ____, we start to administer drugs, remembering?

Answer 22

30 degrees, we start to administer drugs, -remembering that the time interval between two doses should be doubled

Question 23

Answer 23

**Ventricular Tachycardia **
The ECG shows broad QRS tachycardia of ventricular origin.
The ECG record shows wide QRS complexes and the absence of a P wave.
Tachycardia is the result of the activity of the ventricular ectopic focus triggering high-frequency beats or is formed in the reentry mechanism.

Question 24

Answer 24

** assystolia** - no electrical activity of the heart and no contractile activity of the heart. It should be distinguished from pseudo-asystole, which is caused by technical problems of the ECG recording equipment, poor adhesion of electrodes to the skin or errors in the examination technique, there is a systolic function of the heart.

Question 25

Answer 25

**atrial fibrillation **- fast and irregular stimulation and contractions of individual bundles and fibers of the atrial muscle.
It arises most likely as a result of sending excitations through numerous ectopic foci or chaotic circulation of reentry waves over several circuits.

Question 26

Answer 26

torsade de pointes - a rare form of ventricular tachycardia with variable direction and different shapes of QRS complexes.

Question 27

Answer 27

ventricular fibrillation - fast and uncoordinated work of the heart’s ventricles (heart stimulation during relative refraction).
The ECG of the QRS complex is an irregular sine wave. If the sine wave is regular in shape and the heart rate is 200-300 beats per minute, it is called ventricular flutter.

Question 28

causes of acute epigastric pain include:

Answer 28

-peptic ulcer of the stomach and duodenum, ulcer perforation
-acute hepatitis
-intestinal ischemia
-abdominal aortic aneurysm

Question 29

causes of epigastric pain include:

Answer 29

acute hepatitis
abdominal aortic aneurysm
bile duct diseases
drug-induced mucosal damage of the stomach and duodenum
functional dyspepsia
gastroesophageal reflux disease (GERD)
gastroenteritis
intestinal ischemia
malignant tumors
myocardial infarction
peptic ulcer of the stomach and duodenum, ulcer perforation
pancreatitis or pancreatic pseudocysts

Question 30

The potentially reversible causes of cardiac arrest (so-called ‘four H’s) Include?

Answer 30

1. hypoxia
2. hypovolemia
3. hypokalemia or hyperkalemia, metabolic disorders (hypoglycemia, hypocalcaemia, acidosis)
4. hypothermia

Question 31

4T’s:

Answer 31

1. pneumothorax
2. cardiac tamponade
3. toxic causes of sudden cardiac arrest
4. venous thromboembolism (pulmonary embolism, myocardial infarction)

Question 32

Vitamin K antagonists (VKAs)

Answer 32

-have been the mainstay of anticoagulation therapy -VKAs are mainly used for the* prevention of stroke in patients with atrial fibrillation (AF) and the treatment*
-secondary prevention of venous thromboembolism

Question 33

Name 3 tissues with a rapid cell turnover

Answer 33

bone marrow - aplasia
gastrointestinal tract - diarrhea, mucus in the stool, nausea and vomiting, abdominal pain, urgent pressure on the stool, persistent wind and flatulence, bleeding from the lower gastrointestinal tract
skin - moderate or severe erythema; mottled moist exfoliation, usually limited to folds and folds of the skin

CNS - although neurons rarely divide, there are many other cells in the brain outside of them. Radiation causes apoptosis of mature oligodendrocytes, and also** disrupts the function of astrocytes** and microglial cells. Ionizing radiation in cases of strong exposure may also directly affect synaptic conductivity.

Question 34

Haemophilia A (Factor 8)

Answer 34

• is a congenital hemorrhagic diathesis caused by a decrease in the activity of factor VIII which causes increased bleeding.
• Most often, hemophilia A occurs as an inherited disease with the X chromosome but sometimes occurs as a result of de novo mutation. Therefore, most of the patients are males;
• In the majority of cases it is inherited as an X-linked recessive trait, though there are cases which arise from spontaneous mutations.

Question 35

define

Hyperosmolar hyperglycemic state

Answer 35

• is one of the acute disturbances of water-electrolyte balance and is most common in people with type II diabetes, especially in the elderly. -Diagnosis is established on the basis of laboratory values:

Question 36

Hyperosmolar hyperglycemic state

Diagnosis is established on the basis of laboratory values:

Answer 36

-plasma glucose concentration> 600 mg / dl
-pH> 7.3
-bicarbonate concentration> 15 mmol / l
-sodium concentration> 150 mmol / l (in 50% of patients)
-absence of ketone bodies in the urine
-serum osmolality> 320 mOsm / kh H2O
-disturbances of consciousness, coma

Question 37

Diabetes insipidus does not

Answer 37

affect the plasma glucose level.

Question 38

Adrenal crisis is characterized by

Answer 38

hyperkalemia,
hyponatremia,
hypoglycemia.

Question 39

Acute lithium poisoning manifests itself as symptoms:

on the part of the nervous system:

Answer 39

quantitative and qualitative disturbances of consciousness, psychomotor slowness, headaches, visual disturbances, impaired coordination of eye movements, dysarthria, cerebellar ataxia, coarse and fine wave tremors, dystonias, muscle stiffness, seizures

Question 40

Acute lithium poisoning manifests itself as symptoms:

on the part of the digestive tract:

Answer 40

nausea, vomiting, diarrhea, abdominal pain

Question 41

Acute lithium poisoning manifests itself as symptoms:

on the part of the kidneys:

Answer 41

acute prerenal and renal failure - incl. acute tubular necrosis

Question 42

Acute lithium poisoning manifests itself as symptoms:

on the part of the circulatory system:

Answer 42

arrhythmias, changes in the ECG recording, tachyarrhythmias, bradyarrhythmias, widening of the QRS complexes, disturbances in intraventricular conduction, heart blocks, bundle branch blocks, prolongation of the QTc interval, T wave inversion, non-specific ST-T changes

Question 43

Acute lithium poisoning manifests itself as symptoms:

on the part of the respiratory system:

Answer 43

acute respiratory distress syndrome (ARDS).

Question 44

activated charcoal is widely used, however, it is not effective in the treatment of poisoning caused by:

Answer 44

alcohols
solvents
acids and caustics
metals (iron and lithium)

Question 45

It should be remembered that the most effective method of treating acute lithium poisoning is ?

Answer 45

hemodialysis

Question 46

Adrenaline dosage varies with the age of the child:

Age Dose
<6 months

Answer 46

150 µg (0,15 ml)

Question 47

Adrenaline dosage varies with the age of the child:

6 months to 6 years

Answer 47

150 µg (0,15 ml)

Question 48

Adrenaline dosage varies with the age of the child:

6 years to 12 years

Answer 48

300 µg (0,3 ml)

Question 49

Adrenaline dosage varies with the age of the child:

> 12 years

Answer 49

300–500 µg (0,3–0,5 ml)

Question 50

the tidal volume characteristic of an adult

Answer 50

the tidal volume is 500 ml

Question 51

The tidal volume of an infant can be calculated by knowing the child’s

Answer 51

** body weight** and is: 7-9 ml x kg.

Question 52

Pediatric Basic Life Support

Indicate the 3 immediate emergency care factors regarding PBLS:

Answer 52

1. breath assessment should take 10 seconds - same as for adult resuscitation, breath assessment is based on 3 senses:

hearing (the patient’s audible breathing)
touch (feeling the patient exhale)
eyesight (lifting the chest)

2, while performing CPR on an infant you should compress the chest at a rate of at least 100/min;

3. chest compressions to breaths ratio is 15:2 - true, the altered breathing-to-compression ratio in favor of rescue breaths is due to the fact that in children, respiratory arrest usually precedes cardiac arrest. More specifically, we start with 5 rescue breaths, then continue with chest compressions and breaths at a ratio of 15:2.

Question 53

Using ALS - advanced life support after defibrillation, we perform the assessment of the heart rhythm:

Answer 53

• after 2 minutes of CPR
• after signs of return to vital signs
• when there is a sharp increase in the partial pressure of carbon dioxide in the end expiratory air (ETCO2

Question 54

An antidote for benzodiazepine intoxication is

Answer 54

Flumazenil -> BZD receptor antagonist, is used in BZD poisoning.

Question 55

Naloxone is used in

Answer 55

opioid overdose.

Question 56

Hypothermia is defined as a decrease in body core temperature

Answer 56

<35 ° C.

Question 57

Body core temperature can be measured in the

Answer 57

rectum,
esophagus
tympanic membrane.

Question 58

Degrees of hypothermia according to the Swiss Classification of Hypother

HT1 - core temperature

Answer 58

32-35 ° C - conscious patient with shivering

Question 59

Degrees of hypothermia according to the Swiss Classification of Hypother

HT2 - core temperature

Answer 59

28-32 ° C -* impaired consciousness *without shivering

Question 60

Degrees of hypothermia according to the Swiss Classification of Hypother

HT3 - core temperature

Answer 60

24-28 ° C - unconscious, vitals signs present

Question 61

Degrees of hypothermia according to the Swiss Classification of Hypother

HT4 - core temperature

Answer 61

<24 ° C - no vitals signs

Question 62

Degrees of hypothermia according to the Swiss Classification of Hypother

HT5 -

Answer 62

death

Question 63

reversible causes of SCA

4-H’s

Answer 63

hypoxia,
hypokalaemia/hyperkalaemia,
hypothermia/hyperthermia,
hypovolaemia

Question 64

reversible causes of SCA

4-T’s

Answer 64

tension pneumothorax,
tamponade,
thrombosis,
toxins

Question 65

It is a pathophysiological reaction to extensive bodily injury that usua

“Ach”…. triad of death:

Answer 65

acidosis
coagulopathy
hypothermia

Question 66

Which of the following is not used in patients with severe respiratory failure caused by status asthmaticus?

Answer 66

Adenosine can cause bronchospasm, which is highly undesirable in people with asthma.

Question 67

is used in case of paracetamol poisoning.

Answer 67

N-acetylcysteine

Question 68

is used in Organophosphate poisoning

Answer 68

Atropine

Question 69

1

used in Cyanide poisoning

Answer 69

Amyl nitrate

Question 70

2

used in Cyanide poisoning

Answer 70

Hydroxocobalamin

Question 71

used in Opioid poisining

Answer 71

Naloxone

Question 72

Antidote that can reverse benzodiazepine intoxication

Answer 72

Flumazenil

Question 73

We evaluate the depth in terms of the degree of burn, and thus:

I ° -

Answer 73

*covers only the epidermis *- the patient feels a burning sensation, redness and a slight swelling appear, healing takes about 1 week, does not leave a scar.

Question 74

We evaluate the depth in terms of the degree of burn

II ° a -

Answer 74

covers the epidermis and part of the dermis - the patient experiences severe pain, redness and swelling appear, blisters filled with light yellow liquid, healing takes about 2 weeks, leaves discoloration.

Question 75

We evaluate the depth in terms of the degree of burn

II ° b -

Answer 75

covers the epidermis and the entire dermis - the skin takes a white color, and as a result of damage to the sensory nerves, the burn does not hurt. Healing takes up to a few weeks and leaves a permanent scar.

Question 76

We evaluate the depth in terms of the degree of burn

III ° -

Answer 76

covers the entire thickness of the skin - the patient does not feel pain because the sensory receptors are damaged, the skin is hard, dry, white-grayish, the necrosis forms a scab, which, when it falls off, will fill with granulation tissue and large deep wounds will appear.

Question 77

We evaluate the depth in terms of the degree of burn

IV ° -

Answer 77

covers the tissues deeper - muscles, tendons, internal organs - necrosis and charring appear.

Question 78

Parkland rule

Parkland rule

Answer 78

Discusses the amount of fluids that we have to infuse the patient during the first 24 hours after burns.

-Fluid quantity = 2-4 ml x patient weight x percent burned body surface area.

-50% in 8 hours, 50% in the remaining 16 hours.

Example: A patient weighing 50 kg has two upper limbs burned.

2-4 x 50 x (9 + 9) = 1800 - 3600 ml. Half of them within the first 8 hours.

