Emergency Med

Question 1

(I) Partial pressure of Oxygen in air
(II) Partial pressure of Oxygen that reaches lungs normally

Answer 1

I) 21 kPa

II) 13 kPa - due to addition of water vapour and CO2

Question 2

What should the PaO2 be compared to the inspired concentration

Answer 2

PaO2 should be approximately 10 less than inspired concentration

E.g. 60% inspired oxygen should result in a PaO2 of approximately 50 kPa

Lung injury increases the gap between inspired conc. and PaO2
E.g. someone breathing 50% oxygen showing a PaO2 of 13kPa is NOT “NORMAL” - we would expect 40kPa

Question 3

Normal Base excess values

Answer 3

+2 to -2

Question 4

Normal PaCO2 levels

Answer 4

5.3 (4.7-6.0) kPa

Question 5

Normal P-R interval

Answer 5

< 0.20 (5 small squares)

Question 6

ALS modifications in pregnancy

Answer 6

After 20 weeks the uterus can compress the IVC limiting the effectiveness of CPR
- uterus should be manually displaced to the left (left lateral tilts can be used on a firm surface)
- IV/IO access should be placed above the diaphragm due to the potential of IVC compression

Early intubation is recommended (by experienced practitioner)
- increased risk of aspiration

Prep for peri-Morton section
- with a view to removing the infant at 5 mins if ROSC is not achieved

Defibrillation should be delivered as normal

Question 7

ALS considerations in asthma

Answer 7

Ventilation will be difficult due to acute bronco spasm
- avoid gastric inflation and hypoventilation where possible with EARLY INTUBATION

Monitor for hyperinflation (gas trapping)

Risk of tension pneumothorax is greater in asthmatic patient in cardiac arrest

Use of ECMO considered

Question 8

In haemorrhagic shock - what % of blood volume needs to be lost before BP falls?

Answer 8

BP doesn’t fall until 30% of blood volume is lost (Class III)

Question 9

What BP is required to generate a palpable femoral pulse

Answer 9

Arterial BP of >65 mmHg

Question 10

Burns resuscitation fluid formula (Parkland formula)

Answer 10

= SA% x weight (Kg) x 4ml

50% given over 8 hours
50% then given over 16 hours

Question 11

Antidote for Paracetamol overdose

Answer 11

Acetylcysteine

Question 12

Antidote for calcium channel blocker overdose

Answer 12

Calcium chloride

Question 13

Antidote for Antifreeze (ethylene glycol) overdose

Answer 13

Fomepizole
+/- Haemodialysis

Question 14

Antidote for iron overdose

Answer 14

IV deferoxamine (chelates iron)

Question 15

Antidote for methadone/opioids

Answer 15

IV/IM Naloxone

Question 16

Paediatric anaphylaxis adrenaline doses

Answer 16

<6 yrs: 150mcg (0.15ml)
6-12 years: 300mcg (0.3ml)
>12 years: adult dose - 500mcg (0.5ml)

Question 17

At what GCS should you intubate

Answer 17

Less than 8 … INTUBATE!

Question 18

What is ARDS?

Answer 18

Acute Respiratory Distress Syndrome is severe inflammation of the lungs resulting in life-threateningly inefficient supply of oxygen to the body

Question 19

Features of ARDS

Answer 19

Acute onset
Hypoxaemia
Bilateral, fluffy pulmonary infiltrates on chest X-ray
Non-cardio genie pulmonary oedema
Reduced lung compliance

Question 20

Features of wenicke’s encephalopathy

Answer 20

A SOAP

A - Altered consciousness (confusion)
S - Subacute brain injury
O - Ophthalmoplegia
A - Ataxia of gait / Alcoholics affected
P - prodromal nausea

Question 21

Clinical features of anaphylaxis

Answer 21

Broncospasm
Angioedema
Laryngeal oedema
Urticaria
Increased vascular permeability
Cardiovascular collapse (anaphylactic shock)

Question 22

What type of hypersensitivity reaction is anaphylaxis?

Answer 22

Type 1 reaction

IgE mediated

Question 23

Where to check for a pulse in a pediatric patient

Answer 23

Infant < 1 year : Brachial and femoral arteries

Child >1 year: Femoral and carotid