Assessment

Question 1

T/F: When interpreting the PaO2, the inspired O2 is not important

Answer 1

false - it’s extremely important

Question 2

pH is a LINEAR/ LOGARYTHYMIC scale

Answer 2

Logarhythmic

Question 3

True or false. Base excess is:

1. A measure of how much base has to be removed or added to the system to correct the pH in standard conditions
2. A measure of metabolic acidosis or alkalosis
3. A measure of respiratory acidosis or alkalosis
4. Normally within -10 to 10

Answer 3

1. true
2. true
3. false
4. false (-2 to +2)

Question 4

Intrepret the following ABGs:

1. A 64 year old male who presents with persistent vomiting. He is diagnosed with small bowel obstruction. His blood results on 6L O2 via a Hudson mask: pH 7.49 (7.35 – 7.45), PO2 14 (9.3-13.3), PCO2 6.5 (4.7-6), BE 5 (-2 to +2)
2. A 36 year old male motor biker is flown to A&E after being involved in a crash. He has extensive orthopaedic injuries and a suspected head injury. He is shocked and drowsy. His blood results breathing 15L O2 via Hudson mask with a reservoir bag: pH 7.15 ((7.35 – 7.45), pO2 10.1 (9.3 – 13.3), pCO2 8.9 (4.7 – 6), BE -13 (-2 to +2)
3. A 15 year old female who has been found by her parents barely conscious and breathing very heavily. She has recently been complaining of uncontrollable thirst. Her BM is 39. Her blood results breathing 15L O2 via Hudson mask with a reservoir bag: pH 7.25 (7.35 – 7.45), pO2 45 (9.3 – 13.3), pCO2 2.1 (4.7 – 6), BE -11 (-2 to +2)

Answer 4

1. metabolic alkalosis with partial respiratory compensation (He is alkalemic with high pH and high BE caused by loss of acid. CO2 is high as partial respiratory compensation)
2. combined metabolic and respiratory acidosis with no compensation
3. metabolic acidosis with partial respiratory compensation

Question 5

Intrepret the following ABGs:

1. A 26 year old female with a history of pleuritic chest pain, breathlessness and cough. She has been diagnosed with pneumonia. Blood gas results breathing 15L O2 via Hudson mask with a reservoir bag: pH 7.25 (Normal range 7.35 – 7.45), pO2 8.3 kPa (9.3 - 13.3), pCO2 7.5 (4.7 - 6), Base Excess (BE) -1.5 (-2 to +2).
2. A 16 year old female presenting to A&E with a history of abdominal pain. Blood gas results breathing 6L O2 via Hudson mask: pH 7.4 (7.35 – 7.45), pO2 26 (9.3 – 13.3), pCO2 4.7 (4.7 – 6), BE +1 (-2 to +2)
3. A 56 year old male, heavy smoker who presents with increased breathlessness and productive cough with purulent sputum. He is diagnosed with an infective exacerbation of COPD. Blood gas results breathing 24% O2: pH 7.3 (7.35 – 7.45), pO2 6 (9.3 – 13.3), pCO2 7.9 (4.7 – 6), BE +12 (-2 to +2)

Answer 5

1. respiratory acidosis with no compensation
2. no respiratory or metabolic derangement
3. respiratory acidosis with partial metabolic compensation

Question 6

T/F

1. The minimum normally acceptble urine output is 0.5ml/kg/hour
2. A young, fit person will always be tachycardic if they are hypovolaemic
3. Bowel surgery is often associated with significant ‘third space’ fluid loss

Answer 6

1. true
2. false - Tachycardia is often a late sign
3. true - fluids moves from plasma volume into interstitial fluid

Question 7

name 2 blood tests that can help to diagnose dehydration

Answer 7

urea and creatinine

if raised can indicate dehydration or prerenal failure due to hypovolaemia

Question 8

T/F:

1. Normal daily potassium requirements are 1 mmol/kg
2. Normal daily sodium requirements are 4-5 mmol/kg
3. Normal daily water requirements are around 1000mls for a 70kg man
4. The normal daily requirement of sodium is exceeded by using 0.9% saline only, at 100ml/hr, as a maintenance fluid

Answer 8

1. True
2. false - approximately 2mmol/kg
3. false - water is 25-30ml/kg, hence 2 litres for a 70kg man
4. True

Question 9

52-year-old man caught his right hand in machinery at work. He has a compound fracture of his hand.

What kind of pain is he experiencing?

Answer 9

acute, nociceptive, non-cancer pain

Question 10

23 year-old woman has had a severe injury to her leg leading to a surgical below knee amputation six months ago. She complains of pain in the missing foot.

What kind of pain is this?

Answer 10

chronic, neuropathic, non-cancer pain.

