1. Fellowship Written > Thursday Teaching Extras > Flashcards

Thursday Teaching Extras Flashcards

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1
Q

four differentials?

A
  • Ruptured AAA
  • epidrual abscess with shock
  • perforated DU
  • Aortic dissection
  • renal colic
  • lumbar back pain
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2
Q

in a ruptured AAA what are pros and cons of US V CT

A

US

Pro - fast and no radiation
Con - user dependent, not as reliable, low sen and spe

CT
Pro - high sensitibity and specificy, allows surgical planning, rules out other things
cons - radiation, time consuming, danger of going in scanner

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3
Q

what criteria is used by ambos to decide whether to bypass a hospital to go to trauma centre

A

MIS

Mechanism
eg over 60km
fatality in same accident
state of vehicle
children

Injuries
penetrating
severe burns
head injury with coma

Signs
shock
resp distress

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4
Q

advantages and disadvantages of trauma bypass

A

Advantages
* reduces mortality
* concentrate resources
* staff retention

Disadvantages
* deskilling of staff
* over triage of injuries
* longer transit times
* harder for family to accesss

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5
Q

what makes a psych patient high risk for retrieval?

what drugs can you use to ease transfer?

A
  • threats of violence
  • active thought disorder
  • medication non compliance
  • intoxicated
  • history of violence
  • evidence of self harm
  • previous assault

Diazepam 10mg oral prn
Ketamine 20mg aliquots prn, or infusion 50-250mg/hr (0.6-3mg/kg/hr)
Droperidol 10mg IM

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6
Q

doses of sodium bicarb and hypertonic saline

A

Sodium Bicarb 8.4 %
* 50-100ml in arrest or hyperK
* 1-2ml/kg in TCA if seizing

Hypertonic saline 3%
* 100ml bolus to raise rapidly in seizures (2-3mmol)
* Acute - 1-2ml/kg/hr in acute low Na aim for 1-5mmol/l/hr
* Chronic - 10mmol/day
* 3ml/Kg ICH

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7
Q

insulin treatment for
hyperK
Calcium channel/propanolol OD

A

hyper k - 10 units in 50% dextrose 50ml
Ca - 1unit/kg + 50% dextrose 50ml
Then 0.5units/kg/hr and dextrose 50% 50ml/hr

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8
Q

Adrenaline dose for newborns

A
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9
Q

How do you calculate osmolar gap

What is normal

What causes high?

A

Measured osmolality - calculated osmolality

Calculated osmolality = 2 x na + urea + glucose + ethanol

Normal is less than 10

High:
* mannitol
* methanol
* ethylene glyco.
* Drugs - IV lorazepam/phenytoin

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10
Q

what can you not give in quetiapine OD

A

Adrenaline

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11
Q

complications of SCA

A
  • Infections
  • Priapism
  • Vaso occlusive criss
  • Acute chest syndrome
  • Acute splenic sequestration
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12
Q

What is TTP in child?

A

HUS

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13
Q

hunter criteria

A
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14
Q

drugs you can put in tube and dose

A

NAVEL - 2-3x normal dose
Naloxone
Atropine
Vasopressin
Adrenaline
Lidocaine

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15
Q

Chain of survival

A
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16
Q

hypoxia post intubation

A
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17
Q

CVP pressure sepsis target

A

8-12mmhg

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18
Q

ways to incresse electrical impedence in shock

A

shave, dont place over jewellwet, over ecg pads, over lines, ensue gel, ensure good cover

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19
Q

when do you use dual sequential defib?

A

refractory VF

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20
Q

how long does high dose insulin take to work?
When do you use

A

1 hour
Any tox with cardio suppression eg bets blocker, calcium channel blocker

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21
Q

causes of pacemaker failire

A

output failure - battery, wire fracture, lead displacement
capture failure - wire fracture, lead displacement, wire fibrosis, electrolyte derangement, MI (dead tissue)

