MEDICAL Flashcards
- ## You are tasked to a rural clinic who have received a 45M who has a self-inflicted shotgun wound to the face. Patient is currently tripoding, very agitated, choking on secretions, but maintaining saturations at the moment. The medical team is overwhelmed and not yet started any interventions or obtained vital signs.QUESTION 1: Name 2 key pieces of equipment you would need to perform front-of-neck access
i. Scalpel
ii. Bougie
iii. Endotracheal tube (size 6-0 ETT)
iv. Options: Portex, personal PPE (gloves, mask)
Patient is bleeding heavily and you decide to give blood. Where is the blood stored in the AW169?
Behind the rear-facing seat
List 3 criteria for initiation of pre-hospital blood transfusion
- HR>120
- SBP <90
- Penetrating injury
- Positive eFAST
- Both clinicians are in agreement
Patient is likely to need neurosurgical intervention.
QUESTION: Which hospital would you take him to?
Auckland City Hospital
At what heart rate would you start CPR in a neonate?
<60bpm
What is the ratio of chest compressions to ventilation’s in a neonate?
3:1
What is the dose of adrenaline for cardiac arrest in a neonate?
Options:
10mcg/kg,
0.01ml/kg of 1:1000,
0.1ml/kg of 1:10,000
You are tasked to a 4 year old male who presents with severe respiratory distress, stridor, and drooling. He has had a sore throat for a few days. Lateral x-ray demonstrated thumb sign suspicious for epiglottis. He is hypoxemic on arrival with low sats and showing signs of respiratory failure
On the way to the job, you are thinking about the drugs and equipment you might need.
QUESTION: Estimate the weight of a 4yr old male
Approx 16kg (age+4)2
You are tasked to a 4 year old male who presents with severe respiratory distress, stridor, and drooling. He has had a sore throat for a few days. Lateral x-ray demonstrated thumb sign suspicious for epiglottis. He is hypoxemic on arrival with low sats and showing signs of respiratory failure
On the way to the job, you are thinking about the drugs and equipment you might need.
QUESTION: What size ETT would you use for this child?
5 (uncuffed),
4.5 (cuffed) -
option +/- 0.5 formula uncuffed: (age/4)+;
cuffed (age/4)+3.5 or (age/4)+3
You are tasked to a 4 year old male who presents with severe respiratory distress, stridor, and drooling. He has had a sore throat for a few days. Lateral x-ray demonstrated thumb sign suspicious for epiglottis. He is hypoxemic on arrival with low sats and showing signs of respiratory failure
On the way to the job, you are thinking about the drugs and equipment you might need.
QUESTION: What would your induction dose of ketamine be for this child?
2mg/kg = approx. 30mg
QUESTION: Where do you find the pedimate in the AW169?
In the window rear soft storage bag
You are called to a scene an hour’s flight away in a rural small town. Ambulance have received a call with scant details and estimate that there are 4 people with gunshot wounds, one status 1, 2 status 2, and a fourth status 3. The location of the assailant is unknown.
QUESTION: How many victims were there, and what was the status of each?
4 people TOTAL
1 x status 1
2 x status 2
1 x status 3
Where is the blood stored in the AW169?
Behind the rear-facing seat
How quickly can you transfuse blood with the new fluid warmer?
200ml/min
To what temperature dose the Warrior light blood-warmer heat fluid?
38 degrees C
You are called to a remote cottage hospital where a 25 year old woman with rheumatic heart disease, a metallic mitral valve replacement, and anticoagulated on enoxaparin has been admitted with shortness of breath. She is 26 weeks pregnant. She is hypotensive, critically hypoxaemic, and foetal heart rate on auscultation is 110 beats/minute.
QUESTION: • What is a normal fetal heart rate?
i. 110-160bpm
QUESTION: What is the gestation of fetal viability?
24 weeks (allow 23-25 weeks)
1900 on Friday evening. You have just finished all your checks and about to sit down and eat some dinner. The hotline sounds. Code purple in Matakana. 2 year old girl, drowning in a pool. They will drop further details and info on the MDT….
En route, you are preparing for what you might need:
QUESTION: How much is this child likely to weigh?
QUESTION: What size cuffed ETT would you use to intubate her?
Approx 12kg (Age+4)2
Cuffed ETT size 4 (allow +/-0.5) Formula (Age/4)+3.5 or (age/4)+3
1900 on Friday evening. You have just finished all your checks and about to sit down and eat some dinner. The hotline sounds. Code purple in Matakana. 2 year old girl, drowning in a pool. They will drop further details and info on the MDT….
En route, you are preparing for what you might need:
QUESTION: What is the dose (in mcg per kg) of adrenaline for a child?
10mcg/kg = of 1:1000 or 0.1ml/kg of 1:10,000
QUESTION: To transport this child, where is the pedimate stored in the AW169?
Rear window soft storage
You are tasked to Warkworth for RSI of a 65 year-old male with airway burns after a fish smoker exploded in his face. Limited information over the MDT suggests he is in severe respiratory distress.
QUESTION: List 2 key pieces of equipment required to perform a surgical cricothyrotomy
i. Scalpel
ii. Bougie
iii. Endotracheal tube (size 6-0)
iv. Other options: Portex, personal PPE (gloves, mask)
You are tasked to Warkworth for RSI of a 65 year-old male with airway burns after a fish smoker exploded in his face. Limited information over the MDT suggests he is in severe respiratory distress.
QUESTION: You need to take them to a hospital with a burns service – what is your destination hospital?
Middlemore
You are tasked to Warkworth for RSI of a 65 year-old male with airway burns after a fish smoker exploded in his face. Limited information over the MDT suggests he is in severe respiratory distress.
QUESTION: According to the Out-of-Hospital Major Trauma Destination Policy, list 1 criteria for transfer to middlemore hospital
i. Penetrating trauma to arm with arterial injury
ii. Crushed, amputated, mangled or pulseless limb
iii. Paraplegia or quadriplegia
iv. Burns involving the airway
v. Burns > 20% of body surgace area
What are the criteria for pre-hospital blood transfusion in an adult trauma patient?
- HR>120,
- Systolic blood pressure <90,
- Positive eFAST (=free fluid on ultrasound), -penetrating mechanism;
- both clinicians agree
