Blood

Question 1

Define ‘shock’.

Answer 1

A clinical syndrome where tissue perfusion, and hence oxygenation, is inadequate to maintain normal metabolic function.

Question 2

Hypovolaemic shock

Answer 2

Condition whereby rapid fluid loss most often due to hemorrhage (external or internal) leads to multiple organ failure due to inadequate circulating volume and so inadequate perfusion.

Question 3

Cardiogenic shock

Answer 3

Due to failure of the heart pumping blood around the body. Most often caused by acute myocardial infarction.

Question 4

Septic shock

Answer 4

Fluid redistribution due to leaking capillaries and vasodilation. Occurs after an infection and cause very low BP.

Question 5

Spinal/neuro shock

Answer 5

Due to loss of sympathetic vascular tone.

Question 6

Anaphylactic shock

Answer 6

Severe and extreme allergic reaction.

Question 7

Abrasion

Answer 7

Superficial or deep due to dragging against an irregular surface. Clean debris and dress, bleeding is not usually an issue.

Question 8

Degloving

Answer 8

When the skin and its blood supply is torn off. Associated with major trauma. Occurs on limbs and digits.

Question 9

Incised

Answer 9

Sharp or penetrating trauma, often a slash/stab type injury. Clean edges and uniform shape. Stabs can look less dramatic but beware the depth that they investigate for underlying damage.

Question 10

Laceration

Answer 10

Blunt force trauma. Cause skin splitting, tissue bridging, irregular edges and has levels of depth. Has legal/forensic implications. Irrigate/clean and close using glue, steristrips, staples or sutures.

Question 11

Bites

Answer 11

Usually a small entry wound with possible deep penetration. Could have foreign body contamination, blood borne viruses. Give antibiotics, tetanus/other vaccines, irrigation and delayed closure.

Question 12

Advanced Trauma Life Support

Answer 12

Airways with C-spine control
Breathing with oxygenation
Circulation with haemorrhage control
Disability
Exposure

Question 13

What is a FAST scan?

Answer 13

Focused assessment with sonography for trauma.

Question 14

What is IO access and when would you use it?

Answer 14

Intraosseous access. Can be used in both adults and children. It is indicated any time vascular access is difficult to obtain ie. in a medical emergency. Also in drug users who have poor veins and occasionally burns victims.

Question 15

In peripheral venous cannulation, where would you access?

Answer 15

I) Antecubital fossa. II) Wrist or hand. III) Feet, scalp, external jugular.

Question 16

In central venous access, where would you access?

Answer 16

I) Internal jugular vein. II) Subclavian vein. III)Femoral vein.

Question 17

What is arterial embolisation?

Answer 17

An interventional radiologist uses a catheter to deliver small particles to block blood flow. Often used in the treatment of uterine fibroids.

Question 18

What are plasma volume expanders and why are they used?

Answer 18

Either crystalloids, colloids or both. They are used to restore vascular volume, stabilise circulatory hemodynamics and maintain tissue perfusion.

Question 19

What are crystalloids?

Answer 19

Balanced salt solutions that freely cross capillary walls. Shorter half life than colloids in the intravascular space. Saline (0.9% NacCl) is an example.

Question 20

What are colloids?

Answer 20

Better (and more expensive) than crystalloids at expanding circulatory volume because their larger molecules are more easily retained in the intravascular space. Maintain high osmotic pressure. Gelofusine is an example.

Question 21

Which clotting factors are vitamin K dependent?

Answer 21

Factors II, VII, IX and X (2,7,9 and 10). Vitamin K is found in green vegetables, liver and eggs.