Quiz Part B Flashcards
Demonstrate/describe a physical examination of a patient’s abdomen
Inspection consists of visual examination of the abdomen with note made of:
i. The shape of the abdomen
ii. Skin abnormalities (scars/lesions/stretch marks/colour/bruising)
iii. Abdominal masses (herniation/distention/other)
iv. The movement of the abdominal wall with respiration.
v. Abnormalities detected on inspection provide clues to intra-abdominal pathology; these are further investigated with auscultation and palpation.
Auscultation of the abdomen is performed for detection of:
i. Altered bowel sounds [rubs or vascular bruits]
ii. Normal peristalsis creates bowel sounds that may be altered or absent by disease.
iii. Irritation of serosal surfaces may produce a ‘rubbing’ sound as an organ moves against the serosal surface.
iv. Atherosclerosis may alter arterial blood flow so that a bruit is produced.
Palpation is the examination of the abdomen for:
i. Crepitus of the abdominal wall
ii. Abdominal tenderness or masses
iii. The liver and kidneys may be palpable in normal individual, but any other masses are abnormal.
Percussion
Demonstrate/describe a physical application of pressure immobilization technique (PIT)
a. The pressure immobilization technique [PIT] was introduced for the treatment of Australian snakebites and is recommended for envenomation by a number of other animals. The PIT impedes the flow of the lymphatic system by which venom gains access to the circulation. The PIT helps to reduce venom flow.
b. Use PIT for:
i. All Australian venomous snakes - including sea snakes
ii. Funnel web spider
iii. Blue-ringed octopus
iv. Cone shell.
d. Don’t use PIT for:
i. Other spider bites including red back
ii. Jelly fish stings
iii. Fish stings including stonefish bites
iv. Stings by scorpions, centipedes or beetles
Discuss correctly the drawing up and administration of an IV injection of ceftriaxone to a 19 yof who is presenting with signs and symptoms of a possible meningococcal septicemia infection
a. Ceftriaxone is an antibiotic, ACP2 [IM & IV], CCP [IO]
b. Indications
i. Suspected meningococcal septicaemia (with a non-blanching petechial and or purpuric rash)
c. Contraindications
i. KSAR/hypersensitivity
ii. Known anaphylaxis or severe allergic reaction to penicillin based drugs (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone).
d. Precautions
i. Nil
e. Side Effects
i. Nausea and / or vomiting,
ii. Pain at the IM administration site
f. Dose
i. IM = 1g with 3.6mL of water for injection in 10mL syringe (final concentration 1g/4mL).
ii. IV = 1g slow push 3-5min, with 9.6mL of water for injection in a 10mL syringe (final concentration 1g/10mL)
Discuss correctly the drawing up and administration/description of an IM injection of glucagon to a 42 yom who is presenting with signs and symptoms of a symptomatic hypoglycaemia (unable to self administer)
a. Glucagon is a hyperglycemic agent that mobilises hepatic glycogen, which is released into the blood as glucose.
b. Syringe preparation: reconstitute 1mg of glucagon with 1mL of water for injection in a 3mL syringe to achieve a final concentration of 1mg/1mL
c. Indications:
i. Symptomatic hypoglycaemia [with the inability to self-administer oral glucose]
d. Contraindications:
i. KSAR
ii. Hypersensitivity to glucagon
e. Precautions & side effects:
i. NIL
f. Presentation vial powder and solvent – 1mg glucagon IM
Correctly state indications, contraindications, precaution and the side effects of ondansetron
a. Indications
i. Nausea and/or vomiting
ii. Prophylactic administration for patients presenting with ACS
b. Contraindications
i. KSAR
ii. Congenital long QT syndrome
iii. Current apomorphine/parkinsonism therapy
iv. Patients <3yrs
c. Precautions
i. Hepatic impairment,
ii. Intestinal obstruction
iii. Patients with risk factors for QT interval prolongation or cardiac arrhythmias
d. Side Effects
i. Headache
ii. Constipation
iii. Sensation of warmth or flushing
iv. Dysrhythmias
Correctly state the role of insulin and glucagon in the healthy functioning pancreas
a. The pancreas secretes insulin and glucagon; islet cells within the pancreas in response to BGL secrete both.
b. When there is a stimulus of high blood glucose, Insulin is secreted by the beta cells; in response to insulin the cells absorb glucose out of the blood, causing a decrease in BGL.
c. The alpha cells of the pancreatic islet secrete glucagon, but if the BGL is elevated then no glucagon is secreted; when it’s low more glucagon is secreted.
Correctly describe the pathology of renal colic and the management of pain associated with renal colic
a. The pain generated by renal colic is primarily caused by the dilation, stretching and spasm caused by the acute ureteral obstruction. It radiates inferiorly and anteriorly towards the groin.
b. Fentanyl IV 50microg, repeat at 25-50mics/5min – max of 200mic
c. Morphine IV 5mg repeat up to 5mg every 5min – max 20mg
d. Ondansetron 4mg
e. Consider fluid therapy 500mL
f. Causes gout, hormonal disorders, heritable, diet, some medications
Correctly describe the management and treatment for a patient presenting with a suspected over dose of tricyclic medication
presenting with a suspected over dose of tricyclic medication
a. EEA if imminent risk of harm to themselves or others
b. Oxygen, fluid, 12 lead ECG, sodium bicarbonate and midazolam if severe agitation.
Correctly describe early goal-directed therapy [EGDT] in sepsis.
a. Identify of patient’s at risk
b. High flow oxygen
c. IV fluids
i. During sepsis the body’s metabolic rate and thus oxygen requirements are increased
d. CCPs
i. Provide vasopressor support [IV adrenaline]
ii. Some interstate ambulance services will consider IV antibiotics and steroids
