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Module 5 > Study Day 3 Knowledge Questions > Flashcards

Study Day 3 Knowledge Questions Flashcards

1
Q

What are the four key symptoms of an immune response?

A
  1. Redness
  2. Swelling
  3. Heat
  4. Pain
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2
Q

What cells release histamine?

A

Mast Cells

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3
Q

What does histamine do?

A
  • Vasodilation (capillary endothelial cells)
  • Increase permeability

Vasodilation causes swelling at the site of the response (eg injury) which is the cause of increased permeability. Increased permeability allows for t-cells, b-cells and netutrophils to move from the capillaries to the interstital fluid to fight the antigen.

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4
Q

What is the inflammation cascade?

A
  1. Stimuli (internal or external)
  2. Chemokines notice something is wrong and send a signal - activating the mast cells
  3. Mast cells release histamine
  4. Vasodilation/increased permeability occur (swelling). This allows t-cells, b-cells and neurophils to cross from capillary to interstitial fluid.
  5. Those cells fight the stimuli and restore balance.
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5
Q

Major Trauma VSS

A

HR <60 or >120
RR <10 or >30
SBP <90
SP02 <90%
>16yo GCS<13
<15yo GCS<15

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6
Q

Major Trauma Specific Injuries

A

All penetrating injuries (except isolated superficial limb injuries)

Blunt Injuries
- serious injury to a single body region such that specialised care may be required that life, limb or long-term quality of life may be at risk
- significant injury involving more than one body region

Specific Injuries
- Limb amputation or limb threading injury
- suspected spinal cord injury or spinal fracture
- Burns >20% TBSA (>10% if <15) or suspected respiratory tract burns
- High voltage >1000volts
- serious crush
- major compound fracture or open disclocation
- fracture to 2 or more fracture or open disc location
- fracture pelvis

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7
Q

Time to reach highest level of trauma service for major trauma patients

A

Within 60 minutes

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8
Q

Major Trauma High Risk Mechanism

A

5x vehicle
2x height
1x explosion

Motor / cyclist impact >30km
High speed MCA >60km
Pedestrian impact
Ejection from vehicle
Prolonged extraction
Fall from height >3m
Stuck on head by object falling >3m
Explosion

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9
Q

High Risk Major Trauma Co-Morbidities

A

Age <12 or >55
Pregnant
Significant underlying medical condition

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10
Q

New born and small infant VSS

A

HR 110-170
BP >60
RR 25-60

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11
Q

Large infant VSS

A

HR 105-165
BP >65
RR 25 - 55

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12
Q

Small child VSS

A

HR 85-150
BP >70
RR 20-40

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13
Q

Medium child VSS

A

HR 70-135
BP >80
RR 16-34

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14
Q

Paediatric Trauma VSS

A
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15
Q

Critical 02 Illnesses

A

SMASKS

S Shock
M Major trauma / head injury
A Anaphylaxis
S Severe sepsis
K Ketamine sedation
S Status Epilepticus

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16
Q

Why is myasthenia gravis a precaution for midazolam?

A

This condition can weaken the lung and diaphragm. Midazolam has been shown to worsen this

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17
Q

What is the condition myasthenia gravis

A

Myasthenia gravis is caused by an error in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction—the place where nerve cells connect with the muscles they control

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18
Q

Conditions regardless of sp02 3x3

A

Pregnancy:
- cord prolapse
- port partum haemorrhage
- shoulder distocia

Other:
- cluster headache
- decompression illness
- toxic inhalation

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19
Q

Chronic hypoxaemia conditions

A

COPD, neuromuscular disorders, cystic fibrosis, bronchiectasis, severe kyphoscoliosis, obesity

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20
Q

What are we titrationing to with chronic hypoxaemia?

A

88-92%

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21
Q

Autonomic Dysreflexia Pathophysiology

A

Autonomic dysreflexia (hyperreflexia) occurs in people with spinal cord injuries at level of T6 or above, which is above the level of the sympathetic outflow tract. This is a syndrome of massive reflex sympathetic discharge. Any strong stimulus occurring below the level of the injury can trigger autonomic dysreflexia including bowel distension or impaction, appendicitis, labor and delivery, and any sources of pain or infection. 2/3 of pregnant patients with spinal cord injury will develop autonomic dysreflexia during labor.

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22
Q

Signs and symptoms of airway burns

A

RUES FOB

R Resp distress (dyspnea +/- wheeze and associated tachycardia, stridor)
U Facial and upper airway oedema
E Evidence of burns to upper torso, neck, face
S Sooty sputum

F Singed facial hair (nasal hair, eye brows, eye lashes, beards)
O Hypoxia (restlessness, irritability, cyanosis, decreased GCS)
B Burns that have occurred in an enclosed space

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23
Q

Fentanyl over Morphine

A

CNS HH

C Contraindicated to morphine
N Nausea and/or vomiting
S Short duration (dislocation)

H Hypotension
H Severe headache

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24
Q

Why is monoanime oxidase inhibitors a precaution for fentanyl

A

Significant interaction and side effects, can cause serotonin syndrome due to the similar mechanisms

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25
Q

Monoanime oxidase inhibitor mechanism of action

A

They are best known as effective antidepressants, especially for treatment-resistant depression and atypical depression
An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and circuits that have been impacted by depression.

