carbon monoxide poisoning

Question 1

1st line CO poisoning

Answer 1

100% oxygen delivered via a face mask is the first line treatment method for carbon monoxide poisoning. Delivering 100% oxygen aids the unbinding of carbon monoxide from haemoglobin molecules resulting in increased oxygen uptake and treatment of carbon monoxide poisoning.

79%

Question 2

MX of anaphlyaxis

Answer 2

Management of anaphylaxis involves:

Remove trigger if possible
Call for help early
ABCDE assessment
Administer oxygen and
Lie patient flat and raise legs
Administer adrenaline (Adult dose is 500 micrograms IM)
Administer chlorphenamine and hydrocortisone (latest Resus Council guidance puts significantly less emphasis on this in the immediate management)
IV fluid challenge if hypotensive

Question 3

severe difficulty in breathing, a rash and tongue swelling. what blood diagnsotic

and when should samples be taken

Answer 3

Mast cell tryptase

This is the correct answer. This patient is suffering from anaphylaxis, and this would be supported by a rise in the mast cell tryptase during and after the reaction. Samples should be taken during, 4h and 12h post reaction

Question 4

only shock that cuases warm preferies

Answer 4

disributive shock - sepsis

Of the four major types of shock (hypovolaemic, obstructive, cardiogenic and distributive), the only one that causes warm peripheries is distributive shock. This is because, in distributive shock, it is a drop in systemic vascular resistance (SVR) that leads to low blood pressure as opposed to a drop in cardiac output (CO) - note that blood pressure = CO x SVR. Vasodilation cause a decrease in SVR and warm peripheries. In other forms of shock, the SVR increases to compensate for the low cardiac output and hence the peripheries will feel cold.

The two most common causes of distributive shock are sepsis and anaphylaxis. In distributive shock, patients are usually euvolaemic

Question 5

cardiac tamponade is what kind of shock

Answer 5

Obstructive shock

Correct - the history describes a cardiac tamponade and includes becks triad (low blood pressure, muffled heart sounds and a raised jugular venous pressure). The tamponade is preventing the heart from filling adequately, causing what is called an obstructive shock

Question 6

blood in throat what intervention

Answer 6

early endotracheal

Question 7

GCS criteria for CT head 1 hour in

Answer 7

The patient’s Glasgow Come Scale (GCS) score is 14 (E3V5M6)and a GCS <15, 2 h after injury meets the criteria for CT head within 1 h. Other NICE criteria include: (a) GCS <13 on initial assessment; (b) suspected open or depressed skull fracture; (c) signs of basal skull fracture; (d) seizure post injury; (e) focal neurological deficit; and (f) more than one episode of vomiting.

Question 8

GRACE score for stemi found to by high what should you do

Answer 8

Consider coronary angiography within 72 hours

The patient is clinically stable. NICE guidelines suggest that in patients with a intermediate or high risk GRACE score, they should be offered coronary angiography +/- PCI within 72 hours. They should also be given aspirin and prasugrel/ticagrelor. Reference :- https://www.nice.org.uk/guidance/ng185