Medical emergencies

Question 1

CPR in adults is given at what ratio?

Answer 1

30:2 chest compressions to breaths

Question 2

What depth of CPR should be given?

Answer 2

5-6cm

Question 3

What rate of CPR should be given?

Answer 3

100-120 rate

Question 4

Continuous chest compressions should be given in which situation?

Answer 4

When definitive airway in place (e.g. Endotracheal tube)

Question 5

What are the 2 types of shockable rhythm?

Answer 5

VF

Pulseless VT

Question 6

What are the 2 types of non-shockable rhythm?

Answer 6

PEA

Asystole

Question 7

After administering a shock, how long must chest compressions be carried out for before the next shock?

Answer 7

2 minutes

Question 8

When should chest compressions stop?

Answer 8

When patient shows obvious signs of life

Question 9

How often does the cardiac rhythm need to be checked when shocking/CPR?

Answer 9

Every 2 minutes

Question 10

After the 3rd shock, what drugs must be administered?

Answer 10

IV adrenaline 1mg
IV amiodarone 300mg

Repeat doses of adrenaline every 3-5 mins (every other cycle of CPR)

Do not interrupt chest compressions to administer drugs

Question 11

How often does adrenaline need to be administered when treating a shockable rhythm?

Answer 11

Repeat doses of adrenaline every 3-5 mins (every other cycle of CPR)

Question 12

When IV access is not available to administer adrenaline/amiodarone, what can be done?

Answer 12

Administer drugs via intraosseous access (need trained members of team)

Question 13

If initial rhythm is PEA or asystole, what is the first step?

Answer 13

2 minutes CPR before further rhythm check

1mg IV adrenaline (then 3-5 mins after)

DO NOT USE ATROPINE

Question 14

What are the 4 Hs of the reversible causes of cardiac arrest?

Answer 14

Hypoxia
Hypovolemia
Hypo/hyperkalaemia
Hypothermia

Question 15

Whare the the 4 Ts of the reversible causes of cardiac arrest?

Answer 15

Tamponade (cardiac)
Thromboembolism
Toxins
Tension pneumothorax

Question 16

How do you treat hypoxia-induced cardiac arrest?

Answer 16

Airway adjunct (e.g. Guedel)
or definitive airway (ET tube)

High flow O2

Ventilating patient

Question 17

How is hypovolemia treated?

Answer 17

Fluid replacement

Give blood transfusion if large volume blood loss

Question 18

Can Hb levels be used to reassure that a blood transfusion has worked?

Answer 18

No - always examine the patient thoroughly (Hb levels can be falsely raised)

Question 19

How is hyperkalaemia treated?

Answer 19

Insulin and glucose

IV calcium gluconate to stabilise myocardium

Question 20

Why can’t you give calcium and sodium bicarbonate with the same access line?

Answer 20

Insoluble precipitate forms –> blocks access line

Question 21

What drug can be given for persistent VF/VT where hypomagnesaemia is suspected?

Answer 21

Magnesium sulfate

Question 22

How can hypothermia be conservatively managed?

Answer 22

Dry patients

Warm blankets/ambient environment

Cover extremities

Infuse warm fluids

Monitor core temperature

Question 23

If core body temp <30, what do the guidelines say about giving shocks/IV drugs

Answer 23

Limit shocks to 3

Withhold IV drugs (inc adrenaline, amiodarone) until body temp >30

Question 24

If core body temp is between 30-35, how does this affect how you administer resuscitation drugs?

Answer 24

Double the intervals between drug doses

Question 25

What is the treatment of tension pneumothorax?

Answer 25

Immediate decompression with large bore cannula --> chest drain after ROSC

Question 26

What is the main thromboembolic cause of cardiac arrest?

Answer 26

Massive PE

Question 27

Can thrombolysis be used to treat massive PE causing cardiac arrest?

Answer 27

Yes but resuscitation may need to continue up to 90 minutes post thrombolysis

Question 28

What drugs can cause cardiac arrest?

Answer 28

Opiods TCAs Benzodiazepines

Question 29

How is opioid overdose treated?

Answer 29

Naloxone + close monitoring

Question 30

How is TCA overdose treated?

Answer 30

Sodium bicarbonate

Question 31

How is benzodiazepine overdose treated?

Answer 31

Flumazenil | don't use if Pt dependent on benzos as causes seizures

Question 32

How is anaphylaxis reaction to drug treated?

