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PHM BSc - Resus Science > Random Bits I Still Don't Know > Flashcards

Random Bits I Still Don't Know Flashcards

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1
Q

What echo signs would you be looking for in an MI

A

regional wall motion abnormalities
signs of complications: papillary muscle rupture, septal wall rupture, pericardial effusion
signs of old infarct: wall thinning

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2
Q

What echo signs would you be looking for in a PE

A

dilated RV
underfilled D shaped LV
tricuscpid regug
septal flattening

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3
Q

What echo signs would you be looking for in a tamponade

A

swinging heart
diastolic collapse of RA +/- RV later in disease process
IVC plethora: reduced IVC collapse on inspiration

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4
Q

What echo signs can exclude a pneumothorax

A

lung sliding
A and B lines
lung pulse (rhythmic motion of visceral along parietal pleura with each cardiac contraction)

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5
Q

What echo signs would indicate a pneumothorax

A

lung point - the point at which visceral pleura is no longer associated with parietal pleura

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6
Q

What are A and B lines on an echo

A

A - horizontal reflective lines which are artefact. Generated by pleural layers

B - They extend radially from the pleura and indicate that the parietal and visceral pleura are in apposition and therefore no pneuomothorax

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7
Q

What echo signs would indicate hypovolaemia

A

small hyperkinetic LV
kissing ventricles: LV is obliterated at the end of systole
small IVC with exaggerated collapse on inspiration

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8
Q

What ECG features would make you suspect a RV infarct and how could this be confirmed

A

ST elevation in V1 +/- depression in V2

confirm with ST elevation in V4R

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9
Q

Why is giving nitrates to inferior STEMI’s bad

A

With poor RV contractility the heart is preload sensitive so giving nitrates (reduces preload) lead to profound hypotension

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10
Q

What ECG features would make you suspect a posterior infarct and how would you confirm it

A 
reciprocal changes (ST depression, upright T) in V1-V3
dominant R in V2
confirm: ST elevation in V7-V9
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11
Q

What could lead to a AV block following MI

A

ischaemia of the AVN following RCA infarct (AVN artery arises from RCA)

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12
Q

MOA of reteplase, aspirin, clopidogrel and LMWH

A

reteplase: recombinant TPA
aspirin: reduced thromboxane A2 so reduced binding to TXA2
clopidogrel: inhibit ADP binding to P2Y12 receptors
LMWH: indirect factor Xa inhibitor and direct thrombin inhibitor

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13
Q

elevated R in aVR =

A

Na channel blockers!!

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14
Q

causes of bidirectional VT

A

CPVT

severe digoxin toxicity

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15
Q

How far are you inserting an ET tube

A

small adult: 21cm
big adult: 22-23cm
child: age/2 + 12

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16
Q

what can be used to better look for epsilon waves

A

fontain bipolar precordial leads

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17
Q

define deffered consent

A

patient is randomised according to criteria that have been made clear in ethical review then request for patient/their representatives informed consent is done at a later stage

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18
Q

what is exception to informed consent with prior community consult

A

researchers consult with members of the community in which the research will be carried out prior to the research being done

19
Q

what is transthoracic impedance and what effects it

A

the bodies resistance to current flow

inter-electrode distance, skin-electrode interface, ventilation

20
Q

What benefits does TTM have on a cellular level

A

stops MPTP opening
preserves mitochondrial function
lower metabolic demand from tissues

21
Q

Give an example of a hallogenated volatile anaesthetic and a depolarising neuromuscular relaxant

A

halogenated volated anaesthetic: halothane

depolarising neuromuscular relaxant: succinylcholine

22
Q

What extra tests are needed for ROLE in hypostasis, rigor mortis, submersion

A

no heart sounds
asystole on ECG for 20 seconds
bilaterally absent pupil response
no pulse

23
Q

False positive ETCO2 can be caused by:

A

exposure to acidotic fluid eg stomach contents or adrenaline

fizzy drinks or vigorous BM ventilation can give false +ve if tube in oesophagus

24
Q

False negative ETCO2 can be caused by

A

low pulmonary flow - PE

25
Q

describe cerebral performance categories 1-5

A

1: conscious, can work, may have minor deficit
2: conscious, can work in a sheltered environment
3: conscious, dependant on others for ADLs
4: coma, vegetative state, unaware, sleep wake cycles, may open eyes
5: brain dead

26
Q

What does the cormack-Lehane intubation classification classifiy

A

views seen on direct laryngoscopy to determine how difficult intubation is likely to be

27
Q

calculation for mean arterial pressure

A

1/3 systolic + 2/3 diastolic

28
Q

NPA size for majority of adults

A

green 6mm

orange 7mm

29
Q

NPA insertion method

A

advance along septum horizontally with the bevel towards the septum

30
Q

OPA sizes

A 
green = size 2
orange = size 3
red = size 4
31
Q

how do you calculate the weight of a child

A

(age + 4) x 2

(months/2) +4

32
Q

how do you calculate ET tube depth insertion for paediatrics

A

3 x tube size or

(age/2) + 12

33
Q

If adrenaline is needed to maintain BP post ROSC, how much is given

A

50 micrograms

34
Q

When should you feel for a pulse during ALS

A

only when an organised rhythm (narrow or regular) is seen at the end of a 2 minute cycle

35
Q

lactate range

A

0.5-2.2

36
Q

when would you measure lactate

A

post resuscitation - MABP should be targeted to achieve a normal or decreasing lactate

37
Q

what are the 3 classifications of a newborn according to their initial assessment

A

1: vigorous breathing, HR > 100, crying, good tone
2: breathing inadequate, HR <100, normal-reduced tone
3: breathing inadequate, undetectable HR, floppy, pale

38
Q

How would you treat a newborn categorised as 2 on initial assessment

A

dry and wrap and baby should improve with mask inflation

39
Q

How would you treat a newborn categorised as 3 on initial assessment

A

dry and wrap, immediate airway control, lung inflation and ventilation. May need chest compressions

40
Q

What would make you suspect a RV infarct

A

Patients with inferior infarct + clinical shock + clear lung fields

41
Q

paeds adrenaline dose

A

0.1mg/kg of 1:10,000

42
Q

GRADE

A

grading of recomendations, assessment, development and evaluation

43
Q

SEERS

A

scientific evidence evaluation and review system

44
Q

COSTR

A

consensus on science with treatment recommendations

PHM BSc - Resus Science (29 decks)

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