Question 11

What drug and dose of drug should be used in a post-op patient with PCA morphine who has a respiratory rate of 6 breaths per minute, and who is drowsy and difficult to rouse?

Answer 11

40mcg increments of naloxone titrated to effect and reassess the patient

Question 12

Warfarin should be withheld for how long prior to elective surgery?

Answer 12

5 days

Question 13

how are Oropharyngeal airways sized?

Answer 13

by measuring the distance between the angle of the mandible and the incisors

Question 14

what is the first choice of airway opening manoeuvres in a patient with a suspected cervical spine injury?

Answer 14

A jaw thrust

Question 15

Oropharyngeal airways are contraindicated in patients with an intact ___ reflex

Answer 15

gag

Question 16

T/F: Possible base of skull fracture is an absolute contraindication to naso-pharyngeal airways

Answer 16

false - relative

Question 17

Normal range of PO2 found in arterial blood in a healthy patient breathing air?

Answer 17

12-15kPa

Question 18

Treatment of life-threatening asthma should include, high flow oxygen, nebulised salbutamol and _____, and intravenous _____

Answer 18

ipratropium

hydrocortisone

Question 19

T/F: Patients who are experiencing difficulties with breathing should be positioned flat in bed

Answer 19

false - Sitting patients up normally helps both airway and breathing.

Question 20

T/F: A mask with a reservoir bag can deliver greater concentrations of oxygen than one without

Answer 20

true

Question 21

The rate of flow through an IV cannula is proportional to the gauge of the cannulae used.

What gauge of cannulae would give the most rapid rate?

1. 14G (Orange)
2. 18G (Green)
3. 16G (Grey)
4. 22G (Blue)

Answer 21

1. 14G (Orange)

Question 22

When performing pleural decompression, where is the proper location for needle insertion?

Answer 22

Second intercostal space, mid clavicular line

Question 23

State the correct dose and route of adrenaline for administration during

1. cardiac arrest
2. anaphylactic shock

Answer 23

1. 1mg IV
2. 0.5mg IM

Question 24

The ABGs of a patient in sudden cardiac arrest having had no bystander CPR and with no preceding ABG abnormality will likely demonstrate:

1. Respiratory acidosis, metabolic alkalosis
2. Respiratory alkalosis, metabolic acidosis
3. Mixed respiratory and metabolic acidosis
4. Mixed respiratory and metabolic alkalosis

Answer 24

Mixed respiratory and metabolic acidosis

Due to ischaemia and apnoea

Question 25

name the drug which:

1. reverses the effects of opioid overdose
2. promotes potassium entry into cells
3. reverses the effects of benzodiazepine overdose

Answer 25

1. naloxone
2. insulin
3. flumazenil

Question 26

Delayed (up to 12 hours) respiratory depression can occur in patients with what route of opioid administration?

Answer 26

spinal or epidural

Question 27

Anaphylaxis is a 2 phase reaction:

1. Phase 1- Sensitisation
2. Phase 2 - Effector Phase

what do these involve?

Answer 27

1. Immune system encounters allergen and makes IgE against it
2. Allergen cross-links IgE on surface of mast cells

Causes widespread degranulation and release of histamine which mediates inflammatory bronchospasm, vasodilatation, increased capillary permeability, and tisue oedema

Question 28

Which of the following statements is FALSE?

1. All patients with a GCS
2. Patients with a GCS less than 8 or whose GCS is falling rapidly should be urgently assessed for intubation and ventilation
3. Patients with a low GCS are at risk of aaspiration of stomach contents
4. Intubation & ventilation of patients with head injuries can reduce secondary brain injury
5. An ‘Adults with Incapacity’ form should be completed for all patients with a reduced GCS undergoing treatment in Scotland

Answer 28

All patients with a GCS < 8 should be intubated and ventilated

• these patients are at risk of airway compromise, both from aspiration and airway obstruction. It is important to involve a Clinician with advanced airway skills eg. Anaesthetist, early in order to protect the patients airway.

It is not appropriate to intubate and ventilate ALL patients with a reduced GCS. A full history of the patients background health and the reversibility of their neurological injury are important factors considered in the patient assessment of suitability for airway protection and Intensive Care.

Question 29

Major risk factors for PE (“SLOMMP”)

Answer 29

Surgery – major abdominal/pelvic, hip/knee replacements, post ICU

Lower limb problems – #, varicose veins

Obstetrics – late pregnancy, C/S, puerperium

Malignancy – abdominal/pelvic, advanced/metastatic

Mobility – hospitalization, institutional care

Previous VTE

Question 30

Itch is a SE ass with epidural when what drugs are used?

Answer 30

opioids

Question 31

why is cardiac Output and blood pressure reduced after an epidural blockade?

Answer 31

due to symphathetic blockade