Question 79

name 5

Advanced Life Support (ALS):

Answer 79

1. Assess whether the patient is responding or breathing
2. Call the resuscitation team
3. Perform CPR 30 compressions up to 2 rescue breaths
4. RATE THE RHYTHM
5. Perform CPR for 2 minutes until your next rhythm analysis.

Question 80

name 2

DEFIBRILLATION RHYTHM -

Answer 80

ventricular fibrillation (VF)
or
pulseless ventricular tachycardia (VT)

Question 81

Prepare intravenous access. After 3 failed shocks, give

Answer 81

• amiodarone 300 mg in 20 ml 5% glucose and adrenaline 1 mg.
  -Subsequent doses of drugs - adrenaline 1 mg every 3 - 5 minutes,
  -amiodarone after 5 unsuccessful defibrillation 150 mg.

Question 82

Remember: adrenaline is _______ dependent

Answer 82

“time-dependent”, we give it every 3 - 5 minutes

Question 83

amiodarone is “_______-dependent”, we give it after ______

Answer 83

“defibrillator-dependent”, we give it after** 3 and 5 failed defibrillation.**

Question 84

When amiodarone is not available, it is recommended to administer?

Answer 84

** lidocaine **3 mg / kg. within an hour.

Question 85

NON-DEFIBRILLATION RHYTHM = ASSYSTOLY AND PEA OR ELECTRICAL ACTIVITY OF

NON-DEFIBRILLATION RHYTHM = ASSYSTOLY AND PEA OR ELECTRICAL ACTIVITY OF THE HEART WITHOUT A PULSE

Answer 85

1. Provide intravenous access as soon as possible and give 1 mg of adrenaline.
2. Repeat dose every 3-5 minutes, on average every other CPR cycle.
3. The guidelines for resuscitation state that “survival from an asystole or PEA cardiac arrest is unlikely if a potential cause is not identified and treated.” Therefore, actively seek 4H / 4T.

Question 86

shockable rhythm -

Answer 86

-defibrillate as quickly as possible,
-after 3 unsuccessful shock deliveries give amiodarone and adrenaline

Question 87

non-shockable rhythm -

Answer 87

-cardiac massage,
-adrenaline administered as quickly as possible, 3 - 5 minutes apart.

Question 88

torsade de pointes

Answer 88

(polymorphic ventricular tachycardia)

Question 89

In the event of persistence:

• ventricular fibrillation or ventricular tachycardia after 3 ineffective electrical shocks and suspected hypomagnesaemia,
• torsade de pointes (polymorphic ventricular tachycardia)

Answer 89

-> use magnesium in the form of** magnesium sulphate**
-dose of 1-2 g i.v., if necessary,
-repeat after 10-15 minutes.

Question 90

Symptoms of PE:

A classic triad of symptoms in pulmonary embolism, occurring in 25% of patients, includes:

Answer 90

1. sudden onset, 80% reports dyspnea
2. Pluric chest pain
3. hemoptysis.

-In studies: tachycardia, tachypnea, increase in the volume pulmonary component of the 2nd tone and tricuspid regurgitation (right ventricular dilation) murmur.v

Question 91

Pulmonary embolism (PE) is

Answer 91

a narrowing or closure of the pulmonary artery or its branches by an embolus (embolic material).

Question 92

Examples of emboli:

Answer 92

1. thrombi - most often from the deep veins of the lower limbs
2. amniotic fluid
3. air
4. adipose tissue - when a long bone is broken
5. tumor masses
6. foreign bodies

Question 93

Pathophysiology of embolism:

Answer 93

1. When the embolic material closes the pulmonary artery, the ventilation to perfusion ratio decreases, and hypoxemia develops.
2. As a result of the embolism, blood from the right side of the heart must overcome more resistance.
3. This leads to right ventricular dilatation and a reduction in the amount of blood that goes to the left heart.
4. The minute capacity decreases and shock develops.
5. In addition, as a result of impaired perfusion, symptoms of myocardial ischemia may appear.
6. The clinical picture depends on the size of the embolus and the general condition of the patient.
7. A young, healthy patient may have only minor symptoms.
8. In an elderly patient with numerous chronic diseases, even a small embolism can lead to shock.

Question 94

Risk factors:

Pulmonary embolism

Answer 94

age >40 years old
obesity
varicose veins of the lower extremities
multi-organ injuries
fractures of the pelvis and femur
operations and associated long-term immobilization
long >4 hour flight
cancer
pregnancy and puerperium (first 6 wks postpartum)
HRT and contraception

Question 95

Pulmonary embolism

Supplementary tests: PE

Answer 95

-D-dimers - have a negative predictive value - that is, increased D-dimer levels do not allow the diagnosis of PE, but when they are normal (i.e. <500 in people <50 years of age, 10 for each year of life in people >50 years old) this allows you to exclude PE
-ECG - right axis deviation, RBBB - right bundle branch block, “SIQIIITIII” syndrome
--Angio-CT - remember to include information about suspicion of PE on the referral
-CUS - compression ultrasound examination of lower limb veins

Question 96

Levine’s symptom

Answer 96

when the patient points to the source of pain by placing a clenched fist or an open hand on the chest.

Question 97

name 5

Features and characteristics of chest pain:

Answer 97

angina pectoris - retrosternal, can radiate to the left jaw, left shoulder, epigastrium, crushing, burning, intensifying during physical exertion
unstable angina or myocardial infarction - the same characteristics as above and does not subside after stopping exercise and taking nitroglycerin, lasting> 20/30 minutes
pericarditis - sharp, stinging, variable intensity, decreases in a sitting position with a forward lean, pericardial friction present
pleural pain - one-sided, sharp, stinging, it decreases when you lie on your side where the pain occurs
aortic dissection - sudden, severe, excruciating, covers the anterior chest wall.

Question 98

In the event of electrocardiographic features of** hyperkalemia or arrhythmias** you should administer problems.

Answer 98

30 ml of a 10% solution of calcium gluconolactobionate
or
10 ml of a 10% solution of calcium chloride .
-This procedure does not cure hyperkalemia itself !
These drugs are cardioprotective and should always be given if you have heart rhythm

Question 99

In order to move potassium into the cells, give

Answer 99

20-40 ml of 40% glucose solution + 4-8 units of short-acting insulin (1 unit of insulin for 3 g of given glucose).

Question 100

If you have acidosis, give

Answer 100

50 ml of 8.4% NaHCO3 (Sodium bicarbonate) solution.

Question 101

treatment that removes excessive potassium from the body - options:

Answer 101

*loop diuretic in patients with preserved diuresis , eg furosemide 20-40 mg iv, the dose can be repeated after 6-8 h. Loss of fluids due to increased diuresis is compensated with 0.9% NaCl infusion.

cationic exchangers binding potassium in the gastrointestinal tract - polystyrene sulphonate p.o. or p.r. 30 g in 150 ml of water or 10% glucose solution; a 0.5-1.0 mmol / l reduction of kalemia occurs within 4-6 hours

hemodialysis (rarely peritoneal dialysis) - in the case of life-threatening hyperkalemia and in patients with severe renal insufficiency.

Question 102

Spurious hyponatremia occurs secondary to:

Answer 102

Hyperglycemia

Question 103

Hyponatraemia is a serum sodium concentration of

Answer 103

<135 mmol / L.

Question 104

We can divide hyponatraemia according to the degree of severity:

mild
moderate
severe

and due to the duration:

acute - lasts
chronic - lasts

Answer 104

mild 130 - 134 mmol / l
moderate 125 - 129 mmol / l
severe <125 mmol / l,

duration:
acute - lasts <48 hours
chronic - > 48 h and any undocumented hyponatremia.

Question 105

hypotonic with hypovolemia -

Answer 105

high loss of fluids and Na, e.g. in diarrhea.

Question 106

hypotonic with isovolemia -

Answer 106

a decrease in Na concentration causes the passage of water into the extracellular space, causing edema. The most common form of hyponatraemia. It occurs in patients with inadequate secretion of vasopressin.

Question 107

isotonic or hypertonic -

Answer 107

-it occurs when there are a lot of osmolally active substances in the plasma.
-They cause fluid to pass from the cells into the blood. Plasma is diluted.
-Depending on the concentration of these substances, the plasma osmolality is normal or increased.

Question 108

hypotonic with hypervolaemia -

Answer 108

may occur when there is an excessive supply of electrolyte-free fluids, with AKI or CKD.

Question 109

A tourniquet is a type of dressing used to?
name specific situations: name 4
Placement ?

Answer 109

-provide first aid.
-This band helps to stop severe bleeding that threatens life by pushing the artery to the bone and completely closing its light . According to the latest guidelines of the European Resuscitation Council, we only use the tourniquet in specific situations:

1. mass accident,
2. amputation,
3. crushing,
4. when the direct compression does not block the bleeding

-It is placed about* 5 centimeters above the source of hemorrhage* , but never below the elbow or knee,

Question 110

“It is good to remember the following important facts:

the radial pulse can be checked at a systolic pressure of about ____

Answer 110

80 mmHg,

Question 111

“It is good to remember the following important facts:

the femoral artery can be checked at systolic pressure of ___

Answer 111

70 mmHg

Question 112

“It is good to remember the following important facts:

The carotid artery systolic pressure can be checked at

Answer 112

60 mmHg.

Question 113

name 10 from top -> bottom

We test the heart rate on the artery:

Answer 113

jugular
subclavian
axillary
brachial
radial
ulnar
femoral
knee-length
posterior tibia
dorsal foot.

Question 114

Hypothermia reduces the body’s sensitivity to

Answer 114

medication

Question 115

patient with irregular tachycardia with narrow QRS, no symptoms of circulatory failure is considered ?

Answer 115

• stable. **
  -the most common symptoms are* atrial fibrillation with an uncontrolled ventricular response* or *atrial flutter with variable AV block. *
  -We do not stimulate the vagus nerve in such patients**

-We** do** it in patients with regular tachycardia in order to release the conductivity in the atrioventricular node.

Question 116

Management of a patient with pulse tachycardia: Point 1- 3 of 4

Management of a patient with pulse tachycardia:
Point 1-3

Answer 116

1. Examine the patient according to the ABCDE scheme
2. Obtain intravenous access, perform an ECG, and administer oxygen when indicated
3. Recognize and treat a reversible cause

Question 117

Management of a patient with pulse tachycardia: Point 4 of 4

Management of a patient with pulse tachycardia:
Point 4

Answer 117

4. Assess whether the patient is stable, whether there are any disturbing symptoms such as shock, fainting, myocardial ischemia or heart failure

Question 118

Management of a patient with pulse tachycardia: Point 4 of 4

Management of a patient with pulse tachycardia:
Point 4a

Answer 118

-If the patient is unstable, we should perform cardioversion up to 3 attempts, then give amiodarone 300 mg IV. within 20 minutes

Question 119

Management of a patient with pulse tachycardia: Point 4 of 4

Management of a patient with pulse tachycardia:
Point 4b

Answer 119

-If the patient is stable, we need to evaluate the QRS

-When they are narrow <120 ms and regular, we should stimulate the vagus nerve and administer adenosine in the 6-12-18 mg regimen

-When they are narrow and irregular, it is most likely atrial fibrillation that requires appropriate treatment.
-Included here: pharmacological ventricular rhythm control - A with B-blocker or diltiazem.
-Moderation with medication - pharmacological cardioversion or electrical cardioversion.
-In such patients, treatment to prevent complications should also be started.
-When the duration of the arrhythmia is greater than 48 hours or unknown, in order to perform cardioversion, we must administer antiplatelet drugs for 3 weeks before the procedure and 4 weeks after the procedure.
-If the patient requires immediate moderation, we must perform a transesophageal ECHO in order to exclude a thrombus in the left atrial appendage.

Question 120

Cardioversion is a medical procedure that

Answer 120

-uses quick, low-energy shocks to restore a regular heart rhythm. It’s a treatment for certain types of irregular heartbeats (arrhythmias), including atrial fibrillation (A-fib).
-Sometimes cardioversion is done using medications

Question 121

in order

Management of recurrent ventricular tachycardia is as follows:

Answer 121

cardioversion
overdrive electrostimulation
amiodarone
lidocaine

Question 122

adenosine in the case of

Answer 122

tachycardia with pulse with narrow and regular QRS.

