Emergency Medicine

Question 1

Define contusion?

Answer 1

Contusion – blunt impact, leading to subcutaneous blood escape

Question 1

Define abrasion?

Answer 1

Abrasion – superficial wound, not penetrating to full thickness

Question 2

Define laceration?

Answer 2

Laceration – penetrate full thickness of skin, blunt forces (irregular object)

Question 3

Define incision?

Answer 3

Incision – penetrate to full thickness, sharp object and a regular cut (e.g. knife)

Question 4

Define dirty/ contaminated wounds?

Answer 4

6 hours post injury
Organic material
Foreign material
Bites
Contact with raw meat
Dead / devitalised tissue

Question 5

When does someone need a tetanus booster?

Answer 5

when they have an unclean wound (more than 6 hr post injury, organic, foreign material, bites, raw meat, dead/ devitalised tissue) and it has been more than ten years since their last tetanus booster

Those who have never had any tetanus vaccines should receive immediate dose even if the wound is clean

Question 6

Antibiotics for bites?

Answer 6

Given if broken skin and drawn blood, and may be considered if broken skin, if no broken skin generally dont give antibiotics

Question 7

Most common minor trauma in paeds?

Answer 7

torus/ buckle fracture
incomplete fracture where one side of the bone bends creating a bulging of the cortex

Question 8

3 types of paediatric fractures?

Answer 8

buckle/ torus
greenstick
growth plate fractures

Question 9

In paediatric BLS what is position for giving rescue breaths?

Answer 9

if under 1 keep head flat - no head tilt chin lift
head tilt chin lift in children over 1

Question 10

How can you assess work of breathing in children?

Answer 10

Recession of ribs - children have more pliable rib cages (will recess more in younger children - recession in older children is more worrying):
intercostal, subcostal, supraclavicular and tracheal tug

abdominal breathing
head bobbing

grunting
nasal flaring

more worrying when occurring at rest

Question 11

Differences in paediatric BLS?

Answer 11

start with 5 rescue breaths (child is more likely to have a pure respiratory arrest vs an adult)

then CPR in 15 compressions to 2 rescue breathing

2 fingers, 1 hand or both hands depending on how big the child is

Question 12

Worry about baby milk intake if dropped below?

Answer 12

100mls/kg

Question 13

Tricyclic antidepressant OD antidote?

Answer 13

sodium bicarbonate

Question 14

Beta blocker overdose antidote?

Answer 14

glucagon

Question 15

How do you size and oropharyngeal and nasopharyngeal airway?

Answer 15

oropharyngeal - incisor teeth to angle of mandible
nasopharyngeal - tip of patients nose to tragus of ear

Question 16

Cardiac arrest procedure?

Answer 16

Start CPR 30:2
Assess rhythm
Shockable rhythms give one shock and immediately resume CPR for 2 minutes
In non shockable give adrenaline straight away and then every 3-5 minutes 1mg IV
In shockable give adrenaline after 3 shocks and also 300mg amiodarone

Question 17

What makes high quality CPR?

Answer 17

Depth 5-6 cm
rate 100-120 per minute
give time for recoil
in centre of chest bottom 1/3 of sternum
minimal interruptions

Question 18

Shockable and non shockable rhythms?

Answer 18

shockable - pulseless VT and VF (vf will never have a pulse)
non shockable - PEA and systole

Question 19

4Hs and 4Ts of cardiac arrest?

Answer 19

hypoxia, hypovolaemia, hypothermia, hypokalaemia/ metabolic
tamponade, tension pneumothorax, toxins and thromboembolic