Providing Pre-Hospital Emergency Care Flashcards
What equation governs flow?
Hagen-Poiseuille equation
What is the Hagen-Poiuseuille equation?
Flow =
(Pi x change in pressure x radius4) / (8 x length of tube x viscosity of fluid/air)
What induction agents have anti-epileptic properties and which can cause epileptiform activity?
- Ketamine, propofol, thiopentone, midazolam
- Etomidate
What are the 4 types of necrotising fasciitis?
Type 1 = > common + polymicrobial (usually both aerobes and anaerobes)
Type 2 = Group A haemolytic strep and >common with toxic-shock syndrome
Type 3 = rare + gram negative monomicrobial
Type 4 = rare, fungal
What is dissociative anaesthesia defined as?
Functional and electrophysiological dissociation between the thalamo-neocorticol and limbic systems
What are the consequences of Addisonian crisis?
- Cortisol insufficiency: vasodilation and hypoglycaemia (loss of gluconeogenesis)
- Aldosterone insufficiency: increased renal sodium loss, increased potassium reabsorption and increased water excretion (reduced IV volume)
What are the landmarks for a radial nerve block?
Palpate radial styloid and radial artery (to avoid hitting).
Inject proximal to radal styloid process and lateral to artery.
Then inject medially to midpoint of wrist to avoid missing superficial branches.
What are the landmarks for an ulnar nerve block?
Medial border for flexor carpi ulnaris, 2cm proximal to palmar crease
Insert needle 0.5-1cm and inject 2-4ml LA
What are the landmarks for a median nerve block?
1cm between tend of palmaris longus and flexor carpi radials 4cm from palmar crease and inject 5ml LA
What are the landmarks for the following ankle blocks?
1. Ring block technique
2. Posterior tibial nerve block
3. Deep peroneal nerve block
- Includes saphenous/sural and superficial peroneal nerve. Ring of LA (15-20ml) subcutaneously at level of malleolus, anterior to Achilles tendon
- Palpate PT artery and insert just posterior to this to bone. Withdraw 1-3mm and inject 5ml LA
- Immediately lateral to extensor hallucis, 3cm distal to the intermalleolar line and medial to DP artery
What are the landmarks for FIB?
ASIS and pubic tubercle - junction between lateral and middle third of this line. Move 1cm caudal to this
Will feel 2 pops - first through fascia lata and second through fascia iliaca
What are the indications for pre-hospital amputation (4) and what is strongly advised beforehand?
- Immediate risk to patients life due to scene safety
- Patient deteriorating and physically trapped by their limb and most likely will die during the time it takes to extricate
- Mutilated non-survivable limb with minimal soft tissue attachment causing a delay to extrication that is not life threatening
- A patient is dead but heir entrapment is blocking access to potentially live casualties
Call with senior clinician on call (or another consultant)
How does GMC define EOL?
Likely to die in next 12 months
What is the definition of death?
Irreversible loss of capacity of consciousness and breathing, therefore of cessation of integrative function of brainstem.
What can / cannot be done pre-hospital in terms of organ donation?
Unable to initiate organ donation us death certificate cannot be issued immediately
However, tissues maybe viable for up to 48 hours and this can be initiated by coroner
With respects to PRC what:
1. Temp should they be stored at?
2. Time can they be out of the fridge and still administered
3. Is the shelf life?
- 2-6 degrees C
- Used within 4 hours, cannot go back into fridge once out
- 35 days
With respects to FFP:
1. what temp should it be stored in?
2. what is the shelf life?
-after thawing, how quickly must it be administered if kept at:
3- 22 degrees
4. 2-6 degrees
- < -25 degrees
- 36 months
- 4 hours
- Extends time to administer by 24 hour
What is TACO defined as?
Transfuion Associated Circulatory Overload
Acute or worsening pulmonary oedema within 6-12 hurs
How long after transfusion should a TRALI occur?
2-6 hours
What is a TRALI?
Transfusion Related Acute Lung Injury
- antibodies in donor blood reacting to patients pulmonary endothelium
- inflam response and non-cardiogenic pulmonary oedema
How much blood is needed to cause and ABO incompatibility reaction?
As little as 30ml
What is LyoPlas?
Freeze dried plasma
Donated lyophilised plasma (lyophilisation is process by which water removed)
With respects to LyoPlas?
1. What is the shelf life?
2. What temp should it be stored?
3. Once reconsitituted how quickly should it be administered?
- 15 months
- 2-25 degrees
- < 6 hours
What is in PCC?
Isolated vit K dependent factors: II, VII, IX and X + protein C and S
What is the dose of PCC?
25-50 units/kg
