Medical Emergency

Question 1

What approach should be used when assessing a patient in a medical emergency

Answer 1

A- airway
B - breathing
C - circulation
D - disability
E - exposure

This should be constantly reassessed until the patient is stable

Question 2

What is the triple manoeuvre for helping an airway

Answer 2

Head tilt
Chin lift
Jaw thrust

Question 3

How do you measure an oropharyngeal airway

Answer 3

From the angle of the mandible to the tip of the incisors

Question 4

Why do people with neurological conditions hypo-ventilate

Answer 4

This is because they have reduced muscle tone

Question 5

What is the normal respiratory rate

Answer 5

12-15 breaths per minute

Question 6

What is the normal 02 saturation

Answer 6

98%

Question 7

If a patients lips and nails have become cyanotic, what percentage of 02 saturation have they passed

Answer 7

84%

Question 8

If the patients tongue has changed colour due a breathing issue what is this a sign of and what is there 02 saturation

Answer 8

This is a sign of central cyanosis and 02 saturation would be about 60%

Question 9

What is the optimum position for opening up the intercostal muscles

Answer 9

The tripod position

Patient is sitting slightly forward with arms propped in front,on table, bed or knees.

It allows for greater chest expansion and increased ability to use acessory muslces

Question 10

At what beats per minute do the radial and brachial pulse disappear

Answer 10

Radial at 70
Brachial 60

Question 11

What is a common cause for a drop in neurology and what should we test

Answer 11

Change in blood glucose

Question 12

As per GDC guidance what level of o2 should we give any patient who is sick

Answer 12

15 litres via a non re-breathing mask

Question 13

When doing ABCDE approach for a patient in anaphylaxis what might we see

Answer 13

A - swelling/ stridor
B - increased rate and a wheeze
C- increased rate, hypotension
D - LOC
E - itchy rash and swelling

Question 14

How do we treat anaphylactic shock, what is the technique?

Answer 14

Intramuscular injection of 1;1000 adrenaline 0.5mg

• Apply tension and inject into anterolateral aspect middle third of the thigh
• aspirate
• come out half and let go of the tension then remove the rest of the needle

Question 15

What is the technique called for giving I’m injection for anaphylactic shock and why do we do this

Answer 15

This is called the Z track technique and we do this to prevent loss of drug when removing the needle

Question 16

Why do we give adrenaline to someone with anaphylactic shock

Answer 16

It is a bronchodilator - this will help the wheeze and open up the airway
It is a peripheral vasoconstrictor which helps reduce the
BP
It is a central vasodilator so getting more blood to the brain
Increases contractiiblity of the heart
Dampens the histamine

Question 17

After injecting the adrenaline into an anaphylactic patient what else should we do

Answer 17

Establish and airway and give high flow 02

Question 18

What would we see in the ABCDE for angina/mI

Answer 18

A - talking
B - increased
C - increased, may be a bit tachycardia due to their anxiety of thinking they are having a heart attack
D - alert
E - pale, clammy, central chest pain
◦ Central crushing radiating down left arm and jaw

Question 19

How would you know if it was stable/unstable angina

Answer 19

Stable angina is chest pain on exertion and relived by rest whereas unstable comes on suddenly and isn’t relieved by rest

Ask the patient

Question 20

How do we treat angina

Answer 20

GTN spray, 400micrograms per dose - 2 puffs sublingual
◦ This is symptom relief only
◦ Works very quickly as it gets into the circulation fast
◦ Vasodilator, reliving pressure on the heart and BP drops
◦ Always check the patients BP before giving this, it they have have a good strong pulse, they will tolerate it if not omit it.

Question 21

If GTN spray doesn’t work for an angina patient what else can we give

Answer 21

Aspirin 300mg crushed or chewed if MI
◦ Chew it, if patient can’t it can be crushed
◦ Do not let them have a drink for 1o minutes to allow it to be absorbed into the oral mucosa

Question 22

What kind of medication is aspirin and how quickly do we want the patient to be given it

Answer 22

This is an anti platelet medication - want this in the first 10 minutes of the MI
◦ It is also an anti-pyretic
◦ (reduce fever) and analgesic

Question 23

In our ABCDE approach for Asthma what might we see

Answer 23

A - Difficult to complete sentences
B - increased rate with wheeze
C - increased rate
D - alert
E - tripods position

Question 24

How do we treat asthma

Answer 24

Salbutamol 10 micrograms per actuation
Spacer device when appropriate

Question 25

Go over BLS

Answer 25

DRSABC

Question 26

What is the heimlich maneuver and when do we use this

Answer 26

This is abdominal thrusts and we use this when a patient is choking

Stand behind them with your arms around their waist.
Make a fist with one hand and postion it slightly above belly button.
Grasp the fist with the other hand pressing into the abdomen with quick hard upwards thrust

Perform 5 then 5 air blows

Question 27

What may we see in our ABCDE approach for hypoglycaemia

Answer 27

A - initially talking
B- initially increased rate
C - initially increased rate
D - initially alert
E - irritable, confused and pale

Question 28

How do we treat a patient with hypoglycaemia

Answer 28

If they are still able to talk get some sugar into them - this can be in the form of a glucose gel e.g. ralipose

If we cannot do this and they are starting to become unconscious
Glucagon 1miligram IM injection

Question 29

How Do we set up a glucagon injection

Answer 29

Inject fluid into the vial with powder DO NOT SHAKE
Z track technique to inject

Question 30

Once a patient has regained consciousness following glucagon injection what do we need to do

Answer 30

Give them sugar so they dont collapse again

Question 31

What is a complication following glucagon injection

Answer 31

Makes the patient feel awful

Question 32

What do we always assume with seizure patients

Answer 32

Always assume they have an airway problem
Do a gentle jaw thrust, dont put the mask on them put it on the pillow next to them

Question 33

How do we treat a seizure.

Answer 33

If it is repeated or longer than 5 mins

Midazolam 10miligrams via the buccal mucosa

Question 34

Why does a faint happen

Answer 34

It is a vaso-vago attack, the BP drops

Vagal tone gets strong and the HR drops to below 10 beats per minute meaning that the patient brain doesn’t get perfused and they drop to the floor.

They usually come round very quickly if they don’t something else is going on

Question 35

How do we treat syncope

Answer 35

Elevate legs and give them time to come round don’t move them too quickly