Question 123

Sudden Cardiac arrest

What is used in the case of SCA

Answer 123

We use defibrillation and adrenaline in the case of SCA

-Heart attack is when blood flow to the heart is blocked.
-heart attack is a “circulation” problem

-Sudden cardiac arrest is when the heart malfunctions and suddenly stops beating.
-sudden cardiac arrest is an “electrical” problem.

Question 124

it should be noted that if a patient is not in cardiac arrest therefore we do not perform ___

Answer 124

it should be noted that the patient is** not in cardiac arrest **and therefore we do not perform CPR.

Question 125

percutaneous ablation

Answer 125

-an experienced interventional radiologist places a needle through the skin in the back and into the tumor.
-This is done under CT scan or ultrasound guidance.
-The ablation machine is then turned on and the tumor is destroyed.

Question 126

the use of* intravenous lidocaine* to treat recurrent sVT or VF is considered in the event of unresponsive treatment with?

Answer 126

β-blocker or amiodarone therapy

Question 127

formulas to calculate the QTc.

Answer 127

Bazett formula is most commonly used.

Question 128

Bazett formula =

Answer 128

QT interval (s) / √ RR interval (s)

Question 129

QT prolongation is confirmed occurs when QTc is:

Answer 129

≥0.45s in males

≥0.46s in females

Question 130

The cause of prolongation QT is

Answer 130

hypokalemia
hypocalcemia
hypervagotonia

Question 131

In the case of acute pulmonary edema, the following medications are used:

Answer 131

1. loop diuretics: furosemide, torasemide
2. oxygen
3. **opioids: ** morphine - this group of drugs is considered, in the case of strong agitation, anxiety, they also reduce the feeling of shortness of breath

Question 132

depending on the systolic pressure

In the case of acute pulmonary edema, the following medications are used:
a) SBP <85 mmHg
b) SBP <110 mmHg

Answer 132

4. depending on the systolic pressure

a) SBP <85 mmHg - **positive inotropic drugs: **dopamine, dobutamine, milrinone, levosimendan, noradrenaline, adrenaline

b) SBP <110 mmHg - vasodilators: nitroglycerin, sodium nitroprusside

Question 133

digoxin - it also belongs to ___ ___ drugs, but we only use it if ?

Answer 133

-belongs to positive inotropic drugs
-but we only use it if ?
the pulmonary edema was caused by a tachyarrhythmia, (eg atrial fibrillation).
-It is not recommended if pulmonary edema was caused by a myocardial infarction - it works arrhythmogenically.

Question 134

What is ARDS?

Answer 134

It is an acute respiratory distress syndrome (ARDS).

Question 135

What is cardioversion?

Answer 135

It is a procedure to restore the normal heart rhythm by simultaneous appearance of the R wave in the ECG and discharge of the short-term current of high voltage, resulting in partial depolarization of the myocardium.

Question 136

The indications for cardioversion are:

Answer 136

1. Urgent: supraventricular and ventricular tachyarrhythmias inducing hemodynamic disturbances.
2. Elective cardioversion: tachyarrythmiaa (predominantly atrial fibrillation and atrial flutter) that do not cause hemodynamic disturbance, persisting despite pharmacological treatment or when it is not possible to use drugs.

Question 137

A racing heart rate is known as ___. If it is fast and an arrhythmia, it is called ___

Answer 137

tachycardia
tachyarrhythmia

Question 138

Elective cardioversion indication in :

Answer 138

tachyarrythmiaa (predominantly atrial fibrillation and atrial flutter)

Question 139

Atrial fibrillation is a

Answer 139

-supraventricular tachyarrhythmia,
-heart disorder that is an indication for electrical cardioversion.

Question 140

VF / pVT are

Answer 140

-cardiac arrhythmias synonymous with cardiac arrest
-requiring CPR and defibrillation

Question 141

Asystole and PEA as well as

Answer 141

VF / pVT are rhythms identical to cardiac arrest, but they do not require defibrillation.

Question 142

name 4

rhythms identical to cardiac arrest, but they do not require defibrillation:

Answer 142

Asystole
PEA
VF / pVT

Question 143

name 6

Antihypertensives used parenterally for the treatment of hypertension with urgent indications are:

A - dilating vessels:

Answer 143

1. sodium nitroprusside - onset of action: immediate
2. nicardipine - onset of action: 5-10 min
3. fenoldopam - onset of action: <5 min
4. nitroglycerin - onset of action: 2-5 min
5. enalaprilat - onset of action: 15-30 min
6. dihydralazine - onset of action: 10-20 min

Question 144

name 4

Antihypertensives used parenterally for the treatment of hypertension with urgent indications are:

B - betablockers:

Answer 144

1. labetalol - onset of action: 5-10 min
2. esmolol - onset of action: 1-2 min
3. phentolamine - onset of action: 1-2 min
4. urapidyl - onset of action: 1-5 min

Question 145

The CURB-65 scale is .

Answer 145

a medical scoring scale that allows you to assess the severity of pneumonia and determine the place of treatment of the patient

Question 146

CURB-65
The name of the scale is an acronym of the risk factors taken into account when calculating the score:

Answer 146

-consciousness disorders and ( **C **onfusion)

-urea level ( U rea) greater than 7 mmol / l (BUN> 19)
-respiratory rate ( R ) equal to or greater than 30 / minute
-blood pressure ( B ) equal to or lower than 90/60 mmHg
- age over 65.

You can get 1 point for each answer
0-1 = outpatient
2 - recommended admission to the hospital
3-5 - obligatory hospitalization, possible treatment in ICU

Question 147

Infusion fluids can be divided into two groups: crystalloids and colloid

Crystalloids - these are

.

Answer 147

-water solutions:
-mineral salts such as sodium chloride, potassium chloride, calcium chloride, magnesium chloride,

-salts of organic acids, e.g. sodium acetate, sodium lactate, sodium citrate, low molecular weight carbohydrates.

They are cheap, easily available, do not cause allergic reactions.

Crystalloids after intravenous infusion quickly pass into the extravascular space, only briefly replenishing the plasma volume.

Question 148

The crystalloids include:

Answer 148

1. 0.9% NaCl
2. Polyelectrolyte fluid
3. Ringer’s lactate and lactate-free Ringer

Question 149

Colloids - these are

Answer 149

-aqueous solutions of macromolecular substances, most commonly polymers of glucose or derivatives of gelatine.

In contrast to crystalloids, colloids stay longer in the plasma without going quickly to the tissues.
-They better supplement plasma loss.
-Colloidal solutions are more expensive than crystalloids.
-All of them may cause allergic reactions (especially dextranes and to a lesser extent gelatine) with anaphylactic shock,

.

Question 150

Colloids include:

Answer 150

1. Hydroxyethylated starch - HES (HAES)
2. modified gelatin
3. dextrans
4. albumin.
5. Plasma is also a colloid, although it is not a typical infusion fluid

Question 151

ischemic stroke - S/D bp of

Answer 151

systolic blood pressure > 220 mm Hg
or
diastolic> 120 mm Hg

Question 152

if the patient is to receive thrombolytic therapy, the blood pressure must not exceed 185/110 mm Hg;

• are used to reduce BP ?

Answer 152

185/110 mm Hg;

• Labetalol and urapidil are used to reduce BP

Question 153

symptoms of increased intracranial pressure:

Answer 153

somnolence,
double vision
abnormal reaction of the pupils to light,
optic disc swelling → remember, however, that this is a late symptom,v

Question 154

symptoms of brain intussusception:

Answer 154

bradycardia
irregular breathing
high blood pressure

Question 155

A 36-year-old patient weighing 80 kg was taken to the ED because of burns from boiling water. Thorough examination revealed the burns to both legs and the right upper limb.

What amount of fluids should be infused in this patient during the first 8 hours after the trauma?
Name the Rule’s used to calculate ?

Answer 155

1. First, calculate the area of the patient’s burn.
   -According to Wallace’s rule, we count it as follows:

• 2 x lower limb (18%) = 36
• 1 x upper limb (9%)

In total, we obtain a result of 45%

2. Then, the demand for crystalloids within 24 hours should be calculated, according to the Parkland rule, using the formula:

x = 4 ml x body weight x area burns (%) = 4 ml x 80 kg x 45% = 14400 ml

3. The obtained result should be divided in half.
4. We will then get a demand for the first 8 hours, and the other half should be distributed over the remaining 16 hours, i.e.

14440 ml / 2 = 7200 ml - this is the amount to be given within 8 hours and the remaining volume within the next 16 hours

Question 156

A patient with diabetes mellitus is suffering from an acute complication known as ____ which is an acute syndrome of?

Answer 156

ketoacidosis
carbohydrate, lipid, protein, water-electrolyte and acid-base disorders.

Question 157

The latest ERC 2021 Guideline recommends Targeted Temperature Management (TTM) control in any adult patient following cardiac arrest who does not regain consciousness after ROSC. Target temperature should be

Answer 157

-between** 32°C and 36°C for min. 24 h, **
-in addition, in these patients, an increase in temperature> 37.7°C should be avoided for at least 72 h.

Question 158

Antidote for carbon monoxide:

Answer 158

OXYGEN

Question 159

Hyperbaric oxygen therapy is used in pregnant women with a COHb concentration __, regardless of the clinical condition, and if the concentration of COHb ___ - when neurological and / or cardiac disorders persist.

Answer 159

> 25%
15% (a <25%)

Question 160

What is a normal ABG level?
pH
PaO2
PaCO2

Answer 160

pH (7.35-7.45)
PaO2 (75-100 mmHg)
PaCO2 (35-45 mmHg)

Question 161

A patient with diarrhoea symptoms lasting several days was admitted to the hospital. Arterial blood gas test showed pH = 7.2, PaCO2 = 28 mmHg. Which acid-base imbalance should be diagnosed in the patient?

Answer 161

metabolic acidosis

The correct pH of human blood is: 7.35 - 7.45
Based on this, we can diagnose acidosis in the patient .
Now you need to determine which type of acidosis it is.

Diarrhea is given in patient history. As a result, the patient loses bicarbonate ions, i.e. anions of an alkaline nature, which meets the definition of metabolic acidosis. In the ABG test we will have a reduced HCO3- concentration.

Question 162

name 8

The characteristic fractures in Battered Child Syndrome include

Answer 162

1. sternum
2. shoulder blade,
3. ribs (especially the back section),
4. spinous processes and vertebral bodies,
5. collarbone,
6. tibia and thigh in infants (shaft),
7. bones of fingers in children who do not walk yet
8. epiphyseal, metaphyseal and intra-articular fractures

Question 163

Pulmonary embolism is a disorder involving

Answer 163

the occlusion or narrowing of the pulmonary artery or its branches by embolic material, which may be: thrombus - from deep veins of the lower limbs or pelvis, amniotic fluid, air, adipose tissue, tumor masses, foreign bodie

Question 164

Symptoms of Pulmonary embolism include

Answer 164

sudden dyspnoea (in 80% of patients),
chest pain of pleural origin,
less frequently coronary (in 50% of patients),
cough (in 20% of patients),
moreover fainting, collapse, hemoptysis.

Question 165

Physical examination of Pulmonary embolism shows

Answer 165

tachypnoea, tachycardia,
sometimes distension of the jugular veins,
louder pulmonary compound of the S2 sound,
sometimes murmur of tricuspid regurgitation,
hypotension and symptoms of shock

Question 166

The correct respiratory rate at rest is

Answer 166

12-15 / min.

Question 167

One of the pathological cycles and breathing paths is the deepened and accelerated breath, so-called

Answer 167

Kussmaul breathing

Question 168

Kussmaul breathing - occurrs in

Answer 168

metabolic acidosis

Question 169

name 6

Kussmaul breathing - occurring in metabolic acidosis, to which the following can lead:

Answer 169

1. diabetic ketoacidosis (sudden insulin deficiency),
2. lactic acidosis,
3. acidosis caused by the supply of acid precursors (eg. poisoning with ethanol, methanol, ethylene glycol, salicylates),
4. impaired regeneration of bicarbonates by the kidneys - acidosis in acute or chronic renal failure - it may occur in the case of metformin overdose;
5. loss of the bases by kidneys - proximal and distal tubular acidosis;
6. through the digestive tract - diarrhea, biliary fistulas, pancreatic, intestinal fistulas.

