Emergencies

Question 1

Management of transfusion reaction

Answer 1

Stop transfusion
Airway
Breathing o2 mask
circulation
2nd IV line
Bloods (CBC, U/Es, haemolysis screen, CRP, cultures)
Assess for angiooedema, pulmonary oedema, wheeze
D/W Haematology and blood bank
Monitor continuously until stable, consider HDU
Can give antihistamines, H2 blocker
Have adrenaline ready

Question 2

Maternal collapse differential diagnosis

Answer 2

eclampsia
intracranial haemorrhage
epilepsy
Haemorrhage
Hypoxia
vasovagal
afe
MI
transfusion reaction
LA toxicity
Electrolyte imbalance (hypo/hyperkalaemia)
Sepsis
Tamponade
VTE
tension pnuemothorax

Question 3

Management of maternal collapse sequence

Answer 3

Call for help, left lateral tilt
1.Primary survey and resuscitation
Airway, Breathing, Circulation, Disability or neurological factors, exposure and environmental control
2. Assess fetal well-being and viability ?deliver
3. Secondary survery (top to toe and front to back exam)
4. Definitive care/Specific Management

Question 4

Perimortem caesarean - when and indications/reasons

Answer 4

4 minutes of CPR
Hypoxic brain injury at 6 min.
Do if fundus at least at umbilicus
Makes chest compression easier
Reduce maternal oxygen consumption
Increase venous return
Make ventilation easier

Question 5

During CPR

Answer 5

Establish IV access
High flow O2
Intubate and then give chest compressions
Correct reversible causes
Give adrenaline every 3-5minutes
Consider amiodarone, atropine and magnesium

Question 6

Emergency alphabet (maternal)

Answer 6

Help, LLT
Airway
Breathing - start O2, if not breathing chest compressions
Circulation
Disability - start bloods, IV lines, IVFs
Exposure, ECG, ecbolics
Fetus
Glucose
Head to toe, front to back (secondary survey)
Identify cause and treat

Question 7

Magnesium sulfate toxicity

Answer 7

Calcium gluconate (10mls of 10%)

Question 8

LA toxicity

Answer 8

intralipid

Question 9

Anaphylaxis management

Answer 9

Help, ABCDE
stop/remove potential trigger if possible
Lay patient flat and elevate legs (to combat vasodilation)
0.5ml of adrenaline 1:1000 (Q5min)
chlorphenamine 10mg
200mg IV hydrocortisone
High flow O2
IV crystalloid (stop colloids as may be trigger)
bloods for tryptase levels
?HDU/ICU monitoring - can have biphasic reaction

Question 10

ACS

Answer 10

Morphine
Oxygen
GTN
high dose aspirin (300mg)

Question 11

Shoulder Dystocia Mneumonic (PALE SISTER)

Answer 11

Prepare
Assistance
Legs (McRoberts)
Episiotomy
Suprapubic pressure
Internal rotation
Screw
Try recovering posterior arm
Extreme measures
Repair, record and relax

Question 12

Derivatives of blood products which some JWs accept

Answer 12

albumin solutions, cryoprecipitate, clotting factor concentrates (including fibrinogen concentrate) and immunoglobulins

Question 13

usually ok in JW

Answer 13

intraoperative cell salvage (ICS), apheresis, haemodialysis, cardiac bypass or normovolaemic haemodilution
Recombinant products eg erythropoiesis stimulating agents
granulocyte colony stimulating factors
intravenous iron
tranexamic acid.

Question 14

Pre-procedure in OT

Answer 14

Surgical sign in
WHO checklist
VTE prophylaxis
preg test
Antibiotics
timeout
Positioning

Question 15

JW techniques to reduce blood loss

Answer 15

optimise Hb pre-op (transfuse, iron)
cell saver
TXA, DDAVP
use diathermy 
Consider EPO before or after OT
Ensure advanced directive
keep warm/avoid hypothermia

Question 16

Management of uterine inversion

Answer 16

call emergency
IV line; G&S
palpate abdomen ?fundus
TXA
weigh losses
move to OT
analgesia
attempt manual replacement
consider uterine relaxants (GTN)
hydrostatic reduction
antibiotics
uterotonics once uterus replaced
if no techniques work - huntingdon procedure