elearning Flashcards
AMPLE
Allergies
Meds
PMHs
last meal
events
Definitive airway definition
- tube placed in trachea with cuff inflated below vocal cords
- connected to a form of o2 enriched ventilation
- stablised in situ
GCS for a definitive airway
8 or less
LEMON airway
Look externally
Evaluate 322 rule
Mallampati
Obstruction
Neck mobility
Criteria for definitive airway
Burns
Facial trauma
GCS < 8
Failure to maintain oxygenation
Criteria for definitive airway
Burns
Facial trauma
GCS < 8
Failure to maintain oxygenation
How many people for safe log rolling
4
1 on c spine
2 on rolling
1 on assessing spine
How many people for safe intubation of trauma patient
3
1 on c spine
1 on laryngoscope
1 passing bougie - connecting tube
How to ensure placement of Endotracheal tube
Listen : bilat air entry
Look: capnography (no CO2 -> OG intubation), CXR
Sources of bleeding
blood on the floor and 4 more
Chest
Abdo
Long bone
Pelvis
How to estimate blood volume
7 % of adults weight
7 % obese adults ideal body weight
8-9% of child’s body weight
Classes of haemorrhagic shock
Base deficit for classes of haemorrhagic shock
0 to -2
-2 to -6
-6 to -10
< -10
Response patterns to fluid resus
Rapid response
Transient response : transfuse and control ongoing bleeding ( op vs angio)
Minimal response (massive transfusion protocol + op)
Massive transfusion def
10 units of RBC in 24hrs or 4 units in 1 hr
Massive haemothorax def
1.5 l on insertion of chest drain
200ml/hr for 4 hrs
Types of pelvic fractures
Lateral compression 60 %
Anterior posterior (open book) 10-15
Vertical shear 10-15
Normal ICP
10mmHg
Cerebral perfusion pressure
CPP = MAP - ICP
In presence of variance between GCS score of upper limb and lower limb (eg E3V4M5 vs E3V4M4) which one should be used for overall GCS
the better one E3V4M5
In presence of variance between GCS score of upper limb and lower limb (eg E3V4M5 vs E3V4M4) which one should be used for overall GCS
the better one E3V4M5
Reversal agent for spirin
desmopressin
Reversal agent for heparin
protamine
Reversal agent for dabigatran
idarucizumab
CI to use of Mannitol
Systemic hypotension
What med to use in cerebral hypertension secondary to trauma
Hypertonic saline
Mannitol
Phenytoin
What med to use in cerebral hypertension secondary to trauma
Hypertonic saline
Mannitol
Phenytoin
How to diagnose brain death
No alternative cause (hypothermia, volaemia, glycaemia)
No brainstem reflexes (oculocephalic, corneal, gag reflex)
No response to apnoea testing
Neurogenic shock spinal level
T6 or higher
Neurogenic vs spinal shock
Neurogenic: loss of sympathetic tone
Spinal: loss of muscle tone and reflexes post spinal cord injury
Central cord syndrome sx
Motor loss upper worse than lower
Anterior cord syndrome sx
Injury to motor and sensory in the anterior cord
Paraplegia + loss of spinothalamic
Brown sequard syndrome sx
Hemisection of cord
Ipsilateral motor and dorsal column
Contralateral spinothalamic
Most common c spine fracture
C5
Most common c spine subluxation
C5 on C6
Chance fracture
Through spinous process, pedicles and vertebral body
How to control arterial bleed
- apply manual pressure
- pressure dressing
- manual pressure to proximal artery
- consider tourniquet
Resus fluid volume calculation post thermal burn
2ml * kg * TBSA
or
3ml * kg * TBSA if child
Indication for gastric tube in burns patients
if >20% tbsa
or
if vomiting
Abx in burns
Not indicated unless get infection
Tetanus in burns
give if not immunised
Medical mx for rhabdo treatment
IV fluids
Mannitol (free radical scavanger and osmotic diuretic washing out myoglobin)
Frostbite management
warm water 40 degrees
warm fluids to drink
Analgesia
Def of hypothermia vs severe hypothermia
Hypothermia: <36
Severe: < 32
Estimating child’s weight
2*age + 10
Position of needle decompression in children
2nd intercostal space midclavicular line (not changed like adults has to 5th intercostal mid axillary)
Escalation ladder for venous access in paeds
- 2 attempts at peripheral cannulas
- Intraosseus
- femoral
Escalation ladder for venous access in paeds
- 2 attempts at peripheral cannulas
- Intraosseus
- femoral
Changes to FBC and clotting in pregnancy
Increased:
- WCC, RBC, Clotting factors,
Decreased:
- Hct, PT and APTT (but bleeding and clotting times unchanged)
When to give Rh immunoglobulins to pregnant
if Rh negative
Which side should a pregnant woman be monitored on
Left side to avoid IVC compression