Question 170

causes of Kussmaul breathing, you can use the following acronym:
“KUSMAUL”

Answer 170

“K” Ketosis
“U” Uremia
“SS” Salicylate poisoning
“M” Methanol poisoning
“A” Ethylene poisoning (earlier spelt Aethylene)
“U” Uremia
“L” Lactic Acidosis

Question 171

Epiglottitis is a rare form of___ ?
Aetiology

Answer 171

** laryngitis** that occurs more often in children than in adults (usually from 2 to 6 years of age)

-The most common aetiological factor is Haemophilus influenzae type B

Answer 172

The disease begins suddenly with pain in the upper part of the larynx, when swallowing, the pain intensifies to such an extent that the patient avoids it. This results in abundant salivation. From the onset of the disease there is high temperature and rapidly increasing dyspnoea (with stimulation of the sympathetic system and subsequent tachycardia)

Question 173

Epiglottitis is a rare form of laryngitis that begins

Answer 173

• begins suddenly with pain in the upper part of the larynx, when swallowing, the pain intensifies to such an extent that the patient avoids it. –This results in abundant salivation.
• From the onset of the disease there is high temperature and rapidly increasing dyspnoea (with stimulation of the sympathetic system and subsequent tachycardia)

Question 174

The Parkland formula is the basic protocol for

Answer 174

-replacement of fluids in burned patients
-4-5 ml × mass (kg) × burn area (%) *

• calculated on the basis of Wallace rule of nines

Question 175

Near-drowning

Answer 175

is the survival (at least temporarily) of an incident associated with being submerged in water.

Question 176

Drowning

Answer 176

is death due to asphyxiation caused by being submerged in water.

Question 177

Sudden immersion syndrome

Answer 177

is a sudden death caused by immersion in very cold water.

Question 178

Drowning leads to ->

Answer 178

Drowning → hypoxia → laryngospasm → no aspiration of water to the respiratory tract.

Question 179

Wet drowning

Answer 179

where water is aspirated into the lungs.

Question 180

Hypokalemia is defined as

Answer 180

a decrease in serum potassium **<3.8 mmol / l **.

Question 181

Acidosis is most often associated with

Answer 181

hyperkalemia.

Question 182

name & provide the amount

Antidote used intravenously in paracetamol intoxication amounts to:

(coma, severe lactic acidosis) massive drug overdoses (75-100 g).

Answer 182

N-acetylcysteine (NAC)
300 mg/kg m.c.

NAC dosing regimen (3 doses in 21h):

I dose - 150 mg/kg
II dose - 50 mg/kg
III dose - 100 mg/kg

Summing up all 3 doses, the total dose is 300 mg/kg

Question 183

Mallampati classification or Mallampati score - is used

Answer 183

-four-level classification used in anaesthesiology, -defining the degree of difficulty of tracheal intubation determined by the anatomical structure of the oral cavity.

The classification is as follows:

visible soft palate, uvula, fauces and pillars
visible soft palate and uvula
visible soft palate and the base of uvula
one cannot see the soft palate

Question 184

name 4

Convulsions may occur in the following electrolyte and metabolic disorders:

Answer 184

hyponatremia
hypocalcaemia
hypomagnesemia
hypoglycemia

Question 185

In Poland, septic shock is most often caused by ____ ____ infections, followed by ___-___ infections, which are the most common cause of severe sepsis treated in ICUs.

Answer 185

respiratory tract infections
intra-abdominal infections

Question 186

Normocapnia or normocarbia is a state of

Answer 186

normal arterial carbon dioxide pressure (32 - 45 mmHg)

Question 187

Proceeding in ICU after ROSC (return of spontaneous circulation)

Answer 187

-Temperature control: constant temperature 32 - 36 ℃ for ≥ 24h; prevent fever for 72 hours.
-Keep normocapnia (32 - 45 mmHg) and **normoxia (75 - 100 mmHg); lung-saving ventilation
-Optimalization of hemodynamic parameters** (MAP, lactates, ScvO2, CO / Cl, diuresis)
-echocardiography
-Maintain normoglycemia
-Diagnose / treat convulsions (EEG, sedation, anticonvulsants)
-Delay assessment of prognosis for at least 72h

Question 188

present symptoms characteristic of hypercalcemia:

Answer 188

-impaired renal function - polyuria, calcinosis and kidney stones
-gastrointestinal disorders - lack of appetite, nausea, vomiting, constipation, gastric and duodenal ulcer disease, cholecystolithiasis - these conditions usually occur with abdominal pain
-dysfunction of the cardiovascular system - hypertension, tachycardia, arrhythmia
-neuromuscular symptoms - muscle weakness, facial muscle paralysis
-neurological symptoms - headache, depression, drowsiness
dehydration

note; metastasis to the bones are very often associated with hypercalcaemia.

Question 189

Thyroid (or hypermetabolic) storm

Answer 189

• is a life-threatening condition associated with an increased concentration of thyroid hormones in the blood serum and the inability of the body to adapt to this situation.
• It can occur in patients with any form of hyperthyroidism.
  -Mortality in the course of thyroid storm is up to 30% .

Question 190

Thyroid (or hypermetabolic) storm main symptoms

Answer 190

hyperthermia,
disturbances of consciousness,
tachycardia,
arrhythmia (supraventricular arrhythmias, atrial fibrillation)

Question 191

in Thyroid (or hypermetabolic) storm

Inhibition of thyroid hormone synthesis:

Answer 191

Thiamazole - iv 40-80 mg
*Iodine *- over an hour after the administration of thyrostatine - 4-5 drops; possibly Lugol’s iodine or iohexol

Question 192

Thyroid (or hypermetabolic) storm

Blockade of ß-adrenergic receptors:

Answer 192

Propranolol orally 40-80 mg or iv 2 mg very slowly (also inhibits peripheral conversion of T4 to T3)
Esmolol iv 0.25 - 0.5 mg / kg very slowly (selective ß1-blocker)

Question 193

Inhibition of peripheral conversion of T4 to T3:

Answer 193

β-blocker , e.g. propranolol
Hydrocortisone iv 50-100 mg (also acts as anti-shock)

Question 194

Body temperature equalization:

Answer 194

Cold compresses
Paracetamol, less frequently NSAIDs (salicylates, eg acetylsalicylic acid are CONTRAINDICATED! They remove thyroid hormones from complexes with proteins.)

Question 195

Normalization of fluid and electrolyte disturbances:

Answer 195

Hydration of the patient iv about 2-3 l / day
Electrolyte and 10% glucose supply

Question 196

Anaphylaxis

Answer 196

is a severe, generalized or systemic hypersensitivity reaction which is potentially life-threatening.

Question 197

Anaphylactic shock

Answer 197

-is an anaphylactic reaction in which there is a life-threatening reduction in blood pressure.
-It reduces tissue perfusion and cell damage.

Question 198

Urticaria

Answer 198

hives

Question 199

electric cardioversion can be started with energy of 50J in the following conditions

Answer 199

-supraventricular tachycardia (SVT),
-stable ventricular tachycardia
-atrial flutter (AFI)

Question 200

Cardioversion with the energy of 100J, 200J, 300J, and 360J are applied to

Answer 200

atrial fibrillation (AF),
unstable ventricular tachycardia (VT)

Question 201

Electric cardioversion is a procedure used to?
differs from defibrillation ?

Answer 201

• normalize tachyarrhythmias hemodynamically unstable but without circulatory arrest.
• It differs from defibrillation in that the electric impulse is synchronized with R-waves.

Question 202

The conductivity of tissues is determined by

Answer 202

• electrolyte ions (Na +, K +, Ca ++, Cl-).
• These tissues, which are rich in electrolytes, will therefore have the lowest resistance.

Question 203

Central venous catheters with large diameter are used in situations where it is

Answer 203

impossible to gain access to peripheral veins.

Question 204

Spironolactone

Answer 204

-is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease
-also used in the treatment of high blood pressure, low blood potassium that does not improve with supplementation, early puberty in boys, acne and excessive hair growth in women, and as a part of transgender hormone therapy in transfeminine people

Question 205

START

Answer 205

( Simple Triage and Rapid Transport ) protocol is one of the protocols enabling the initial selection of the patients according to their condition and priority of providing assistance at the time of a mass event.

Question 206

name and describe

-We distinguish four categories in it, marked with colors:

Answer 206

BLACK - Victims considered dead .
RED - Injured people requiring immediate assistance - the priority of evacuation.
YELLOW - Injured, whose condition does not require immediate intervention - evacuated in the second place.
GREEN - Victims walking.

Question 207

__ __ The chest compressions in newborns should be started if the heart rate is slower than 60 beats per minute despite adequate ventilation.

Answer 207

The chest compressions in newborns should be started if the heart rate is slower than 60 beats per minute despite adequate ventilation.
- two thumbs on the lower 1/3 of the sternum, with the remaining fingers embracing the chest and back of the child.
- compressed to 1/3 of the anterior-posterior dimension of the chest
- frequency with which resuscitation should be performed is 120/minute, maintaining the ratio of compressions to breaths 3:1,
- Within a minute, therefore, 90 compressions and 30 breaths should be performed
- The re-evaluation of heart rate should occur after about 30 seconds, then it should be checked periodically.
- Chest compressions should be discontinued if the spontaneous heart rate exceeds 60 beats per minute.

Question 208

define and name each

ABCDE

Answer 208

• short assessment that should be performed at the site of the event for the initial assessment of the patient’s condition.

**A - airway **- it should be managed by tilting the head back and pointing the mandible upwards, or by just jaw-thrust. The oral cavity should also be assessed to reveal items that could potentially cause airway obstruction
B - breathing - after airway patency is confirmed, breathing is assessed for 10 seconds using three senses - sight, hearing, touch. If breathing occurs, its speed, depth and character are assessed
C - circulation - indirectly by assessing the breath (in the absence of circulation, the breath will also stop), directly assessing the heart rate of the carotid artery
D - disability - the AVPU scale is used most often, in which the A - alert - V - verbal response - P - response for pain - U - unconscious. You can also use a more accurate Glasgow scale.
E - expose and examine - eg a quick trauma assessment.

Question 209

Aortic dissection (AD)

Answer 209

-occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart.
-Symptoms:
1. associated with a sudden onset of strong, tearing chest pain radiating to the back, often leading to fainting.
2. You may experience symptoms of shock, neurological symptoms, and heart attack symptoms. The preferred diagnostic method is angio-CT.
3. vomiting, sweating, and lightheadedness may occur
4. Other symptoms may result from decreased blood supply to other organs, such as stroke, lower extremity ischemia, or mesenteric ischemia.
- Aortic dissection can quickly lead to death from insufficient blood flow to the heart or complete rupture of the aorta

Question 210

name 2- define

aortic dissection Classification

Answer 210

Standford classification:
type A - dissection includes the ascending aorta regardless of the place of origin
type B - dissection does not include the ascending aorta
DeBakey classification:
type I - dissection starts in the proximal part of the aorta and travels to the descending part
type II - dissection limited to the ascending aorta
*type III *- dissection is located distally to the branching of the left subclavian artery
III a) only thoracic aorta
III b) Aorta below the diaphragm

Question 211

A massive haemorrhage is a loss of at least

Answer 211

20% of the circulating blood in a short time, which is about 1000 ml.

Question 212

General principles of transfusion of packed RBC:

Answer 212

1. Before commencing the transfusion of packed cells, the patient’s blood should be collected for a crossmatch.
2. If there is time for this, the patient’s blood type should be marked and a type -compatible pack should be ordered. If the patient is in a life-threatening condition, universal packs are transfused, in the case of packed RBS it will be blood type 0 RhD (-)
3. Transfusion speed should be planned - in the case of massive hemorrhages it is possible that packed cells will have to be transfused at high speed, e.g. 1 unit in 5-10 minutes
4. The patient’s* body temperature, blood pressure and heart rate* should be measured before connecting the blood component. Measurements should be repeated 15 minutes after the start of transfusion.

