Emergencies

Question 1

Stages of treatment of acute left ventricular failure

Answer 1

1. Sit patient up right - reduced venous return to the heart
2. Administer 100% oxygen through a trauma mask
3. Etsablish venous access (for sampling and administration)
4. Administer IV furosemmide (80-100 mg)
5. Insert urinary catheter

Question 2

What are shockable and non-shockable rhythms for defibrillation?

Answer 2

Shockable - ventricular fibrillation or ventricular tachycardia
Non-shockable - asystole or pulseless electrical activity

Question 3

What are the four “Hs” and how are they managed?

Answer 3

Hypoxia - minimized by ventilating the patient with a bag-valve mask or endotracheal intubation
Hypovolaemia - can be due to haemorrhage - lost volume should be replaced
Hyper/hypokalaemia - may cause ECG abnormalities and should be detected with biochemical testing
Hypothermia - should be excluded with a low reading thermometer and treated with external or internal warming

Question 4

What are the four “Ts” and how are they managed?

Answer 4

Tension pneumothorac may occur during central venous cannulation - needle thoracocentesis/thoracostomy may be required
Tamponade - should be excluded with echocardiography and if presented should be treated with pericardiocentesis
Toxins - may have been ingested by accident or by self harm and should be considered
Thromboembolism - massive PE may cause pulseless activity and patient should be considered for IV thrombolysis

Question 5

What new drug is being used to treat asystole?

Answer 5

Vasopressin

Question 6

DC Cardioversion (DCC)
What does the ECG look like for this to happen?
How is it timed?
What is it used for?

Answer 6

Must have definite QRS complexes - timed for the downstroke of the QRS complex. Used in:

• AF
• Atrial flutter
• Sustained ventricular tachycardia
• Junctional tachyarrhythmias