Instruments

Question 1

Yellow cannula

Answer 1

24G - 15mls/min

Question 2

Blue cannula

Answer 2

22G - 30mls/min

Question 3

Pink cannula

Answer 3

20G - 60mls a minute

Question 4

Grey cannula

Answer 4

16G - 230ml/min

Question 5

Brown cannula

Answer 5

14 G - flow rate of 270mls

Question 6

Poiseuille’s law

Answer 6

Flow rate is proportional to the radius to power of 4 and inversely proportional to length

Question 7

Complications of intravenous cannula

Answer 7

Heamatoma
Malplacement
Blockage
Superficial thrombophlebitis

Question 8

Purple vacutainers

Answer 8

Contains EDTA - prevent clotting and keeps cells alive

FBC, cross match

Question 9

Yellow vacutainer

Answer 9

Contains activated gel which promotes clotting facilitating easy seperation of serum and red cells

Question 10

Red vaccuicatier

Answer 10

Normally contains nothing

Immunology ABS, Ig, protein electrophoresis

Question 11

Green vacutainer

Answer 11

Contain Li heparin which is an anticoagulant

Question 12

Blue vaccutainer

Answer 12

Contains citrate - chelates calcium preventing clotting

Used for clotting

Need precise volume of blood

Question 13

Green cannula

Answer 13

18G - 90mls/min

Question 14

Grey vaccutainer

Answer 14

Contains - fluoride - inhibits glycolysis and oxalate which anticoagulate

Used for glucose

Question 15

Indications for general catheterisation

Answer 15

Diagnostic: measure urine output, sterile urine sample, renal tract imaging

Therepeutic: urinary retention, immobile patients, bladder irrigation, intermittent decompression of neuropathic bladder

Question 16

Complications of catheterisation

Answer 16

Early 
- creation of false tract 
- urethral rupture 
- paraphismosis 
- heamatura 
Delayed
- infection
- blockage 
- urethral stricture

Question 17

Contraindication to catheters

Answer 17

Urethral trauma

• blood at urethral meatus
• high riding prostate
• scrotal haematoma
• pelivic fracture

Question 18

Indications for long term catheterisation

Answer 18

Chronic bladder outlet obstruction
Neurogenic bladder with chronic retention
Complications of incontience: refractory skin breakdown, palliative, patient preference

Question 19

Indication for intermittent self catheterisation

Answer 19

Chronic retention

Neuropathic bladder: MS, DM neuropathy, spinal trauma

Question 20

How do you measure a hard neck collar

Answer 20

Measuring the number of fingers from the clavicle to the angle of the mandible

Question 21

Clinical clearance of c spine indication

Answer 21

Indication: NEXUS criteria 
There is no evidence of any of the following 
- Neurological defecit 
- Spinal tenderness in the midline 
- Altered consciousness 
- Intoxication 
- Distracting injury

Question 22

What is a definitive airway

Answer 22

An airway which is protected from aspiration

Question 23

02 concentration with Venturi masks

Answer 23

Yellow - 5% 
White - 8% 
Blue -24% 
Red-40% 
Green - 60%

Question 24

Complication of endotracheal tube

Answer 24

Early: oropharygeal trauma, laryngeal trauma, c-spine injury, oesophageal intubation, bronchial intubation
Delayed: soar throat, tracheal stenosis, difficult to wean patients

Question 25

How to check position of an ET tube

Answer 25

Inspect symmetrical chest movement 
Listen over epigastric for gurgling 
Listen over each lung for air entery 
Caponography 
CXR

Question 26

Seldinger technique

Answer 26

Method of percutaneous insertion of a catheter into a blood vessel or space

Method

1. Needle is used to puncture the structure
2. A guide is used through the needle
3. When needle is withdrawn a catheter is inserted over the wire
4. Wire is withdrawn leaving the catheter in place

Question 27

Complication of a chest drain

Answer 27

Immediate: pain due to inadequate analagesia, haemorrhage due to neurovascular nerve bundle damage, organ perforation or laceration, incorrect location
Late
- failure: bronchopleural fistula
- long thoracic nerve damage - winged scapula
- wound infection
- blockage

Question 28

Removal of a chest drain

Answer 28

Remove when no longer swinging or bubbling and CXR confirms reseloution of pneumothorax
Using two people, remove in forced expiration and use mattress suture to close wound
Complete with a chest X-Ray to confirms no new pneumothorax

Question 29

Temporary tracheostomy tube complications

Answer 29

Immediate 
- haemorrhage
- surgical trauma: oseophagus, recurrent laryngeal N 
- pneumothorax, pneumomedistinum 
Early 
- tracheal erosion 
- tube displacement 
- tube obstruction
-surgical emphysema 
- aspiration pneumonia 
Late 
- tracheomalcia 
- traceo-oesophageal fistula 
- tracheal stenosis

Question 30

Indication for NG feeding

Answer 30

Catabolic state: sepsis, burns, major surgery
Coma/ITU
Malnutrition
Dysphagia - stricture or stroke

Question 31

Types of enteral nutrition

Answer 31

Polymeric - intact protein, starches and long term fatty acid
Disease specific
Elemental: simple AA - requires minimal digestion and used if abnormal GI tract

Question 32

Indications for TPN

Answer 32

Unable to swallow 
Prolonged obstruction or ileus 
High output fistula 
Short bowel syndrome 
Severe Crohns 
Severe malnutrition

Question 33

Complication of TPN

Answer 33

Line related
- pneumothorax, heamothroax
- cardiac arrhythmias
- line sepsis
- central venous thrombosis - PE or SVCO
Feed related
- villious atrophy of GIT
- electrolyte disturbance - refeeding syndrome
- hyperglycaemia and reactive hypoglycaemia
- vitamin and mineral defficancy

Question 34

Complications of transurethral ressection of the prostate

Answer 34

Immediate 
- TUR syndrome: absorption of large quantity of fluids - low Na
- haemorrhage 
Early: haemorrhage, infection, clot retention 
Late 
- retrograde ejaculation 
- erectile dysfunction
- incontience 
- urethral stricture 
- reoccurrence