Question 213

Supraventricular tachycardia (SVT)

Answer 213

-is every rhythm with a frequency of> 100 ud / min, which is formed in the bundle of His or above it.
-In the ECG record, it will be characterized by narrow QRS complexes.

Question 214

Supraventricular tachycardia (SVT)

We distinguish the following types of SVT:
name 3

Answer 214

1. *AV nodal reentrant tachycardia *- AVNRT - arises as a result of the circulation of the excitation wave in the AV node through the fast path with longer refraction and the slow path with shorter refraction.
2. *atrioventricular reentrant tachycardia *- AVRT
3. atrial tachycardia - AT - paroxysmal or continual tachycardia that arises in the atrium outside the sinus node

Question 215

Supraventricular tachycardia symptoms

Answer 215

• Symptoms usually include palpitations, fatigue, dizziness, shortness of breath, fainting or loss of consciousness.
• Most often it is paroxysmal.
• Supraventricular tachycardia usually occurs in patients without any organic heart disease.

Question 216

treatment of supraventricular arrhythmias, the following are used:

Answer 216

1. treatments that increase the tension of the vagus nerve :
   **Valsalva maneuver **- an attempt to make a forced exhalation with a closed epiglottis. The modified Valsalva maneuver ends with a patient lying down with raised legs
   a. provoking vomiting
   b. dipping the face in cold water
   c. cervical sinus massage
2. Anti-arrhythmic drugs - depending on the type of SVT:
   a. adenosine
   b. Beta-blocker
   c. Ca-blocker ( Werapamil, Diltiazem )
   d. amiodarone

3.Electrotherapy - in states of hemodynamic instability - electric cardioversion
4. Percutaneous and surgical ablation - in recurrent and persistent tachycardias

Question 217

Atropine

Answer 217

• is an anticholinergic drug
• used principally to treat bradycardia
• selective antagonist of the M1 and M2 cholinergic receptors.
• It lowers the effects of acetylcholine
• serves as an antidote for poisoning with organophosphorus compounds, AChE inhibitors and digitalis.

Question 218

specific antidote in the intoxication with zolpidem

Answer 218

flumazenil
a selective benzodiazepine receptor antagonist

Question 219

Zolpidem

Answer 219

• is a drug from the group of non-benzodiazepine hypnotics.
• It is a selective agonist of the GABAa receptor omega-1 subunit, which modulates the chloride channel function.
• has a rapid hypnotic effect, thanks to which it facilitates falling asleep
• ensures the occurrence of deep sleep phases.
• dose of 10 mg just before going to bed.
• Treatment: short time due to the high addictive potential - a maximum of 4 weeks.
• Discontinuation: gradually with dose reduction.

Question 220

in the case of overdose of Zolpidem: the following procedure is done

Answer 220

-gastric lavage should be used,
-supply of activated charcoal,
-monitoring of vital signs.
-When severe symptoms like respiratory depression occur, the supply of flumazenil, which is a selective benzodiazepine receptor antagonist, may be considered .

Question 221

Sodium bicarbonate antidote used for intoxication with

Answer 221

cyclic antidepressant drugs

Question 222

Glucagon

Answer 222

• is used in the case of beta-blockers and Ca-blockers poisoning -
• it accelerates heart activity,
• increases the strength of myocardial contraction
• facilitates conduction in the atrioventricular node by acting on specific receptors for glucagon located in the myocardium.

Question 223

Acute pancreatitis

Answer 223

• is a condition associated with the premature activation of pancreatic proenzymes and their destructive effects on surrounding tissues.
• The most common causes: diseases of the gallbladder and bile ducts and alcohol.

Question 224

Acute pancreatitis
Symptonms

Answer 224

sudden, severe abdominal pain
nausea
vomiting that do not bring relief
fever

Question 225

Acute pancreatitis
laboratory tests

Answer 225

• an increase in serum amylase activity
• increase in lipase activity
• leukocytosis
• increase in CRP and procalcitonin

Question 226

Treatment in uncomplicated form of Acute pancreatitis (AP)
is conservative treatment:

Answer 226

1.* Intensive fluid therapy, alleviation of electrolyte and glycemic disorders*

2. Combating pain
   a. Metamizol ad hoc 1 g
   b. Tramadol 50 mg every 6 - 8h
   c. Buprenorphine 0.2 - 0.6 mg every 6 hours
   d. Pethidine 50 mg every 6 - 8h
   e. Continuous epidural blocking with bupivacaine
3. Nutritional treatment - initially diet “0”
4. Antibiotic therapy as a treatment for pancreatic necrosis

Question 227

Morphine is not recommended for use in the AP due to its potential

Answer 227

-contraction effect on the Oddi sphincter - if the cause of AP is the stones of this area, - morphine may exacerbate symptoms.

Question 228

The indications for the use of temporary electrostimulation of the heart are:

Answer 228

1. Symptomatic bradycardia or bradyarrhythmias, resistant to anticholinergic drugs and other treatments
2. Symptomatic type II second degree atrio-ventricular block (Mobitz II)
3. Third degree atrioventricular block (also asymptomatic)
4. Asystole with P waves in the ECG

Question 229

Myosis is accompanied by poisoning with the following substances:

Answer 229

-opioids
-barbiturates
-Horner syndrome (unilateral myosis)
-damage to the pons

Question 230

Wide pupils (mydriasis) can be observed in poisoning with:

Answer 230

-Anticholinergic substances:
a. Atropine
b. TCAs
-cannabinoids
- LSD
- sympathomimetics:
a. Amphetamine
b. derivatives

Question 231

Name group of opioid drugs which cause narrowed (myosis)- pin-like pupils

Answer 231

Tramadol
Morphine
Fentanyl
Codeine

Question 232

symptoms of toxemia

Answer 232

• fever, tachycardia, anemia

Question 233

Young scale =

Answer 233

Young Mania Rating Scale (YMRS) - defines the presence and severity of clinical symptoms and manic states occurring in the course of bipolar disorder.

Question 234

Tile classification

Answer 234

• refers to the classification of pelvic fractures:
  a. stable fractures (Type A),
  b. vertically unstable fractures and vertically stable fractures (Type B)
  c. vertically and rotationally unstable fractures (type C) are distinguished.

Question 235

Cormack-Lehane system

Answer 235

• classifies the conditions prevailing in the area of entry to the larynx assessed by means of direct laryngoscopy. There are 4 levels on this scale:

Grade I - entry into the glottis completely visible
Grade II - visible back of the glottis
Grade III - only the epiglottis visible
Grade IV - only the soft palate is visible

Question 236

Key and Conwell classification

Answer 236

is a classification of pelvic fractures.

Question 237

ERC 2015 guidelines allow administration of medications during the resuscitation of a neonate right after the birth. When the heart rate remains below 60/min the administration of which one below should be considered?

Answer 237

adrenaline
-in the *initial dose of 10 μg / kg *. administered intravenously.
-Subsequent doses can be increased up to 30 μg / kg

Question 238

Charcot triad, which consists of:

Answer 238

pain in the right hypochondrium
fever and chills
mechanical jaundice

This triad refers to acute cholangitis,

Question 239

define

acute cholangitis

Answer 239

• or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine).
• It tends to occur if the bile duct is already partially obstructed by gallstones.

Question 240

acute cholangitis

can be observed in laboratory tests

Answer 240

Leukocytosis,
high CRP and conjugated bilirubin ,
possible increase in activity of ALT, AST , GGTP, ALP.
In imaging studies - widening of the bile ducts.

Question 241

Treatment of acute cholangitis

Answer 241

-Emergent ERCP
-consists of fluid replacement,
-supply of diastolic drugs, strict diet
- broad-spectrum antibiotics: ciprofloxacin with metronidazole.

Question 242

The indications for electrical cardioversion are:

Answer 242

• Urgent indications
  ventricular and supraventricular tachyarrhythmia causing haemodynamic disturbances
• Scheduled indications
  ventricular and supraventricular tachyarrhythmias that do not cause hemodynamic disturbances, which do not pass despite pharmacological treatment or when it is not possible to use it

Question 243

Ventricular tachycardia without pulse is, of course, an indication for

Answer 243

defibrillation

Question 244

The normal respiration rate for an adult at rest is

Answer 244

12 to 20 breaths per minute

Question 245

young pregnant woman, 34hbd. Symptoms: headache, nausea, vomiting, edema, blurred vision. On exam: tachycardia, tachypnea, high blood pressure. Seizures have occurred. The patient presents the symptoms of eclampsia. The main drug used in eclampsia is

Answer 245

magnesium sulfate administered intravenously at a dose of 4-6 g .

Question 246

adenosine is a drug that is administered in

Answer 246

tachycardia with a pulse, with narrow regular QRS. At a dose of 6mg-12mg-12mg.

Question 247

crepitation audible over the lungs, the patient has edema and crackling that may suggest pulmonary edema.
What drug can be used in this patien condition of eclampsia with pulmonary edem?

Answer 247

furosemide is a drug used also for pulmonary edema.

Question 248

relanium is diazepam, a

Answer 248

benzodiazepine drug that has anxiolytic, sedative, anticonvulsant, hypnotic and miorelaxant effects.
Category D.

Question 249

Arterial hypertension in a pregnant woman can be divided into:

Chronic HTN -

Answer 249

diagnosed before pregnancy or before 20 hbd and persisting for more than 6 weeks after delivery

Question 250

Arterial hypertension in a pregnant woman can be divided into:

Gestational HTN -

Answer 250

identified after 20 hbd, without proteinuria; we divide them into 1. transient - disappears up to 12 weeks after delivery and 2. chronic - persisting 12 weeks after delivery

Question 251

Arterial hypertension in a pregnant woman can be divided into:

preeclampsia -

Answer 251

increased blood pressure> 140/90 after 20 hbd and proteinuria> 300mg / day; or no proteinuria but there present: thrombocytopenia PLT <100,000 / ul, Alat / Aspt> 2 x upper limit, creatinine> 1.1mg / dl, pulmonary edema , CNS problems, visual impairment

Question 252

Arterial hypertension in a pregnant woman can be divided into:

eclampsia - .

Answer 252

the appearance of tonic-clonic seizures in the course of preeclampsia

Question 253

eclampsia: prevention

Answer 253

rest
stress reduction
physical activity
acetylsalicylic acid 100mg from 16 hbd
low molecular weight hepari

Question 254

Eclampsia Treatment:

Answer 254

Ending pregnancy before 40 hbd
Magnesium sulfate iv 4-6 g in 20 minutes, then 1-2g / h for 24h = Zuspan method.
Control reflexes and breathing when administering magnesium!
Pressure control - nifedipine, urapidil, dihydralazine, labotalol
Oxygen 8-10l / minute.

Question 255

A 44-year-old male complains of severe abdominal pain and hematemesis. On examination: respiratory rate - 24/min, normal respiratory sounds over the lungs, SpO - weak signal, heart rate - 130/min, no pulse on the distal arteries, blood pressure - 75/50 mmHg, the skin is pale and sweaty, on the ECG - a regular rhythm with narrow QRS complexes. Which of the following should be performed?

Answer 255

Causal treatment -** LIQUID THERAPY** - 500 ml crystalloids within <15 minutes; within 30 minutes 1000 ml of crystalloids or 300-500 ml of colloids. After the transfusion of 2000 ml, further portions of fluid are administered depending on the patient’s condition, 200-500 ml.

Question 256

A 44-year-old male complains of severe abdominal pain and hematemesis. On examination: respiratory rate - 24/min, normal respiratory sounds over the lungs, SpO - weak signal, heart rate - 130/min, no pulse on the distal arteries, blood pressure - 75/50 mmHg, the skin is pale and sweaty, on the ECG - a regular rhythm with narrow QRS complexes. Which of the following should be performed?

provide explination

Answer 256

Data from the question: abdominal pain, bloody vomiting - bleeding into the upper gastrointestinal tract, tachycardia 130 / minute, tachypnoe, lack of pulse on distal arteries and a weak pulse oximeter signal suggests centralization of circulation, pressure 75/50, Allgover index 1.7 .
Patient pale and sweaty.
Symptoms suggest hypovolemic shock due to upper gastrointestinal bleeding.

