Cardiovascular

Question 1

Drug-induced long QT

Answer 1

ABCDEF,H

• anti-Arrhythmics
• anti-Biotics (macrolides)
• anti-Cychotics, Chloroquine (anti-malarials)
• anti-Depressants
• anti-Emetics (ondansetron)
• anti-Fungals (fluconazole)
• anti-Histamines

Question 2

Parameters for occult shock
1. Shock index ?
2. Delta shock index?
3. RUSH protocol (POCUS) HIMAP
* caution with neurogenic shock d/t bradycardia

Answer 2

Shock index = HR/SBP
>1 = increased mortality

Delta shock index
SI at scene - SI on arrival
> 0.1 = increased mortality

RUSH protocol- HIMAP
Heart
IVC
Morrisons pouch
Aorta
Pulmonary

Question 3

Classes of Haemorrhagic Shock

Answer 3

Class 1:
- minimal blood loss (<15%/750ml)
- no measurable changes in BP/PP/RR
- minimal tachycardia
- replacement not required
Class 2:
- blood loss 15-30%/750-1500ml
- HR > 100, decreased PP, anxiety/hostility
- give fluid +- blood if no response
Class 3:
- blood loss 30-40%/2000ml
- HR > 120, RR 30-40, fall in SBP, confusion
- early fluid replacement +- blood if poor response or signs of inadequate perfusion
Class 4:
- blood loss >40%
- HR > 140, very narrow PP, greatly decreased BP, depressed mental state
- rapid transfusion and surgical intervention needed

Question 4

Complications of massive transfusion