Resus

Question 1

What is the management of PEA and asystole?

Answer 1

NON shockable
Continue CPR
Adrenaline 1mg IV in every other cycle if persists

Question 2

What is the management of VF and VT?

Answer 2

Shock - **
Amiodarone 300mg IV (one off) and adrenaline (every other cycle) 1mg IV 1 in 10,000 given after the third shock

Question 3

What are some causes of airway compromise?

Answer 3

Angioedema
Anaphylaxis
Burns
Wheeze
Surgical emphysema
Reduced conc

Question 4

What are some simple airway manoeuvres?

Answer 4

Suction - visible vomit, blood, secretions or foreign body
Head tilt/chin lift
Jaw thrust - both hands, hook fingers under angle of pt jaw and lift mandible forwards

Question 5

What are some airway adjuncts?

Answer 5

Oropharyngeal airway - insert upside down and rotate 180 degrees to keep the tongue away from airway, rigid, need to be unconc
Nasopharyngeal airway - through nostril, used in conc pt, CI in basal skull fracture

Question 6

What is an iGel?

Answer 6

Supraglottic airway - flexible plastic tube w inflatable cuff - sits over the top of the larynx

Question 7

What is a definitive airway?

Answer 7

Endotracheal tube, need to insert w laryngoscope
Only airway that protects against aspiration

Question 8

What is the management of a conc choking pt?

Answer 8

1. Cough !!
2. 5 back blows between shoulder blades
3. 5 abdo thrusts pulling up and in sharply
   Cont until obstruction dislodged or pt loses conc

Question 9

What is the management of an unconc choking pt?

Answer 9

1. 2222
2. Open the mouth and observe if obstruction is visible and remove - attempt this once
3. Jaw thrust or head tilt/chin lift
4. CPR if pt not breathing

Question 10

What are the GCS scores for motor response?

Answer 10

6 - obeys commands (normal)
5 - localises to pain
4 - w draws to pain
3 - flexor response to pain
2 - extensor response to pain
1- no response to pain

Cause pain - squeeze trap

Question 11

What are the GCS scores for verbal response?

Answer 11

5 - oriented
4 - confused conversation
3 - inappropriate speed
2 - incomprehensible
1 - none

Question 12

What are the GCS scores for eye opening?

Answer 12

4 - spont
3 - open in response to speech
2 - opens to pain
1 - no eye opening

Question 13

When would a GCS make you worried?

Answer 13

GCS <8 = pt unable to maintain their airway

Question 14

What are the classifications of hypothermia?

Answer 14

Mild - 32-35
Mod - 28-32
Severe - <28

Question 15

What are the features of hypothermia on an ECG?

Answer 15

Bradyarrhythmia - sinus brady, slow AF, heart block
J waves
Prolonged PR, QRS and QT intervals
Shivering artefact
V ectopics
Cardiac arrest

Question 16

What is the management of hypothermia?

Answer 16

Warming the pt:
- Warm blanket
- Warm fluid
- Warm IV fluids
- Bair Hugger
- ECG monitoring - high risk of cardiac arrest

Question 17

What are some causes of burns?

Answer 17

Thermal - hot liquids, steam, fire
Chemical - acid = coagulation necrosis, alkali = liquefaction necrosis
Electrical - electrical source passes through body, has an entry and exit wound and causes internal damage

Question 18

What is inhalation injury?

Answer 18

Damage to the airway secondary to inhalation of hot air, normally when there is flame or smoke exposure in a closed space
Mortality in burns increased 20% when there is an associated inhalation injury

Question 19

When would you suspect inhalation injury?

Answer 19

Stridor, hoarse voice, resp or airway compromise
Singed nasal hairs, facial burns, soot around nose

Question 20

What is the initial management of a burns patient?

Answer 20

AtoE
IV morphine
Strict fluid balance chart
Wound dressing - varied guides but initially clingfilm
Risk of hypothermia due to heat loss from burns sites so warmed room, warmed fluids

Question 21

What is the management of minor burns?

Answer 21

• Remove source of the burn
• Remove non adherent clothing
• Cool wound under running water for 20 mins

Question 22

What is Wallace’s rule of nines?

Answer 22

Head = 4.5%
Torso = 18%
Arm = 4.5%
Gentials = 1%
Upper and low leg = 9%
These percentages only count for anterior, if ant and post affected double them
eg. front of L arm = 4.5%, all L arm front and back = 9%

Question 23

What are the different classifications for burns thickness?

Answer 23

Superficial
Superficial partial thickness
Deep partial thickness
Full thickness

Question 24

Superficial burn:
- Deepest layer involved
- Appearance
- Pain
- Prognosis

Answer 24

Epidermis
Dry, pink no blisters, blanches
Painful
Heals w/o scarring in 5-10 days

Question 25

Superficial partial thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis

Answer 25

Upper dermis
Blisters, wet, pink, blanches
Painful
Heals w/o scarring <3 weeks

Question 26

Deep partial thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis

Answer 26

Lower dermis
Yellow or white, dry, non blanching
Decreased sensation
Heals in 3-8 weeks, scars if takes >3 weeks

Question 27

Full thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis

Answer 27

Subcut tissue
Leathery or waxy white, dry, non blanching
Painless
Heals by contracture and will scar

Question 28

How do you calc fluid resus in burns?

Answer 28

Parkland formula
adults - 4ml (Hartmann’s) x weight (Kg) x %TBSA burned
50%given in first 8 hours post burn then remaining 50% in next 16 hours
children - 3ml

Question 29

What is the ongoing care of a burns pt?

Answer 29

Burns unit - 10-39%, deep or full thickness, specialised areas, chemical electrical injury, pregnant, NAI
Burns centre - >40% or inhalation injury, concomitant major trauma, concomitant co morbidities

Question 30

What are some physical cooling methods?

Answer 30

Remove clothes, water sprays, ice packs, cooling blanket
Water immersion
Cold IV fluids
IV cooling catheters
ECMO?

Question 31

What are some pharmacological cooling methods?

Answer 31

Paracetamol aspirin NSAIDs (no benefit in heat stroke)
Stop serotonin meds
Dantrolene for malignant hyperthermia (not beneficial in heat stroke)