Allgover index = heart rate / systolic pressure

0.6 - 1 - norm
~ 1 - developing shock
> 1.4 - heavy shock.

Question 257

According to 2015 guidelines, in a patient with tachycardia we should proceed as follows:

Answer 257

1. Examine the patient according to the ABCDE scheme
2. Get intravenous access, do ECG, give oxygen when indicated
3. Diagnose and treat a reversible causes !!
4. Assess whether the patient is stable or has disturbing symptoms such as shock, syncope, myocardial ischaemia or heart failure.
5. If so, we should perform cardioversion up to 3 times, then give amiodarone 300mg iv. within 20 minutes
6. If the patient is stable, we must assess QRS
7. When they are narrow <120 ms and regular (as in our patient’s) we should perform vagal maneuver and give adenosine in the 6-12-12 mg approach.
8. When they are narrow and irregular, it is probably atrial fibrillation that requires appropriate treatment.

Question 258

hyperosmolarity.

Answer 258

• It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances.
• This draws the water out of the body’s other organs, including the brain. Risk factors include: A stressful event such as infection, heart attack, stroke, or recent surgery

Question 259

What causes Hyperosmolarity?
Symptoms and Causes

Answer 259

Hyperosmolar Hyperglycaemic State (HHS) occurs when the blood sugar of a person with diabetes becomes too high (hyperglycemia) for a long time.
The extra sugar is passed into the urine, which causes the person to urinate frequently.
As a result, he or she loses a lot of fluid, which can lead to severe dehydration (extreme thirst).

Question 260

There are 4 major acute diabetes complications.

Answer 260

Ketoacidosis - the most common, especially in patients with type 1 diabetes.
*Lactic acidosis *- the least common.
HHS, i.e. Hyperglycemic-Hyperosmolar Syndrome - common in people with type 2 diabetes.
Drug-induced hypoglycaemia.

Question 261

HHS is characterized by

Answer 261

high hyperglycemia, high plasma osmolality and often prerenal AKI (due t

Question 262

Criteria for diagnosing HHS:

Answer 262

Glucose> 600mg / dl
pH> 7.3
Serum bicarbonate> 15 mmol / l
Na serum> 150 mmol / l
Plasma osmolality> 320 mOsm / kg h20
Ketone bodies in urine - NONE!

Question 263

Criteria for diagnosing HHS:

Answer 263

Glucose> 600mg / dl
pH> 7.3
Serum bicarbonate> 15 mmol / l
Na serum> 150 mmol / l
Plasma osmolality> 320 mOsm / kg h20
Ketone bodies in urine - NONE!

Question 264

Treatment: of HHS (Hyperglycemic-Hyperosmolar Syndrome

Answer 264

• Hydrate 0.45% or 0.9% NaCl Within 1 hour - 1000 ml During the next 4 - 6 hours - 500 ml per hour Until the shortage is compensated - 250 ml per hour.
• Reduce hyperglycemia - short-acting insulin Bolus - 0.1j / kg bw Start continuous infusion 2-4j / h
• Correct potassium deficiencies
• Look for the reason.

Question 265

Remember that a patient with ZHH has a higher risk of

Answer 265

*rhabdomyolysis *
venous thromboembolism.

Question 266

causes

torasemide -

Answer 266

-a loop diuretic that has no potassium-sparing effect.
-when using such diuretics, i.e.* furosemide, torasemide*, we expect HYPOkalemia.

Question 267

medications that can cause hyperkalaemia:

Answer 267

ARB
potassium supplements
heparin
digoxin.

Question 268

ramipril - ACEi -

Answer 268

-angiotensin converting enzyme inhibitors - blocking this enzyme prevents the change of angiotensin I to angiotensin II.
-Angiotensin II is a potent hormone. It compresses vessels, accelerates the formation of compounds with the same effect, stimulates the formation of aldosterone. In short, aldosterone works to cause HYPERnatremia and HYPOkalemia.
-If we use a drug blocking this pathway, we will get the opposite effect, i.e. **HYPERkalemia. **
-Other side effects of ACEi are kidney damage, cough and angioedema.

Question 269

ketoprofen -

Answer 269

-NSAIDs - when it comes to potassium, they reduce the concentration of renin and aldosterone.
-Thus, the effect of aldosterone is reduced, which can lead to HYPERkalemia.

Question 270

propranolol -

Answer 270

B-blocker - competitive β1 and β2 adrenoceptor antagonist.
-By blocking β2 adrenergic receptors, potassium transport into cells is impaired.
-Thus, HYPERkalemia will be a side-effect .

Question 271

trimethoprim -

Answer 271

an antibiotic - it works by inhibiting dihydrofolic acid reductase.
-It is used in the case of urinary tract infection, upper respiratory tract infection or diarrhea.
-Has many side effects: pruritus, gastrointestinal disorders, kidney and bone marrow toxicity, HYPERkalemia.

Question 272

Principles of chest compressions in adults:

Answer 272

compressions in the middle of the chest, in the lower half of the sternu

Question 273

BLS in adults:

Answer 273

-Check if the patient responds: “Can you hear me?”
-Open the airway and check if the patient is breathing - I look, listen, feel. Take a maximum of 10 seconds ( 1 minute in hypothermia)
-Call the Emergency Medical Team
-30 chest compressions - in the middle of the chest. in the lower half of the sternum, compression depth 5 cm, not more than 6 cm, with a frequency of 100-120 per minute
-2 breaths - open the airway, breathe in normally, surround the patient’s mouth, make sure there is no leakage, slowly blow the air for 1 second, checking if the chest rises.
—Repeat.
To make 2 breaths, stop compressing the chest for no more than 10 seconds.
When available, connect AED.

Answer 274

• assessment of whether the patient is breathing - 10 seconds, hypothermia - 1 minute
  inhale - 1 second
• ventilation pause - 10 seconds
• cardiac rhythm assessment - every 2 minutes
• Adrenaline supply - every 3-5 minutes t, in hypothermia - extended 2x until reaching over 35 ° C
• change of rescuers oppressing KLP - every 2 minutes
• recommended time till defibrillation since unconsciousness starts- 3 minutes
  for children, after 5 rescue breaths, perform CPR for 1 minute before you look for help.

Question 275

• suspect cardiac arrest (SCA)* should always be suspected in people with

Answer 275

seizures!
- check breathing and rule out cardiac arrest!!

Question 276

values - symptoms

Hyperkalemia -

Answer 276

1. K + > 5.5 mmol / l.

symptoms:

weakness
flaccid paralysis
paraesthesia
weakness of deep reflexes
bradycardia
cardiac arrest.

Question 277

values & synmptoms

Severe hyperkalemia -

Answer 277

concentration K> 6.5 mmol / l.

Question 278

ECG changes: (guidelines state that ECG changes will occur when K+ is ?

Answer 278

K +> 6.7 mmol / l)**

1st degree block (PQ interval> 200ms)
flattening or lack of P wave
high, pointed T wave
lowering of the ST segment
QRS widening> 120ms.

Question 279

When* hyperkalemia is mild (5.5-5.9 mmol / l)*, we want to remove potassium from the body. We use

Answer 279

*Calcium resonium 15-30g ion *exchange resin.
We give it orally or rectally. It binds potassium ions in the intestine and is removed with the stool.

Question 280

When hyperkalemia is moderate (6.0-6.4 mmol / l), we give ion exchange resins for the same purpose. However, we also want to move K + ions to the cell. We use ? nebulization.

Answer 280

10 units of short-acting insulin and 25 g of glucose or salbutamol 10-20 mg in

Question 281

When the hyperkalaemia is* moderate* but there are ECG changes or the hyperkalaemia is severe> 6.5 mmol / L, in addition to the treatment described above, we also use myocardial protection. For this purpose we use ?

Answer 281

10 ml 10% calcium chloride iv.

Question 282

in the case of acidosis, we can give ___ ___ ___ mmol in a quick bolus. Reducing acidosis will reduce ___ levels.

Answer 282

-sodium bicarbonate 50
-K +

Question 283

In summary, in the treatment of hyperkalemia, we use drugs that are designed to reduce the amount of potassium in the body. These are:

Answer 283

1. ion exchange resins
2. short-acting insulin
3. salbutamol
4. furosemide / torasemide
5. sodium bicarbonate

Question 284

We also use __ __, which is designed to protect the heart from high potassium levels and protect the patient from sudden cardiac arrest. __ does not cause a decrease in K + in the blood -

Answer 284

-calcium chloride

Question 285

The maintenance fluid requirement in a child weighing 35 kg amounts to:

Answer 285

• Holliday and Segar method *

Our patient weighs 35 kg (20 kg +15 kg).

1500 ml + (20 ml x 15 ) = 1800 ml

Question 286

Indicate the true statement concerning capnography (ETCO2) used during chest compressions in the course of CPR:

Answer 286

ETCO2 monitoring allows:

Confirmation of the location of the endotracheal tube in the trachea
Monitoring the frequency of ventilation during CPR
Monitoring the quality of chest compressions - the deeper the greater the cardiac output, so ETCO2 also increases
Prognosis during CPR - when we cannot get a value greater than 10mm Hg for 20 minutes, this is associated with poor prognosis for the patient
Diagnosis of ROSC - ETCO2 increase.

Question 287

PEEP -

Answer 287

-positive end-expiratory pressure- this is the pressure that is present in the lungs after normal exhalation.
-In a person breathing spontaneously, it is about 2-3 cm H2O.
-During ventilation, we also set this pressure, but it is higher,* in standard circumstances it is about 5-8 cm H2O.*

Question 288

Advantages of PEEP:

Answer 288

-alveoli do not collapse and it is easier to take another breath (“open it and keep them open”)
-allows reduction of FiO2 in the gas mixture, thanks to which we eliminate the negative effects of oxygen treatment
-it also causes the inclusion of dead areas in the gas exchange.

Question 289

Adversity that high PEEP can carry:

Answer 289

-chest pressure increases, so venous return to the heart and cardiac output decrease
-the phenomenon of auto-PEEP - can occur in patients with obstruction, where as a result of an air trap there is air retention and a decrease in cardiac output.

Question 290

Characteristics of opioid toxidrome:
& Antidote

Answer 290

Naloxone - a non-selective antagonist of all classes of opioid receptors, is mainly used to improve breathing, not to restore consciousness.

pinpoint pupils (like poppy seeds)
drowsiness or coma (CNS depression)
breathing disorders - shallow, irregular breathing, can lead to apnea (respiratory depression)
bradycardia
hypotension
paralysis of intestinal motility
urinary retention
nausea, vomiting
pallor of the skin
dizziness.

Question 291

Provide Antidote

Active substance
Methanol :

Answer 291

Ethanol, Fomepizol, folinic acid

Question 292

Provide Antidote

Active substance
Ethylene glycol

Answer 292

Ethanol, Fomepizol

Question 293

Provide Antidote

Active substance
benzodiazepines

Answer 293

flumazenil

Question 294

Provide Antidote

Active substance
cyanide

Answer 294

hydroxocobalamin

Question 295

Provide Antidote

Active substance
Digoxin

Answer 295

Fab fragments of digoxin binding antibodies

Question 296

Provide Antidote

Active substance
paracetamol (acetaminophen)

Answer 296

N-acetylcysteine

Question 297

Provide Antidote

Active substance
Carbon monoxide

Answer 297

Oxygen

Question 298

Provide Antidote

Active substance
Anticholinergic syndrome

Answer 298

physostigmine

Question 299

Provide Antidote

Active substance
Cholinergic syndrome

Answer 299

Atropine, Pralidoxime

Question 300

Provide Antidote

Active Substance
Opioids

Answer 300

naloxone

Question 301

Activated charcoal - 0.5-1.0 g / kg It binds to a poisonous substance and prevents its further absorption. Do not use in case of poisoning with alcohol, metals, cyanide. These substances are poorly absorbed by charcoal. Do not administer when there is an antidote to be given orally, suspected bleeding to the upper GI tract or obstruction.

