Emergency Department

Question 1

What is the AUDIT questionnaire?

Answer 1

Alcohol use Disorder Identification Test
1) How often do you have a drink containing alcohol?
2)How many units of alcohol do you drink on a typical day when you are drinking?
3)How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
4)How often during the last year have you found that you were not able to stop drinking once you had started?
5)How often during the last year have you failed to do what was normally expected from you because of drinking?
6)How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
7) How often during the last year have you had a feeling of guilt or remorse after drinking?
8) How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9)Have you or someone else been injured as a result of your drinking?
10) Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
Score >8 = hazardous/harmful

Question 2

What is the difference between insulin in DKA and insulin in other diabetes?

Answer 2

DKA: Fixed rate Intravenous Insulin Infusion (FRIII)
Other: Normal, long-acting, bi-phasic, infusion devices

Question 3

What is the difference between a crystalloid and a colloid?

Answer 3

• Crystalloid: Describe all clear glucose/salt containing fluids for IV use (0.9% saline, Hartmann’s, 5% dextrose)
• Colloid: Fluid consisting of microscopic particles (starch/protein) suspended in a crystalloid for intravascular vol expansion (albumin, starch, gelatin)

Question 4

What is a fluid challenge?

Answer 4

Aims at identifying patients in whom fluid administration improves hemodynamics (known as “fluid responsiveness”)

Question 5

What is vasovagal syncope?

Answer 5

A syndrome characterised by a relatively sudden, temporary, and self-terminating loss of consciousness, associated with the inability to maintain postural tone, with rapid and spontaneous recovery.

Question 6

What are the causes of syncope?

Answer 6

Neurally-mediated reflex syncopal syndromes: Vasovagal, carotid sinus syncope, situational
Orthostatic: Vol depletion, primary/secondary autonomic (MSA, Parkinson’s, diabetic neuropathy, drugs & OH)
Cardiovascular: Implanted devices, arrhythmias, AV conduction disease, valvular disease, PE, obstructive cardiomyopathy, acute MI

Question 7

What investigations should be done in vasovagal syncope?

Answer 7

ECG

Bloods: Hb/FBC, glucose, bHCG, U&Es, cortisol

Question 8

What is the management of vasovagal syncope?

Answer 8

Education
Avoid triggers
Physical techniques (counter pressure manoeuvres, tilt training)
Volume expansion
Fludrocortisone
Midodrine

Question 9

What are the causes of complete heart block?

Answer 9

Inferior MI
Av nodal blocking drugs (CCBs, Digoxin, beta blockers)
Idiopathic degeneration of the conducting system

Question 10

How is complete heart block managed?

Answer 10

Atropine
Monitoring
Pacing

Question 11

What does CHESS stand for?

Answer 11

Used in syncope
C: Hx of congestive HF
H: Haematocrit <30%
E: Abnormal ECG
S: SOB
S: Systolic BP <90
1/5 then admit

Question 12

What is the OESIL risk score?

Answer 12

>2 implies increased risk of cardiac death
Age >65
Hx of CVD
Abnormal ECG
Syncope without prodrome