Answer 32

IM adrenaline 500mcg + antihistamine + corticosteroid (do all this pre-arrest) If cardiac arrest occurs, give 1mg IV adrenaline instead!

Question 33

How is cardiac tamponade investigated and treated?

Answer 33

Ix: Echocardiogram Tx: Pericardiocentesis

Question 34

When managing a cardiac arrest in a woman in the later stages of pregnancy, what manouevre must be done?

Answer 34

Manually displace the uterus to the left | add left lateral tilt if only feasible

Question 35

When should you consider emergency C-section if the woman has a cardiac arrest?

Answer 35

If initial resus attempts fail and within 5 mins of cardiac arrest

Question 36

In cardiac arrest following cardiac catherisation, how many DC shocks may be administered to achieve ROSC?

Answer 36

3 stacked DC shocks

Question 37

Which 2 vital signs are the most important when considering the management of Post-cardiac arrest syndrome?

Answer 37

Oxygen sats (94-98) + CO2 levels Temperature (<36)

Question 38

What is the difference between HHS and DKA?

Answer 38

Ketones and acidosis not present in HHS

Question 39

Severe hypoglycaemia can be treated via parenteral treatment with which 2 drugs?

Answer 39

IM glucagon or IV glucose

Question 40

What is the most common cause of hypoglycaemia in hospital patients?

Answer 40

Prescribing errors

Question 41

What is the 1st principle of HHS treatment?

Answer 41

Give fluids to restore circulating volume | only initiate insulin when blood glucose is no longer falling with IV fluids alone

Question 42

What is the difference between mild and severe hypoglycaemia?

Answer 42

Mild - blood glucose levels drop and person self-treats Severe - 3rd-party required to treat the person

Question 43

For hospital inpatients, what is the defining value of hypoglycaemia in mmol/litre?

Answer 43

Blood glucose <4.0 mmol/litre

Question 44

What are adrenergic/autonomic symptoms (early) of hypoglycaemia?

Answer 44

``` Sweating Tachycardia Palpitations Pallor Hunger Restlessness ```

Question 45

What are neuroglycopenic symptoms (late) of hypoglycaemia?

Answer 45

``` Confusion Slurred speech Drowsiness Numbness of nose/lips/fingers Anxiety Blurred vision ```

Question 46

Frequent episodes of hypoglycaemia can lead to _______ awareness of hypoglycaemic symptoms

Answer 46

Reduced

Question 47

What drug can mask adrenergic symptoms of hypoglycaemia?

Answer 47

Non-cardioselective beta blockers e.g. propanolol

Question 48

What are lifestyle risk factors for hypoglycaemia?

Answer 48

``` Diet inc. fasting periods Age(older) Exercise History of severe hypos Hypo unawareness ```

Question 49

What are medical risk factors for hypoglycaemia?

Answer 49

Insulin or glucose lowering drugs Problems with BM monitoring Comorbidity Concomitant meds (e.g. stopping long-term steroids) Renal issues (aki/dialysis) Learning difficulties

Question 50

When treating severe hypoglycaemia what is important to check first before starting treatment?

Answer 50

Pt's level of conciousness Gag reflex? Able to tolerate oral meds

Question 51

If blood glucose is still low despite repeated attempts at providing quick-acting carbs, what drug treatment can be given?

Answer 51

IM glucagon 1mg (also give larger carb snack together) or 10% glucose infusion 150-200ml over 15 mins

Question 52

If patient is conscious and able to swallow but confused, unable to cooperate or aggressive - how can hypoglycaemia be treated?

Answer 52

1.5-2 tubes of glucogel squeezed into mouth between teeth and gums or IM glucagon 1mg 1x and monitor after 15 mins

Question 53

How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS AVAILABLE?

Answer 53

75-100ml 20% glucose over 15 mins via standard giving set OR 150-200mlm 10% glucose over infusion pump/giving set Rpt BM at 10 mins, if still <4.0 then repeat administration

Question 54

How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS NOT AVAILABLE?

Answer 54

IM glucagon 1mg Remember to give large carb snack 40g afterwards

Question 55

Severe spontaneous hypoglycaemia is when blood glucose is below?

Answer 55

<2.2 mmol/litre

Question 56

If no good reason for hypoglycaemic episode, which 2 things can be done?

Answer 56

Take bloods (insulin, C-peptide, IGF-1 and 3-beta-hydroxybutyrate) Give glucose orally or IV (20% glucose solution) to restore blood glucose to normal