Misc

Question 1

what are the management priorities for renal stone with septic features?

Answer 1

As with all sepsis:

1 -Fluid resuscitation/inotropic support aim MAP >65 in patient with severe sepsis

2. Broad spectrum ABs – early administration reduces mortality
3. Urgent operative intervention with Urology to insert stent/relieve obstruction

Question 2

four differentials?

Answer 2

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

Question 3

why may you get a difference in brachial and radial pulses?

Answer 3

cuff not good at low BPs

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

with trauma, why is including mechanism of injury in triage difficult

Answer 6

poor specificity so over triage

Question 7

advantages and disadvantages of trauma bypass

Answer 7

Advantages
* reduces mortality
* concentrate resources
* staff retention

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

Question 8

what is permissive hypotension

Answer 8

in penetrating injury and short transit times to care its allowed

aim is not to disrupt clots

Question 9

what makes a psych patient high risk for retrieval?

what drugs can you use to ease transfer?

Answer 9

• 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

Question 10

doses of sodium bicarb and hypertonic saline

Answer 10

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

Question 11

insulin treatment for
hyperK
Calcium channel OD

Answer 11

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

Question 12

Adrenaline dose for newborns

Answer 12

Question 13

How do you calculate osmolar gap

What is normal

What causes high?

Answer 13

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

Question 14

what can you not give in quetiapine OD

Answer 14

Adrenaline