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22
Q

fluid components

A
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23
Q

dex dose kids
midaz dose

A

10% 2-5ml/kg
0.15mg/kg

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24
Q

age weight tube size kids

A

1 - 10 - 4
5 - 20 - 5
10 - 30 - 6

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25
adrenaline infusion dose anaphylacxis
1ml of 1:1000 in litre 5ml/kg/hr
26
contraindications for ED thoractomy
* Penetrating injury + no signs of life and CPR > 10min * Blunt injury + no signs of life > 5 minutes * Multiple severe blunt trauma * Non-survivable head injury No signs of life on scene
27
when to stop ED thoractomy
no cardiac activity, no tampanade found, SBP under 70 after 30 mins of management
28
principles of damage control resus
1) recognition 2))haenostatic resus – stop triad, 1:1:1 blood 3)Rapid movement to theature eg scoopr and run and wllow permissive hypotension
29
steps in thracotomy
intubated and have had bilateral thoracostomies (in the 4th or 5th Using a 10-blade scalpel, connect the bilateral thoracostomies. Make your incision count; cut through the skin and subcutaneous tissue down to the intercostal muscles. Try and remain in a single intercostal space. You may need to extend the incision laterally, but if you do so, remember to not go straight down to the bed, but extend up into the axillae. Using heavy scissors, cut through the intercostal muscles towards the sternum and through Now that you are through the sternum, lift up the chest wall (clamshell) and expose the thoracic organs. Place your rib-spreader .
30
Trauma scores
ISS TS RTS GCS
31
infusion doses for dissection
GTN - 50mcg/min fent - 100mcg/hr labetalol - 20mg/hr hydralazine 3ml/hr
32
eye movements
33
drawbacks GCS
* not in tox * not in kids * inter user variability * need to be skilled * not a good indicator of mortalirt between 7-9 * only designed for head injury
34
cord syndromes
35
steps after clam shell
* Open the pericardium to relieve tamponade * Identify and repair any cardiac injuries * Perform internal cardiac compressions * Cross-clamp the aorta if needed * In the presence of major lung injury, collapse and compress the lung
36
deep sulcus sign
pneumothorax
37
co2 for all head stuff
35-40
38
signs of tampanade
becks triad tachy chest pain pulsus paradoxus
39
NB for all trauma
Abx and ADT
40
when do you not do permissive hypotension
head injury
41
Venlafaxine
SNRI AND SSRI Serotonin syndrome and seizures
42
shocks in hypothermia? stacked shocks
Three in VF/VT then none till 30 witnessed VF
43
mnemonic for difficult FON
SMART: Surgery, Mass, Anatomy, Radiation, and Tumo
44
when may local not work?
abscess as too acidic - add bicarb
45
normal capnograhpy
46
capnography
47
Extubation process
Extubation: 30 degrees Suction oropharynx Deep breath in first Deflate cuff and withdraw as expiration space to reintubate
48
drugs for hypertensive emergency pros cons
GTN 50mcg/min - 200mcg/min Pros - can give SL, familiar Cons - Tachyphylaxis, headache Beta blockers eg labetalol 20mg or 30mg/hr. metoprolol 5-50mg IV Pros - familar, rapid Cons - brady Mg - 10mmol Pros - safe, familair Cons - less predictable, hypermg and arryhymias Hydralazine - 5-10mg IV or 3-5mg/hr Pros - Rapid, familar cons - urinary retention
49
Best drugs for Dissection MI ICH Target
Dissection - Beta blocker, hydralzine, GTN 100-120 and reduce shear forces MI - GTN, metoprolol reduce by 25% and reduce ischamia ICH - Labetlol, hydralzine, GTN 130-150
50
NSAIDS
51
Adrenaline v norad
52
Modified sgarbossa
53
Causes of third nerve palsy
54
most common site of IE
mitral then aortic Tricuspid if I.E
55
mild moderate severe life threatening symptoms fev1 predicted response to b2 agonist
56
salbutamol steroids mg NIV effect and pro and side effects
57
investigations and utility in pregnancy D-dimer CxR CTPA VQ
58
PE diagnostic risk tools
PERC Wells Geneva
59
PE stratification tools
PESI Echo trop ECG
60
RHS on ECG
wide spread t wave inversion
61
wells score risk
62
Strokes
63
Electrolytes causing long Qt
Low potassium, mag, calcium
64
Types of burns with lightning
65
glasgow mmenonic
66
SS v NMS Onset CNS Cause Treatment Resolution
67
principle of assesing capacity
understand retain weight up risks communicate
68
risks of chemical sedation
aspiration arrhtymia QT prolongation anaphylaxis aspiration hypoventilation hypotension respiratory depepression anti cholinergic NMS/SS
69
things to assess for on quick survery of psych patient
suicide risk self harm risk violence risk neglect risk absconding risk
70
justification for sedation
doctrine of neccesity - imminent risk to self or others and minimal method to achieve goal cant sedate under duty of care
71
exclusion criteia for OTTAWA rules
under 18 pregnant injury over 10 days cant follow commands eg head injury or tox
72
73
74
Labetalol, 20mg IV bolus aim 140-160 and sx relef Hydralazine 5mg IV Nifidepine 10-20mg oral
75
management options ectopic
surgical medical - methotrexate expectant
76
severe pre eclampsia
Headache with visual changes Hypertension over 160 Renal failure or HELLP Right upper quadrant pain eg haematoma Pulmonary oedema peripheral oedema
77
methods for shoulder dystocia
Mcroberts Gaskin suprapubic pressure Rubin - apply pressure to posterior shoulder and rotate
78
magnesium toxicity in pregnancy
hypotension bradycardia resp depreesion flushing areflexiaa nause and vomiting
79
classes of drugs not bound by charcoal
Heavy metals and minerals Examples: Iron, Lithium Alcohols Examples: Ethanol, Methanol Corrosive substances / Acids and alkalis Examples: Hydrochloric acid, Sodium hydroxide
80
what makes a drug amenable to dialysis
low protein binding low molecular weight low VOD
81
complications DKA in kids
cerebral odema seizures ARDS pancreritis hypoglycaemia venous thromvoembolism
82
features of addisonian crisis
low BSL recent illness low Na, high K hypotension reduced GCS precipitating illness
83
tests for cushings
24 hour urinary cortisol, late night salivery cortisol. Dexemthasoe suprresison test
84
High lateral STEMI

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