Emergency

Question 1

Fluid challenge for hypotensive patient

Answer 1

1L/500ml crystalloid (plasma-lyte/Hartmanns or 0.9% NaCl) bolus STAT (5-10 minutes)

Question 2

Fluid challenge for normotensive patient

Answer 2

500ml of crystalloid over 5-10 minutes

Question 3

Fluid challenge for someone in cardiac failure

Answer 3

250 ml

Question 4

Maintenance fluid values

Answer 4

Water: 1.5ml/kg/hr
Na+: 1-2 mmol/kg/24hr
K+: 0.5-1 mmol/kg/24hr

Question 5

Airway: Assess: Int

Answer 5

Assess: If speaking airway is patent, if not look for obstruction
Int: Oxygen (15l/min via non re breather mask); open airway (chin lift jaw thrust); call anaethetist/guedel airways etc

GCS if unconscious

Question 6

Breathing
Assess
Ix
Int

Answer 6

Assess: RR, Saturations; trachea central; deformity/accessory muscle use; chest expansion; percuss + auscultate lungs
Ix: ABG.CXR
Int: nebulisers or needle decompression

Question 7

Circulation
Assess
Ix
Int

Answer 7

Assess:temp, CRT, pulse, BP, JVP, MMM, + heart sounds

Ix: bloods, ecg

Int: IV access; Fluid challenge; catheterise

Question 8

Disability
Assess
Ix
Int

Answer 8

Assess: GCS, pupils, neurology

Ix: BGL

Int: glucose; naloxone/flumanezil

Question 9

Exposure

Answer 9

Expose limbs. abdomen, skin- core temperature

cultures

analgesia/abx- sepsis 6??

Question 10

GCS

Answer 10

Eyes:4 spontaneous; 3 speech; 2 pain; 1 none
Voice: 5 coherent; 4 confused; 3 words; 2 noises; 1 none
Movement: 6 obeys command; 5 localises to pain; 4 normal flexion (past clavicle?); 3 abnormal (decortical) flexion; 2 extension (decerebrate); none

Question 11

Sepsis 6

Answer 11

1) Oxygen
2) blood cultures
3) give ABX
4) Fluid challenge (saline)
5) check lactate
6) Check UO