Foundation Exam Flashcards
What are the 6 principles of high performance CPR?
Continuous high quality compressions, correct pad placement, early airway management, refined pharmacological prioritisation, emphasis on non-technical skills, clinical case review and debrief.
What are the 8 patient cohorts that require consult within 15 minutes of commencing CPR?
a. Patients >18 years of age
b. Hypothermia, temp >32 degrees
c. Suspected toxicology/toxinology cause
d. Post QAS fibrinolysis administration
e. Pregnancy (clinically apparent)
f. STEMI diagnosed by 12 lead prior to arrest
g. Suspected PE
h. Evidence of CPR induced consciousness
Why is optimal pad positioning important?
Optimal defib pad positioning ensures transmyocardial current density is maximised and has been proven to improve shock efficacy
What is the correct placement of Antero lateral pads?
a. Anterior pad should be placed to the right of the sternum below the clavicle
b. The lateral pad should be placed at the level of 5th intercostal space on the mid axilla line (where V6 electrode would be places.
What is the stepwise approach to airway management in cardiac arrest?
a. Being with basic adjuncts such as BVM, OPA/NPA or i-Gel insertion.
b. I-Gel should be used early if the patient presents with a patent airway clear of any soilage or vomitus
c. If the patient is able to be ventilated effectively with an i-Gel it should not be removed.
d. Escalation to intubation should only occur if the i-Gel is not effective at providing adequate ventilation.
In regards to pharmacological prioritisation in resuscitation, when should adrenaline and amiodarone be used?
a. Adrenaline should be prioritised in patients that present with non-shockable rhythms. This should not be prioritised over high quality compressions and defibrillation.
b. Amiodarone should be prioritised over adrenaline in patients with shockable rhythms that are refractory to 3 defibrillation attempts.
c. When the patient is in a shockable rhythm and they are refractory to the defibrillations they are in a refractory shockable rhythm. Amiodarone should be prioritised over adrenaline.
How much sodium chloride should be used to flush medications in cardiac arrest?
10-20mL sodium chloride.
What are the 5H’s and 4T’s of cardiac arrest?
a. The Hs and Ts are the reversible causes of sudden cardiac arrest
b. Hypoxia
c. Hypothermia
d. Hypovolaemea
e. Hyper and hypokalaemia
f. Hydrogen Ions (acidosis)
g. Tension Pneumothorax
h. Toxins
i. Tamponade
j. Thrombus
- What are the two categories of bradycardia?
a. Cardiogenic and non cardiogenic
b. Cardiac = diseased conduction system
c. Non-cardiac = environmental conditions (hypothermia), metabolic and endocrine disorders, and toxicology causes
What are the 6 ECG changes to differentiate other broad complex tachycardias with VT? (Wellen’s Criteria)
a. AV dissociation
b. Left axis deviation or extreme axis deviation
c. QRS >0.14 seconds
d. Fusion or capture beats present
e. Precordial QRS concordance – both positive and negative QRS concordance
f. R’SR pattern in V1, or monophasic QS in V6
What are the signs of haemodynamic compromise from broad complex tachycardia?
ALOC, hypotension, chest pain, and heart failure
How do you treat hemodynamically stable broad complex tachycardia and hemodynamically unstable?
a. stable – amiodarone or magnesium sulphate if torsades des pointes
b. unstable – electrical cardioversion
Why should patients with AF of >24 hour duration not be cardioverted?
Due to risk of thrombus formation
What are the 4 signs of shoulder dystocia?
a. Prolonged or difficult birth of the face and chin
b. The head is birthed but remains tightly applied to the vulva
c. Turtle sign – after birth of head, chin retracts into perineum when the birthing parent stops pushing
d. The foetal head fails to undergo restitution
What are the manoeuvres in shoulder dystocia designed to do?
a. Increase the functional size of the pelvis
b. Change relationship of the biacromial diameter within the bony pelvis by rotating the foetus into the wider oblique diameter
c. Decrease the bisacromial diameter of the foetus
What are 3 first line external manoeuvres for shoulder dystocia?
a. Mcroberts
b. Supra pubic pressure
c. All fours
What are the three types of uterine inversion?
a. Incomplete – the fundus reaches the cervix but does not pass through it
b. Complete – the fundus passes through the cervix
c. Prolapsed – the fundus extends through the vaginal opening
What is the management for cord prolapse?
a. Ask mother to replace exposed cord inti the vagina using a dry towel or pad
b. If cord is not pulsating attempt to push the presenting part off the cord
c. Transport in the exaggerated sims position – left lateral with pillow under hip
What is the very brief pathophys of anticholinergic toxidrome?
Competitive antagonism at the muscarinic receptor.
What types of drugs have anticholinergic effects?
a. Antispasmodics
b. Antihistamines
c. Antipsychotics
d. Tricyclic antidepressants
e. Anti-Parkinson agents
f. Belladonna alkaloids (atropine, nightshage
What are the effects of anticholinergic syndrome?
a. Dilated pupils
b. Tachycardia
c. Dry, flushed skin
d. Urinary retention
e. Hyperthermia
f. Hallucinations,
g. Agitation and delirium
h. Seizures
i. Coma
How do benzodiazepines work?
Benzodiazepines work by potentiating the effects of inhibitory neurotransmitter GABA within the CNS there by causing sedation
What does profound coma suggest in the context of benzodiazepine overdose?
Co-ingestion with another CNS depressing agent such as alcohol
What are the symptoms of benzo overdose?
a. Drowsiness
b. Ataxia
c. Slurred speech
d. Decrease level of consciousness
e. Hypotension and bradycardia (only in large ingestions)
What are the symptoms of beta-blocker overdose?
a. Bradycardia
b. Hypotension
c. Heart block
d. Cariogenic shock
e. Hypo and hyperglycaemia
f. Pulmonary oedema
g. Seizures, coma
What are the two particularly toxic beta blockers and why?
a. Propranolol – sodium channel blocker that crosses the blood brain barrier. Causes seizure, coma, and QAS widening due to sodium channel blockade
b. Sotalol – potassium channel blocker that causes long QT and torsades
c. P propranolol is opposite of sotalol – P should be potassium blocker but is sodium blocker. S should be sodium blocker but is potassium blocker.
What do calcium channel blockers cause in overdose?
a. CCB cause hypotension and vasodilatory (distributive) shock in overdose
b. Seizures
c. Coma
d. Hyperglycaemia
e. Metabolic acidosis
What are the two most toxic CCBs?
a. Diltiazem and verapamil
b. Diltiazem and verapamil act on CCBs in the myocardium causing slow heart rate and decreased myocardial contractility. This results in combination of the vasodilation and hypotension plus bradycardia and cardiogenic shock.