medical

Question 1

Signs of dehydration

Answer 1

Postural changes (tachycardia, hypotension, dizziness)
Altered conscious state/fatigue
Evidence of Poor fluid intake 
Decreased urination/sweating
Dry mouth/tongue, poor skin turgor

Question 2

Management of dehydration

Answer 2

Dehydration but adequately perfused
- Fluid 20ml/kg over 30/60
Significant dehydration: less than adequately perfused
- Fluid 20ml/kg repeat 20ml/kg after 40ml/kg consult with clinician for further 20ml/kg

Question 3

Management of Nausea & Vomiting

Answer 3

Undeferential nausea & vomiting
ondans 4-8mg oral/IV
Prochlorperazine if unable to give ondans

vestibular nausea
(Motion sickness, aeromedical evac, vertigo)
Prochlorperazine 12.5mg If older than 21
if under Ondans

Prophylaxis for awake spinal immobilisation/eye trauma
ondans 4-8mg

Question 4

S&S of meningococcal septicaemia

Answer 4

Purpuric rash

septicaemia symptoms

• cold hands & heat
• fever, rigors, joint/muscle pain
• tachypnoea
• tachycardia/hypotension

Meningeal signs

• Fever, headache, photophobia
• Nausea/vomiting
• Altered conscious state

Question 5

Management of Meningococcal

Answer 5

IV
1g ceftriaxone diluted with 9.5ml water for injection
Fluid as per inadequate perfusion(non-cardiogenic)
20ml/kg over 30/60
IM
1 g ceftriaxone diluted with 3.5ml of lignocaine, admin into large muscle

Question 6

Sepsis criteria

Answer 6

HR >90bpm
BP < 90mmHg
RR >20
Temp <36 or >38

Question 7

Management of sepsis

Answer 7

Pt inadequately/ extremely poorly perfused

• Chest clear, meets sepsis criteria & mica not immediately available
• fluid 20ml/kg 30/60
• Oxygen its a critical illness

Question 8

Other opioid cause includes

Answer 8

• Iatrogenic
• Polypharmacy
• Unknown substance
• prescription medication

Question 9

Management of ‘Other opioid causes’

Answer 9

IV access
- Naloxone 100mcg 2/60 to max of 2mg

IM admin
- single dose 400mcg

Question 10

Heroin overdose

Answer 10

IM
1.6-2mg Naloxone
nil repeat
after 10/60 airway Mx consider other causes

Question 11

AEIOUTIPS

Answer 11

Alochol
Epilepsy/seizure
Infection/sepsis
Overdose 
Underdose/uraemia 
Trauma
Insulin
Pain/psychiatric 
Stroke

Question 12

Management Mild agitation

Answer 12

olanzapine 10 mg
elderly/frail/alcohol/drug/<60kg
5mg

Repeat after 20/60
Max 20mg

Question 13

Management of Moderate agitation

Answer 13

IM 
Midazolam 5-10mg 
elderly, frail, <60kg, alcohol affected, renal impairment 
2.5-5mg 
repeat after 10/60 
Max 20mg

Question 14

Severe agitation

Answer 14

Ketamine 
IM 
200mcg - <60kg 
300mcg 60-90kg 
400mcg >90kg 

Ketamine not available
20mg midazolam repeat after 10/60 to max 40mg

Question 15

Management of hypoglycaemia

Answer 15

BGL <4mmol Obeys command 
Glucose paste 
BGL <4mmol unable to obey command 
15g dextrose IV or 1 g IU glucagon 
10/60 
If GCS <15 
10g dextrose IV 

10 ml flush post dose of dextrose

Question 16

Common tricyclic antidepressants

Answer 16

amitriptyline
Doxepin 
Nortriptyline
Desipramine
Amoxapine 
Imipramine (toframil) 
Protriptyline (vivactil) 
Trimipramine (sumontil) 
Dothiepin

Question 17

Signs of Mild - Moderate TCA overdose

Answer 17

Hyperflexia 
Ataxia 
Respiratory depression 
Drowsiness, dry mouth 
Hypertension 
A
Tachycardia
Slurred speech

Question 18

Signs of severe toxicity from TCA overdose

Answer 18

within 6hrs

respiratory depression/hypoventilation 
coma 
conduction delays 
PVC 
SVT 
VT 
hypotension 
ECG changes 
seizure

Question 19

Signs of TCA toxicity

Answer 19

QRS >0.12 sec
hypotension
ventricular arrhythmias

Question 20

Management of TCA overdose

Answer 20

Manage as required

Hyperventilate @ 20-24 bpm to minimise metabolic acidosis