JC Block C - Emergency Medicine (IV)

Question 1

Regarding field triage in mass casualty incidents, which of the following is/are true?
I. Patients with capillary refill > 2 seconds should be treated immediately.
II. Patients with no breathing after airway maneuvers should be treated immediately.
III. The walking wounded should be seen immediately.
IV. Those shouting loudly for help should be seen immediately.

Answer 1

I only

Question 2

Which of the following bleeding site(s) could lead to significant blood loss and hemorrhagic shock?
I. Intracranial
II. Pelvic fracture
III. Thoracic cavity
IV. Extremity wounds

Answer 2

a) II, III and IV only

Question 3

Which of the following is/are part of focused assessment with sonography for trauma patients?
I. Detect fluid in the peritoneal cavity
II. Detect fluid in the pleural cavity
III. Detect pericardial fluid
IV. Accurate measurement of ejection fraction

Answer 3

I, II and III only

Question 4

Which of the following are typical features of an Accident &Emergency department?
I. Triage station
II. Resuscitation room
III. Negative pressure room
IV. Minor procedure room

Answer 4

All of above

Question 5

In managing trauma patients, which of the following is/are part of the primary survey?

I. Needle decompression for tension pneumothorax
II. Intubation for airway protection
III. Fluid resuscitation in a patient with blood pressure 70/40 mmHg
IV. Head to toe examination

Answer 5

I, II & III only

Question 6

Different types of triage tags

Answer 6

Question 7

START method for adult triage

Answer 7

Question 8

3 steps of triage procedure

Answer 8

Step one:
- Open airway
- Check breathing
 >30 indicates shock. Treat shock and tag IMMEDIATE
 <30 move to step two
 No breathing after two attempts to open airway indicates death. Tag DECEASED

Step two:
 Check circulation/ bleeding
 Control severe bleeding
 Blanch test (nail beds, capillary refill): if normal color takes >2 s to return, tag IMMEDIATE

Step three:
 Check mental status
 Give simple command: “squeeze my hand”, “wriggle your toes”
 If no response treat for shock and tag IMMEDIATE

If victim passes all tests:
 Tag victims that pass all tests as DELAYED
 If a victim fails on test, tag them IMMEDIATE.

Question 9

Treatment for IMMEDIATE triage class

Answer 9

 Airway control: head tilt/ chin lift

 Bleeding control:
o Direct pressure/ pressure bandages
o Elevation above heart
o Pressure points (brachial arm, femoral leg)

 Treatment for shock:
o Lay on back, elevate feet, open airway
o Control bleeding, maintain body temperature

Question 10

Triage

Answer 10

Expectant

Question 11

Triage

Answer 11

Immediate

Question 12

Triage

Answer 12

Delayed

Question 13

Triage

Answer 13

Minor

Question 14

Triage

Answer 14

EXPECTANT

Question 15

Triage

Answer 15

Expectant

Question 16

Triage

Answer 16

Expectant

Question 17

Triage

Answer 17

Immediate

Question 18

Triage

Answer 18

Expectant

Question 19

4 levels of emergency medical services

Answer 19

Question 20

Clinical features of cardiac tamponade:

Management options

Answer 20

 Beck’s triad: hypotension, muffled heart sound, distended neck veins
 Kussmaul’s sign (paradoxical rise in JVP on inspiration, or failure in the appropriate all of JVP with inspiration)
 Pulsus paradoxus
 Pulseless electrical activity (PEA)

Management:
o May need open thoracotomy, or resuscitative thoracotomy
o Needle paracentesis does not work in trauma cases because blood will clot (different from pericardial
effusion in malignancy)

Question 21

Emergency history taking questions for traffic accidents and fall from heights

Answer 21

Traffic accidents:
o Deduce the number of impacts:
 E.g. 2: 1 bumped, 1 fell on ground
 E.g. 3: bumped, then hit windshield, then fell on ground
 E.g. 4: same as above but then rolled over by vehicle
o Find out mechanism of injury (e.g. size of vehicle, speed of vehicle)

Fall from heights:
o How high
o The ground where he fell on
o The body part where he landed on

Question 22

Providers of emergency medical services in HK

Answer 22

First aid in the community

Fire services department (FSD) - ambulance services

St. John Ambulance

Auxiliary Medical Service

Government Flying Service (GFS) - helicopters

Civil Aid Service (Mountain rescue Unit) 民安隊

Question 23

Triage criteria for air ambulance services

Answer 23

Question 24

Key management considerations for traumatic head injury

Answer 24

o Avoid hypotension and hypoxia
o Avoid hypocarbia
o Consider osmotic agents:
 Hypertonic saline
 Mannitol
o Elevate head of bed to 30o but beware of potential spinal injury in patients
o Sedate and treat seizures aggressively
o May consider using fentanyl for RSI (rapid sequence induction) as a pre-induction agent
o Avoid hypoglycemia

Question 25

Pain management for traumatic head injury

Answer 25

Pain – options:
o Morphine
o Fentanyl
o Low-dose ketamine