General

Question 1

shock stages

Answer 1

I = 0-15%, <750mls, P <100, BP Normal
2 = 15-30%, 750-1500mls, P >100, BP normal, mild anxiety
3 = 30-40%, 1500-2000mls, P >120, BP low, confusion and lethargy
4 = >40%, >2000mls, P >140, BP low, confusion

Question 2

anaphylaxis management

Answer 2

0.5 ml IM 1:1000 adrenaline 500mcg
repeat after 5 mins
200mg IV hydrocortisone
10mg IV chlorphenamine

may neeed ionotropes

Question 3

sepsis 6 bundle

Answer 3

oxygen
IV fluids
antibiotics
monitor urine output
lactate
blood cultures

Question 4

qSOFA score

Answer 4

greater risk of poor outcome outside ITU
low BP <100
raised RR 22/min
GCS <15 altered mental state

Question 5

hyperkalaemia

Answer 5

10mls 10% calcium gluconate
10 units actrapid in 50mls of 50% glucose
5mg salbutamol
deplete total body K = calcium resonium 15mg tds
emergency dialysis

Question 6

hypercalcaemia

Answer 6

confusion
coma
thirst
dehydration
muscle weaknes arrythmias
shortened QT
urgent if Ca >3
check PTH, albumin and renal function
aggressive rehydration 4-6L saline over 24 hours
bisphosphonates zolendronic acid 4mg
treat underlying cause - thiazide, rhabdo
emergency dialysis

Question 7

local anaesthetic doses

Answer 7

lignocaine 3mg/kg
7mg/kg with adrenaline

bupivicaine 2mg/kg

prilocaine 6mg/kg

in children lignocaine
Up to 3 mg/kg, dose to be given according to patient’s weight and nature of procedure, dose may be repeated not more often than every 4 hours, 3 mg/kg equivalent to 0.3 mL/kg of 1% solution

Question 7

local anaesthetic doses

Answer 7

lignocaine 3mg/kg
7mg/kg with adrenaline

bupivicaine 2mg/kg

prilocaine 6mg/kg

in children lignocaine
Up to 3 mg/kg, dose to be given according to patient’s weight and nature of procedure, dose may be repeated not more often than every 4 hours, 3 mg/kg equivalent to 0.3 mL/kg of 1% solution

Question 8

LA toxicity management

Answer 8

Managing Local Anesthetic Toxicity
In pediatric practice, early warning signs and symptoms of toxicity may be masked by the concurrent administration of general anesthesia. This means the first sign may be arrhythmia or cardiovascular collapse. Consider the following when managing local anesthetic toxicity:

Stop the local anesthetic injection.
Institute basic life support, and call for assistance.
Secure the airway, ventilate with 100% oxygen, and gain intravenous access.
Seizures can be managed with a benzodiazepine or anesthetic induction agent.
If cardiac arrest has occurred, commence advanced life support.
Note that arrhythmias are often refractory, and resuscitation should therefore be prolonged.
Lipid administration.
The Association of Anaesthetists of Great Britain and Ireland has published a simple protocol to follow (Figure 1).