Question 302

Management of acute poisoning:

WHat is administered in management of acute pisoning ?
It binds to a poisonous substance and prevents its further absorption.
Do not use in case of poisoning with __,__,__.
These substances are poorly absorbed by charcoal.
Do not administer when there is an antidote to be given orally, suspected bleeding to the upper GI tract or obstruction.

Answer 302

Activated charcoal - 0.5-1.0 g / kg
Do not use in case of poisoning with* alcohol, metals, cyanide. *

Question 303

Hemodialysis - can use it in case of ?

Answer 303

-poisoning with substances easily soluble in water, weakly binding to proteins. -
-Examples of these substances are: ethanol, methanol, glycol, paracetamol, lithium (may lead to renal and prerenal/renal AKI), salicylates.

Question 304

Hemodialysis - can use it in case of ?

Answer 304

-poisoning with substances easily soluble in water, weakly binding to proteins. -
-Examples of these substances are: ethanol, methanol, glycol, paracetamol, lithium (may lead to renal and prerenal/renal AKI), salicylates.

Question 305

Hyperthermia -

Answer 305

deep body temperature > 40 ° C due to increased heat production or impaired heat loss mechanisms.

Question 306

Toxidrome -

Answer 306

a set of symptoms that occur after poisoning with a specific substance.

Question 307

Neuroleptic Malignant Syndrome (NMS) -

Answer 307

-an acute state in psychiatry, it is caused by a blockage of dopaminergic conduction, most often as a result of ingesting typical and atypical antipsychotic drugs, combination of these drugs with e.g. metoclopramide, or as a result of sudden withdrawal of antipsychotic drugs.

-Symptoms: muscle stiffness (often the first symptom), “cogwheel” rigidity, muscle tremor, dystonia and dyskinesias, tachycardia, variable blood pressure, tachypnoe, HYPERthermia, extensive sweating.
-We use benzodiazepines and dantrolene for treatment .

Question 308

systemic inflammatory response syndrome
(SIRS) criteria:

Answer 308

> = 2 of the following 4:

1. body temperature > 38 ° C or <36 ° C
2. heart rate > 90 / minute
3. breaths > 20 / minute or PaCO2 <32 mm Hg
4. leukocytes > 12,000 / ul or <4000 / ul, or > 10% of immature forms of neutrophils.

Question 309

Maneuvers that increase the tone of the vagal nerve (e.g. Valsalva maneuver) are frequently effective in the emergency treatment of:

Question 310

Maneuvers that increase the tone of the vagal nerve (e.g. Valsalva maneuver) are frequently effective in the emergency treatment of:

Answer 310

ventricular tachycardia with narrow QRS complexes

-fast cardiac rhythms (generally more than 100 beats/min) with a QRS duration of 100 ms or less.
-Differential diagnosis of tachycardia with narrow QRS complex (shorter than 0.12 second).
-Although rarely life-threatening, these arrhythmias are a common source of morbidity.

Question 311

Valsalva maneuver →

Answer 311

-this is the act of making a forced exhalation with the glottis closed.
-This leads to increased chest pressure and pressure on the heart along with large blood vessels.
-At the moment of exhalation, the baroreceptors are excited and the vagus nerve stimulation increases

Question 312

As a result Valsalva maneuver the following occur:

Answer 312

1. inhibiting the frequency of sinus node depolarization
2. inhibition of conduction velocity in bundle of His
3. breakdown of the wave of recurrent stimulation that causes tachyarrhythmia

Question 313

Tachycardia with narrow QRS complexes → (__ms) non-pharmacological methods of interruption of tachycardia are effective, i.e.

Answer 313

<120 ms

1. Valsalva maneuver
2. carotid sinus massage
3. other methods of stimulating the vagus nerve :
   (e.g. a sip of cold fluid, provoking vomiting, immersing the face in cold water)

Question 314

provide values/ cause

Hypercalcemic crisis is a life-threatening condition that can occur in severe hypercalcaemia, usually

Answer 314

> 3.75 mmol / L.

**Hodgkin’s disease **

Question 315

Hodgkin’s disease →

Answer 315

The most common causes of hypercalcaemia (> 3.75 mmol / L) .(90%) are *hyperparathyroidism and cancer. *
-Tumors can directly infiltrate bones, leading to the release of calcium (hypercalcaemia) or indirectly lead to an increase in calcium levels in the blood by secreting hormones similar to PTH.

Question 316

Glasgow-Blatchford Score,

Answer 316

assesess the risk of gastrointestinal bleeding before performing an endoscopic examination.

Question 317

According to the applicable Resuscitation Guidelines, a capnography graph is used to

Answer 317

-confirm the *position of the endotracheal tube and monitor the frequency of ventilation. *
-Capnometry *registers the carbon dioxide content of exhaled air *and allows you to determine the effectiveness of ventilation in a non-invasive way.
-It also makes it possible to recognize the return of spontaneous breathing.

Question 318

Diazepam is a

Answer 318

-benzodiazepine drug with anticonvulsant, hypnotic and sedative effects.
-It shows an addictive effect both physically and mentally.

Question 319

-Indications for use of diazepam include

Answer 319

anxiety, panic attacks
conditions with increased muscle tone
increased agitation
insomnia
epileptic seizures
febrile seizures

Question 320

The maximal daily dose of diazepam used in the treatment of status epilepticus in adults amounts to:

Answer 320

50mg

Question 321

The dosage of the diazepam depends on the indication.
For the treatment of seizures in adults, __ __ should be used, doses can be repeated to a maximum dose of __

Answer 321

-2 to 10mg 2-4x / d should be used
-maximum dose of 50 mg.

Question 322

Zolpidem

Answer 322

• brand name Ambien
• medication primarily used for the short-term treatment of sleeping problems
• Guidelines recommend that it be used only after cognitive behavioral therapy for insomnia and behavioral changes, such as sleep hygiene, have been tried
• It decreases the time to sleep onset by about fifteen minutes and at larger doses helps people stay asleep longe
• It is taken by mouth and is available in conventional tablets, sublingual tablets, or oral spray

Question 323

Antidote for
Zolpidem

Answer 323

Flumazenil
a specific benzodiazepine antagonist, is useful in reversing the sedation and respiratory depression that often occur when benzodiazepines are administered to patients undergoing anesthesia or when patients have taken an intentional benzodiazepine overdose.

NOTE: antidote for benzodiazepines, such as diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®), and must be administered intravenously.

Question 324

SLAC- slacker has wide pupils

Wide pupils (mydriasis) can be observed in poisoning with:
“SLAC”

Answer 324

S- sympathomimetics:
Amphetamine and derivatives
(Adderall, Concerta, Dexedrine, Focalin, Metadate, Methylin, Ritalin)

L- LSD

A- Anticholinergic substances
Atropine
TCAs

C- cannabinoids

Question 325

belong to the group of opioid drugs,
causing “Myosis”
“TFCM”

Answer 325

Tramadol
Fentanyl
Codeine
Morphine
belong to the group of opioid drugs, hence they will cause narrowed, sometimes pin-like pupils “myosis”

Question 326

The extension of Charcot’s triad is __ __ which includes symptoms of?

Answer 326

-Reynolds pentad
- septic shock and disturbances of consciousness.

Question 327

Charcot triad
consists of:

Answer 327

pain in the right hypochondrium
fever and chills
mechanical jaundice

Question 328

Systemic Inflammatory Response Syndrome
(SIRS)

Answer 328

Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to a noxious stressor (infection, trauma, surgery, acute inflammation, ischemia (lack of blood supply to a part of the body)
or reperfusion,
or malignancy
or certain conditions, such as an autoimmune disorder
or pancreatitis

Question 329

define/ indications/ dosage

Diazepam

Answer 329

is a benzodiazepine drug with anticonvulsant, hypnotic and sedative effects. It shows an addictive effect both physically and mentally. Indications for use of diazepam include

anxiety, panic attacks
conditions with increased muscle tone
increased agitation
insomnia
epileptic seizures
febrile seizures

The dosage of the drug depends on the indication.
For the treatment of seizures in adults, 2 to 10mg 2-4x / d should be used, doses can be repeated to a maximum dose of 50 mg.

Question 330

The *polymorphic ventricular tachycardia *occurred in a patient intoxicated with tricyclic antidepressants.
The treatment should include the administration of:

Answer 330

rapid intravenous infusion of
*magnesium sulfate *
at a dose of 2 g (1 amp. 10 ml MgSO4 20%)

Question 331

A characteristic symptom of cyanide poisoning is the

Answer 331

smell of almonds in the breath.

Question 332

The antidote for cyanide poisoning is

Answer 332

• hydroxocobalamin* (5 g iv infusion over 15 min).

Question 333

A toxic concentration of *methanol *in the serum is considered to be __mg / dl. Antidotes (mainly ___) and ____ can be used to treat methanol poisoning. __ __ is not recommended, nor is the use of __ __.

Answer 333

> 20 mg/dl..
ethanol (antidote) and hemodialysis
Gastric lavage is not recommended, nor is the use of activated charcoal.

Question 334

• Neurogenic shock arises from

Answer 334

Arises from spinal cord injury, intracranial hemorrhage, or brain injury.

Question 335

Neurogenic shock is a type of *distribution shock *in the course of which blood __ __, and thus__ and __ ___ skin occurs and there is a decrease in __ __. This leads to relative __ and __ __ with ___ cardiac output and ___ peripheral blood flow.

Answer 335

vessels dilate, and thus redness and warming of the skin occurs and there is a decrease in vascular resistance.
-This leads to relative hypovolemia and hyperkinetic circulation with increased cardiac output and reduced peripheral blood flow.

Question 336

Neurogenic shock is a type of *distribution shock *in the course of which blood __ __, and thus__ and __ ___ skin occurs and there is a decrease in __ __. This leads to relative __ and __ __ with ___ cardiac output and ___ peripheral blood flow.

Answer 336

vessels dilate, and thus redness and warming of the skin occurs and there is a decrease in vascular resistance.
-This leads to relative hypovolemia and hyperkinetic circulation with increased cardiac output and reduced peripheral blood flow.

Question 337

Image caption shows a ___ ___ with a pulse. In case of haemodynamic instability, we use

Answer 337

supraventricular tachycardia with a pulse
electrical cardioversion, 70-120J

Question 338

hypothermia it inhibits the

Answer 338

coagulation cascade, which in turn leads to coagulopathy, which is the second element of the death triad

Question 339

coagulopathy
is responsible for the appearance of symptoms of a

Answer 339

-hemorrhagic diathesis.
-In addition, the presence of coagulopathies promotes further blood loss and the development of symptoms of hypovolemia.
-Hypovolemia reduces the supply of oxygen to tissues.
-This in turn implies a gradual change in metabolism to anaerobic.
-Under these conditions, the cells produce lactic acid and ketone bodies, which are responsible for the last element of the death triad, i.e. acidosis.

Question 340

metabolic acidosis significantly reduces

Answer 340

• reduces myocardial efficiency, it also leads to ↓ peripheral perfusion, which in turn aggravates hypothermia.

Question 341

Doloplus-2

Answer 341

pain assessment: an effective tool in patients over 85 years with advanced dementia and persistent pain

DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).

Question 342

antidote for carbamazepine poisoning

Answer 342

Multiple doses of *activated charcoal *

Question 343

Repeated administration of *activated charcoal *is also known as?
The method consists in administering 12.5 g of activated charcoal every hour or equivalent doses at greater intervals until the patient’s clinical condition or toxicological parameters improve.

Answer 343

• “enteric dialysis”/MDAC (multi-dose activated charcoal).
  -administering *12.5 g of activated charcoal every hour *or equivalent doses at greater intervals until the patient’s clinical condition or toxicological parameters improve.

Question 344

Which of the following lowers the pressure in the portal venous system in patients bleeding from esophageal varices?

