Emergency Medicine

Question 1

Trauma team members

Answer 1

1 team leader doctor
1 team leader nurse
1 airway doctor
1 airway nurse
2 circulation doctors
2 circulation nurses
1 relatives nurse
1 radiographer

Question 2

Stages to ATLS system

Answer 2

Preparation
Primary survey and resuscitation
AMPLE history
Secondary survey

Question 3

cABCDE

Answer 3

catastrophic haemorrhage and C spine
Airway
Breathing
Circulation
Disability
Exposure

Question 4

Catastrophic haemorrhage

Answer 4

Floor and 4 more

Floor

Pelvis
Abdomen
Chest
Long bones

Question 5

Airway

Answer 5

Patency

Jaw thrust
Foreign body removal
Oropharyngeal / Nasopharyngeal tube
Endotracheal tube (definitive airway)
Cricothyroidotomy

Question 6

Breathing

Answer 6

RR
Sats
Chest wall expansion
Percuss
Auscultate
Tracheal deviation

Question 7

Circulation

Answer 7

HR
BP (signs of shock)
Pulse character and regularity
Auscultation
Access (bloods + fluids)

Question 8

Disability

Answer 8

Abdo exam
Pupils
GCS
Temp
Glucose

Question 9

Exposure

Answer 9

Remove clothing
Blankets to keep warm
Warm IV fluids

Question 10

Signs of heamorrhage as a result of pelvic injury

Answer 10

Unexplained hypotension
Progressive swelling or bruising in flanks
Failure to respond to initial fluid challenge
Mechanical instability of bony pelvis

Question 11

Interventions before secondary survey

Answer 11

ECG
Urinary catheter
Consider gastric catheter
ABG
X ray

Question 12

Three primary survey X-ray films

Answer 12

Chest
Lateral cervical spine
Pelvis

Question 13

Indications for immediate CT post head injury

Answer 13

GCS < 13 at any time
GCS < 15 after 2 hours
Signs of basal skull fracture
Seizure
> 1 vomit
Focal neurological deficit
Amnesia > 30 mins

Question 14

Signs of basal skull fracture

Answer 14

Haemotympanum
CSF oto- or rhinorrhoea
Mastoid bruising
Bilateral periorbital bruising

Question 15

AMPLE history

Answer 15

Allergies
Medications
PMH
Last ingestion
Events

Question 16

Secondary survey

Answer 16

Only once primary survey and resus is completed
Complete history
Examination head to toe (+ neuro)
Reassess vital signs

Question 17

Information required from ambulance pre-alert

Answer 17

ATMIST

Age, name, hospital number
Time of incident
Mechanism of injury
Injuries head to toe
Signs (vital)
Treatment

ETA, mode of transport, special requirements

Question 18

Clinical features of Hypovolaemic shock

Answer 18

Tachycardia
Hypotension
Pale, cold, clammy
Confusion
Low urine output
Thirst

Question 19

ATOM FC

(Serious conditions)

Answer 19

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax

Flail chest
Cardiac tamponade

Question 20

Causes of:

Unilateral dilated pupil + Slow light response

Answer 20

3rd nerve compression

(tentorial herniation)

Question 21

Causes of:

Bilateral dilated pupil + Slow light response

Answer 21

Poor brain perfusion

Bilateral 3rd nerve palsy

Question 22

Causes of:

Bilateral constricted pupil + light response difficult to determine

Answer 22

Opiates

Metabolic encephalopathy

Pontine lesion

Question 23

Causes of:

Unilateral constricted pupil + Preserved light response

Answer 23

Injured sympathetic pathway

Question 24

Opiates antidote

Answer 24

Naloxone

Question 25

Paracetamol antidote

Answer 25

Charcoal NAC (N-acetylcysteine)

Question 26

Adder envenomation antidote

Answer 26

Anti-venom

Question 27

Carbon monoxide antidote

Answer 27

Hyperbaric oxygen

Question 28

Iron (eg. ferrous sulphate) antidote

Answer 28

Desferrioxamine

Question 29

Ethylene glycol antidote | (Anti-freeze)

Answer 29

Ethanol Fomepizole

Question 30

Benzodiazepines antidote

Answer 30

Flumazenil

Question 31

Digoxin antidote

Answer 31

Digibind

Question 32

Tricyclic antidepressant antidote

Answer 32

Sodium bicarbonate

Question 33

Methanol poisoning antidote

Answer 33

Ethanol Fomepizole

Question 34

Beta blocker antidote

Answer 34

Glucagon

Question 35

Salicylates (aspirin) antidote

Answer 35

Sodium bicarbonate

Question 36

Warfarin antidote

Answer 36

Vitamin K FFP

Question 37

Cyanide antidote

Answer 37

Di-cobalt edetate

Question 38

Orangophosphate antidote

Answer 38

Atropine

Question 39

Local anaesthetic antidote

Answer 39

Intralipid

Question 40

When is ATLS useful

Answer 40

Golden hour

Question 41

Mx of pneumothorax

Answer 41

Thoracocentesis - 2nd intercostal spcae midclavicular line Chest drain

Question 42

Flail chest definition

Answer 42

2+ ribs factured in 2+ places Paradoxical chest wall movements

Question 43

Complications of flail chest

Answer 43

Pulmonary contusion Hypoxia

Question 44

Venturi mask

Answer 44

Gives controlled O2 saturations COPD

Question 45

Types of shock

Answer 45

Hypovolaemic Distributive Obstructive Cardiogenic Dissociative Neurogenic

Question 46

Causes of hypovolaemic shock

Answer 46

Bleeding Dehydration

Question 47

Causes of distributive shock

Answer 47

Sepsis Anaphylaxis

Question 48

Causes of cardiogenic shock

Answer 48

IHD MI

Question 49

Causes of obstructive shock

Answer 49

PE Tamponade

Question 50

Causes of acute chest pain

Answer 50

MI Tamponade Aortic dissection PE Pneumothorax Pneumonia Oesophageal rupture

Question 51

Types of wound

Answer 51

Incision Lacceration Abraision Puncture

Question 52

Cushing's triad features

Answer 52

Bradycardia Irregular breathing HTN

Question 53

Cushing's triad definition

Answer 53

Sign of coning