Emergency

Question 1

Dose adrenaline

Answer 1

1 mg iv every 3-5 minutes

Question 2

Dose phenylephrine for hypotension following spinal?

Answer 2

50 micrograms bolus
(General dose 1 mcg/kg)!!

Question 3

Dose adrenaline for hypotension and bradycardia following spinal?

Answer 3

10-20 micrograms

1 mg ampoule adrenaline to 10ml = 100 micrograms/ml
1 ml of this solution to 10ml = 10 micrograms/ml

Or 1mg ampoule to 200ml;this dilution contains 1000micrograms in 200ml = 5 micrograms/ml

Question 4

Dose phenylephrine for CV collapse following induction?

Answer 4

1 microgram/kg (1 to 2ml of the dilution in an adult)
Prepare dilution: 10mg in 200ml saline (50 micrograms per ml)

Question 5

Dose adrenaline following cardiovascular collapse after induction with both hypotension and bradycardia?

Answer 5

200 ng (nano gram) (0,2 mcg) /kg (1 to 2ml of the dilution)
Dilution prepared: 1mg in 200 ml saline (5 microgram/ml)

Question 6

Dose ephedrine following cardiovascular collapse after induction with both hypotension and bradycardia?

Answer 6

0.1 mg/kg (1 to 2 ml of dilution)
Dilution prepared: 50 mg in 10 ml water (5mg/ml)
Increases HR and contractility of heart

Question 7

Which emergency drug and dose is used for severe hypotension following induction with normal HR?

Answer 7

Phenylephrine 1 microgram/kg
Alpha 1 agonist vasotrope

Question 8

Which emergency drug is used for severe hypotension following induction with decreased HR?

Answer 8

Adrenaline 200 ng/kg (direct alpha and beta agonist)
Or ephedrine 0.1 mg/kg or etilephrine (indirect alpha and beta agonists)

Question 9

Dose adrenaline for cardiac arrest?

Answer 9

10-100 microgram boluses

Question 10

Dose ephedrine for hypotension and bradycardia following spinal?

Answer 10

0,1 mg/ kg
Usually 5-10mg bolus
Max 50mg, after this ineffective

Preparation: dilute 50mg to 10ml; this contains 5mg/ml

Question 11

Ample mnemonic for history taking in trauma?

Answer 11

Allergies
Medications or drug abuse
Pertinent medical history
Last meal or intake
Events leading up to injury

Question 12

Name 5 contraindications to urinary catheter placement

Answer 12

• Blood at meatus
• perineal ecchymosis
• high riding prostate
• pelvic fracture
• blood in scrotum

Question 13

Describe haemostatic resuscitation for trauma induced coagulopathy (7)

Answer 13

• Red cells
• if fibrinogen < 1 g/ L, correct with cryoprecipitate
• platelets
• correct clotting factors with FFP
• maintain normothermia
• calcium supplement: co-factor in clotting cascade
• Tranexamic acid (antifibrinolytic)

Question 14

Cerebral perfusion pressure formula and normal value?

Answer 14

Cpp= map-icp
Aim for 60-70 mm Hg in head trauma patient ( 60-80 normal)

Question 15

How can cerebral perfusion pressure be improved? (9)

Answer 15

• Increase mean arterial pressure by give into-tropes, isotonic iv fluids
• decrease venous pressure
•decrease carbon dioxide to cause vasoconstriction and therefore decreased blood flow, which decreases ICP
• decrease brain volume by treat/prevent oedema
• decrease CSF (ventricular drain)
• decrease oxygen consumption of brain ( also prevent seizure activity)
• maintain oxygen delivery (ventilation, hb)
• maintain homeostasis (temperature, glucose, electrolytes, prevent infection etc)
• surgical control of lesions (bleed etc)

Question 16

Moa/class ephedrine?

Answer 16

• Adrenergic alpha and beta receptor agonist (sympathomimetic amine)
• dopaminergic agonist

Question 17

Indication ephedrine?

Answer 17

Hypotension and bradycardia induced by anaesthesia (increase hr and contractility)

Question 18

Class/moa phenylephrine? NB

Answer 18

Alpha 1 agonist

Question 19

Indications phenylephrine?

Answer 19

Hypotension only! (Must have normal to high hr)
(Also shock, paroxysmal atrial tachycardia)

Question 20

Alternative name for adrenaline?

Answer 20

Epinephrine

Question 21

Difference between adrenaline and noradrenaline?

Answer 21

Adrenaline stimulate alpha and beta receptors. Noradrenaline more specific for alpha receptors

Question 22

Indication epinephrine during anaesthesia?

Answer 22

Bradycardia and! Hypotension

Question 23

Dose atropine for bradycardia?

Answer 23

0,04 mg/kg iv every 5 mins, Max 3 mg

Question 24

Lignocaine moa?

Answer 24

Sodium channel blocker.

Question 25

Moa amiodarone?

Answer 25

Potassium channel blocker

Question 26

Name 3 indications amiodarone

Answer 26

• Refractory V fib after defib and adrenaline
• V tach
• supraventricular tachycardia

Question 27

Dose amiodarone?

Answer 27

Iv 5 mg / kg infusion over 20 min - 2h dilated in 250 ml 5% dextrose
Repeat infusion up to 15 mg/kg in up to 500ml dilution per 24h

Question 28

Describe your anaesthetic plan regarding agents for a patient with porphyria. ( 7)

Answer 28

Pre-op
• midazolam premedication (stress-trigger)
•5% dextrose infusion with electrolytes (hypoglycaemia and dehydration = trigger)

Intra-op
• opioid: sufentanyl (fentanyl, morphine, meperidine also fine)
• induction: propofol (avoid thiopentone, etomidate and ketamine controversial )
• muscle relaxant: rocuronium (sux and pancuronium also fine)
• volatile: sevo (any is fine)
• local: procaine.

Question 29

Name a contraindication for nasal tubes

Answer 29

Base of skull #

Question 30

Cerebral perfusion pressure aim in head injury?

Answer 30

60-70 mm Hg

Question 31

Name 8 ways Cerebral perfusion pressure can be improved

Answer 31

• increase mean arterial pressure: inotropes, isotonic iv fluids
• decrease venous pressure
• increase co2 (vasodilatation-increase icp ), decrease co2 (vasoconstriction- decrease blood flow)
• decrease brain volume by treat edema
• decrease CSF: ventricular drain
• decrease oxygen consumption brain, prevent seizures
• maintain oxygen delivery: ventilation, Hb
• maintain homeostasis: temperature, glucose, electrolytes, prevent infection etc

Question 32

Name 10 anaesthetic problems associated with burns

Answer 32

• Airway deformity: scar tissue or contracture of mouth. Difficult intubation
• difficult Iv access.
• impaired thermoregulation
• immunosuppression
• risk hypoxia-carbon monoxide poisoning
• haemodynamic instability, shock
• fluid creep
• blood loss and anemia
• electrolyte abnormalities: fatal hyperkalaemia
• over growth functional receptors at neuromuscular junction
• hypermetabolic state: may need reduced drug doses

Question 33

Anaesthetic of choice for burns patients?

Answer 33

Propofol best for induction, then ketamine 2nd choice. Lower doses than normal
Volatile sevoflurane or isoflurane best: no sensitization of myocardium to arrhythmia
Avoid sux. Nondepolariser will require high dose