Answer 344

terlipressin

It causes constriction of visceral vessels and a reduction in blood flow to the portal vein - it lowers the portal pressure and causes a decrease in pressure in esophageal varices.
Terlipressin is usually used as an adjunct to endoscopic haemostasis.

Question 345

Propranolol -

Answer 345

-a non-selective B-blocker used in the primary and secondary prophylaxis of bleeding from esophageal varices in patients with cirrhosis of the liver at high risk of bleeding.
-Non-selective B-blockers lower the pressure in the portal vein, which reduces the risk of bleeding.

a non-selective B-blocker used in the primary and secondary prophylaxis

Question 346

Sodium nitroprusside -

Answer 346

-a drug which strongly and immediately lowers blood pressure.
-It is used PRN in emergencies.
-Due to the toxicity of the metabolites, sodium nitroprusside is used for a short time, usually up to 48 hours, and one of the contraindications to its administration is liver failure.

Question 347

Urapidil -

Answer 347

α1 adrenergic receptor blocker used PRN to rapidly reduce blood pressure

Question 348

Glucagon -

Answer 348

-according to some reports, glucagon may increase blood flow and pressure in the portal vein, which would be detrimental to bleeding esophageal varices.
-Glucagon is used in hypoglycemia, diagnostics of gastrointestinal motility disorders and intoxication with B-Blockers

Question 349

In children up to 8 years of age, we usually use endotracheal tubes without a cuff. Depending on the child’s age, we choose the size as follows:

premature newborns →
term newborns →
children 1-2 years of age →
children> 2 years of age →____ (knowledge of this formula is most often useful in LEK)

Answer 349

premature newborns → age in weeks / 10
term newborns → 3.5
children 1-2 years of age → 4.0 - 4.5
children> 2 years of age →* age/4 + 4* (knowledge of this formula is most often useful in LEK)

Question 350

Skin infection with rapidly spreading connective tissue infection, purulent discharge from the wound, general symptoms and the formation of distant abscesses, is characteristic of wounds caused by:

Answer 350

“Pasteurella multocida”
-clinical picture corresponds to pasteurellosis.
-The bacterium that causes the disease lives in the upper respiratory tract of various animals, both wild and domestic), but most often (about 60-80% of cases) the cause of the disease is caused by cat bites (long, thin canines → deep penetration of bacteria

Question 351

Differences in Infant CPR

Answer 351

1. Head in neutral position (may need to be slightly tilted by placing a rolled up towel under the baby’s shoulder blades).
2. In infants, we include (if possible) both the mouth and nose - the so-called mouth-nose ventilation.
3. We make 5 initial rescue inhalations.
4. For infants, the recommended chest compressions technique depends on the number of rescuers:
   a. with the tips of two fingers - if there is one rescuer,
   b. two thumbs wrapped around the chest - if there are two rescuers.
5. Compression of the chest to a depth of 1/3 of the chest dimension or to a depth of 4 cm in an infant.
6. When there is one rescuer, he or she should conduct CPR for about 1 minute before seeking help.

Question 352

Nitroglycerin

Answer 352

• if the patient suffers from coronary artery disease and takes the drug on an emergency basis, he should take 1 dose of nitroglycerin sublingually.
• If the pain persists within 5 minutes → call an ambulance.
• Possible administration of subsequent doses under the supervision of medical personnel (a total of 3 sl doses of 0.4 mg every 5 minutes, then continuation iv). -Contraindications: systolic blood pressure <90 mmHg, tachycardia> 100 / min, suspected right ventricular infarction, taking a phosphodiesterase inhibitor within 24h or 48h in the case of tadalafil.

Question 353

Oxygen -

Answer 353

we give each patient with symptoms of hypoxia, SpO 2 <90% - our patient does not have dyspnea and hypoxemia.

Question 354

Morphine -

Answer 354

-the drug of choice for pain management in STEMI. -
-We use doses of 4-8 mg iv, subsequent doses of 2 mg every 5-15 minutes until the pain subsides (in some cases the total dose reaches 2 mg / kg and is well tolerated).

Question 355

Antiplatelet treatment:

Answer 355

-ASA immediately 150-500 mg p.o. (150-300 mg when PCI is planned) or 250 mg IV (80-150 mg IV when PCI is planned) and
-Ticagrelor (B) / prasugrel / clopidogrel
-GP IIb / IIIa blocker - abciximab / eptifibatide / tirofiban for emergency indications or if there is evidence of no-return of blood flow or a thrombotic complication. Do not administer before the procedure.

Question 356

Beta-blockers

Answer 356

-use in patients without contraindications, especially with tachyarrhythmia or elevated blood pressure (metoprolol 50 mg x 2/day, then 100 mg x 2/day)
-In case of contraindications, a calcium channel blocker (diltiazem / verapamil) can be used - provided that there is no left ventricular systolic dysfunction or AV block.

Question 357

ACEI

Answer 357

• use as early as on day 1 of a heart attack, provided that there are no contraindications, especially LVEF ≤40% or with symptoms of heart failure in the early stage of STEMI.
  
  • Use ARB in case of ACEI intolerance.

Question 358

Lipid-lowering drugs

Answer 358

• we use a statin in all patients, regardless of the concentration of cholesterol in the plasma (unless there are contraindications).
• Target LDL cholesterol 1,4 mmol/l (<55 mg/dl) or a decrease of ≥50% from baseline. –Use ezetimibe if patient does not tolerate statins.

Question 359

Anticoagulants

Answer 359

• choice and dosage depends on the STEMI treatment method. Independent indications apply when using heparin:
  a. extensive myocardial infarction, anterior wall infarction, atrial fibrillation, left ventricular thrombus or cardiogenic shock → low molecular weight heparin (D, enoxyparin is a type of LMWH) sc or unfractionated heparin (UFH) (C) iv if we plan CABG in the next 24 h → UFH
  b. prophylaxis of VTE → heparin in a prophylactic dose until the patient is fully mobilized.

Question 360

Use of diuretics - patients intensively treated with diuretics may develop

Answer 360

-metabolic alkalosis associated with *hypokalaemia *and increased elimination of hydrogen ions

Question 361

Diarrhea - can lead to

Answer 361

metabolic acidosis due to the loss of alkalis through the gastrointestinal tract (bile, pancreatic juice and intestinal juices contain HCO3− in high concentration)

Question 362

Alcohol poisoning - excessive consumption of alcohols, especially alcohol not meant for consumption, leads to

Answer 362

**metabolic acidosis associated with the formation of acids and aldehydes during the metabolism of the consumed substances in the liver

Question 363

Metformin overdose

Answer 363

• Lactic acidosis associated with overdose of metformin is known as MILA - Metformin- Induced Lactic Acidosis.
  
  • The mechanism of this phenomenon is not fully understood, but is probably related to the inhibition of gluconeogenesis by blocking pyruvate carboxylase by the drug

Question 364

slow rhythm - about __ bpm

Answer 364

40 beats per minute (to approximate the heart rate at 25mm / s writing speed, divide 300 by the number of 5mm squares between successive R-waves.
-In the above case it will be 300 / 7.3 ≈ 41

Question 365

no P waves …no impulses from the sinoatrial node excludes

Answer 365

sinus bradycardia and sinus rhythm

Question 366

regularity (excludes) , what’s more, the characteristic f-wave is not visible )

Answer 366

atrial fibrillation

Question 367

name type of rhythm

Answer 367

-the nodal rhythm (now more commonly referred to as the AV junction rhythm).
-It is characterized by a frequency of about 40-60 / min,
-no P waves or P waves of extra-sinus origin (negative P in II, III, aVF, positive in aVR)
-and most often morphologically normal QRS waves.

Question 368

Enoxaparin -

“parin”

Answer 368

in patients with a high or intermediate clinical probability of pulmonary embolism, it is recommended that *anticoagulant treatment with low molecular weight heparin *should be started immediately during the diagnostic procedure.

Question 369

Apixaban is a direct

Answer 369

** factor Xa inhibitor (api X aban) from the new generation of anticoagulant drugs (NOACs), which is currently the preferred choice for the prevention of recurrence of VTE.**

Question 370

Indicate body organs that are ranked from the
shortest to longest time of tolerance to hypoxia

Answer 370

cerebral cortex
brainstem
cardiac muscle
kidneys
liver

Question 371

name 7

Primary medications used in CPR:

Answer 371

adrenaline (epinephrine)
amiodarone
lidocainre
sodium bicarbonate
magnesium sulfate
calcium chloride
alteplaza

Question 372

benzodiazepines, zolpidem →

Answer 372

flumazenil

Question 373

opioids, opiates →

Answer 373

naloxone

Question 374

methyl alcohol →

Answer 374

ethyl alcohol

Question 375

beta-blockers →

Answer 375

glucagon

Question 376

ethylene glycol →

Answer 376

ethyl alcohol

Question 377

paracetamol →

Answer 377

N-acetylcysteine

Question 378

organophosphorus compounds →

Answer 378

pralidoxime, obidoxime, atropine

Question 379

pulse pressure is usually __-__mmHg. A fall in blood pressure suggests?

Answer 379

-pulse pressure is usually 35-45 mmHg.
-A fall in blood pressure suggests arterial spasm, which may be caused by cardiogenic, hypovolemic or tachyarrhythmic shock.

This is because arterial contraction causes diastolic blood pressure to increase more than systolic blood pressure, resulting in a decrease in the difference between systolic and diastolic pressure.

Question 380

Diuretics are the mainstay of treatment in patients with AHF and the associated symptoms of fluid overload and concomitant stasis

Question 381

Diuretics are the mainstay of treatment in patients with AHF and the associated symptoms of fluid overload and concomitant stasis

Question 382

The rate pressure product is a?
provide formula ?

Answer 382

-parameter used in cardiology to determine the load on the heart muscle.

-The formula for calculating it is the product of heart rate and systolic blood pressure

(HR x SBP)

Thanks to this indicator, we can see how high the heart’s need for oxygen is.
The parameter is given on a 5-point scale:

Question 383

Carbon monoxide is a

Answer 383

-colourless, non-irritating and odourless gas.
-Carbon monoxide molecules are lighter than air and have size that allows it easily pass through wall porosity and diffuse throughout the room.

-Carbon monoxide binds to hemoglobin 250 times easier than oxygen forming carboxyhaemoglobin (COHb), which is not able to carry oxygen and leads to hypoxia.

Question 384

define

“postictal sleep”

Answer 384

-After the seizure patient may develop so-called “postictal sleep”, you should put the patient in the recovery position and do not wake him up.
-In the postictal phase nervous system is regenerated and the patient should not be woken up.

Question 385

Management in the patients with seizures:

Answer 385

1. you should stabilize the patient’s head and maintain patent airways
2. protect the patient from injuries (e.g. put something soft under the patient’s head)
3. check glucose level, basic parameters - ABCD, provide intravenous catheter
4. measure oxygen saturation and BP
5. diazepam or clonazepam can be given
6. during the seizures you should not put any material objects between patient’s teeth or pour water over his face

Question 386

Aphasia

Answer 386

is a language disorder caused by damage in a specific area of the brain that controls language expression and comprehension

Question 387

What are the 3 types of aphasia?

Answer 387

The three most common types of aphasia are:
Broca’s aphasia.
Wernicke’s aphasia.
Global aphasia1.

Question 388

A 40-year-old male patient has lost consciousness.The patient is unconscious at the time of arrival of an RRT (Rapid Response Team), takes 6 breaths per minute, and occasionally falls into apnea, pulse 120/min, saturation 78%, the pupils are constricted. What do you need to do first?

Answer 388

-* start to ventilate the patient with oxygen, intubate the patient, administer naloxon*e.

-The correct number of respirations in adults is 12-20 per minute, the value of 6/min with 78% saturation indicates acute respiratory failure, which may be caused, among others, by overdosing of certain medications.
-Narrow pupils and symptoms of respiratory depression indicate the possibility of poisoning with opiates.
-As hypoxia may be one of the causes of sudden cardiac arrest, start oxygen ventilation immediately and intubate the patient.
-A specific antidote used in the treatment of opiate intoxication is naloxone at a dose of 0.4-2.0 mg.