26
Q

Tornadoes de Pointes

A

A form of vetricular tachycardia - more common in those with long QT or after taking certain medications

27
Q

Phenylketonuria (PKU)

A

an inherited disorder of protein metabolism in which the absence of an enzyme leads to a toxic buildup of certain compounds, causing intellectual disability

28
Q

Aspartame

A

An artificial sweetener

29
Q

Long QT Syndrome

A

Rare inborn heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsade de pointes and other life threatening arrhythmias. Prolongation of the QT interval is a diagnostic of the condition

30
Q

Dosage for lignocaine and ceftriaxone

A

Adults:
IV 1g ceftriaxone made up to 10 with water for injection
IM 4ml w/3.5ml lignocaine

Paediatrics:
IM 50mg/kg made to 4ml w/3.5ml lignocaine

31
Q

What is a subtle status seizure and why?

A

Subtle status epilepticus represents the late stage of undertreated previous overt generalized convulsive status epilepticus and always requires aggressive ICU treatment.

32
Q

4 types of seizures

A

Absence seizure . This is also called petit mal seizure

Atonic seizure. This is also called a drop attack

Generalized tonic-clonic seizure (GTC). This is also called grand mal seizure.

Myoclonic seizure. This type of seizure causes quick movements or sudden jerking of a group of muscles

33
Q

Classifying Status Epilepticus

A

siezure >5minutes, 2 seizures w/o recovering to baseline or >2minutes without recovery

34
Q

Postictal Symptoms

A

headache, confusion, generalized muscle ache, drowsiness, incontinence

35
Q

SIGNS OF compartment syndrome (5 Ps)

A

pain
pallor (pale skin tone)
paresthesia (numbness feeling)
pulselessness (faint pulse)
paralysis (weakness with movements

36
Q

What causes undifferentiated nausea and vomiting?

A
  • secondary to opioid analgesia
  • secondary to cytotoxic drugs or radiotherapy
  • severe gastroenteritis
37
Q

Cushing triad

A

hypertension, reflex bradycardia, respiratory depression
- sign of increased intracranial pressure (constricts arterioles - cerebral hypoperfusion - sympathetic response causes HTN)

38
Q

Why does GTN cause tachycardia

A

Vasodilation and pooling reduces preload and afterload reducing blood pressure, the body responds by increasing HR to compensate to maintain CO (SV x HR = CO)

39
Q

Why can’t we give GTN to patient tachycardia >150

A

HR is so quick that it is not allowing ventricles to fill with blood, by reducing preload this will further reduce the amount that the ventricles fill.

40
Q

Why can’t you give GTN to patients taking ricoguat or PDE5 inhibitors?

A

Ricoguat is a antihypertensive medication that together with GTN can cause significant BP drops. PDE5 medications are also exacerbated by GTN as they are vasodilators.

41
Q

When to suspect respiratory tract burns

A

B Burns to upper torse/neck/face
Ooedema of face and neck
Ssinged facial hair
Ssooty sputum,
H hypoxia
E enclosed space burns
R respiratory depression

BOSS HER

42
Q

What type of fluid loss is involved in burns?

A

Both absolute and relative fluid loss. Absolute due to weeping therefore loss of fluid volume via burn wounds. Relative due to massive inflammation due to damaged skin cells that causes fluid shifts out of vessels into interstitial space.

43
Q

Why should you elevate limbs of burn?

A

Reduce swelling and odema

44
Q

What is the difference between T1DM and T2DM?

A

The main difference between the type 1 and type 2 diabetes is that type 1 diabetes is a genetic condition that often shows up early in life, and type 2 is mainly lifestyle-related and develops over time. With type 1 diabetes, your immune system is attacking and destroying the insulin-producing cells in your pancreas, whereas type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production

45
Q

What are the four principles of major trauma

A

Identify and manage conditions that are life threatening, pain management is the cornerstone of trauma care, mortality increased by acidosis/coagulopathy/hypothermia, minimize time from injury to definitive care

46
Q

AEIOUTIPS

A

Alcohol
Epilepsy
Insulin
Overdose/oxygenation
Uremia/underdose
Trauma
Infection
Psychiatric / poisoning
Stroke/shock

47
Q

Paediatric Paracetamol dose

A

15mg/kg

48
Q

Paediatric Fentanyl Dose

A

small child 25mcg/IN
medium child 25-50mcg IN

49
Q

why do we administer Ondansetron IV slowly over 30 seconds?

A

slow administration reduces and allows us to visualise adverse effects

50
Q

What is the dose of ondansetron for pediatrics?

A

2mg for small child, 4mg for medium child

51
Q

What is the main focus for paediatric nausea and vomiting?

A

Oral rehydration

52
Q

What is hyphema?

A

A collection of blood in the anterior chamber of the eye generally due to trauma, ondansetron given prophylactically for this injury/eye injured patients as well as spinal patients

53
Q

Paediatric GCS

A

eyes: same

verbal: 5 appropriate words/smile, 4 cries but consolable, 3 persistently irritable, 2 moans to pain

motor: obeys command is “spontaneous

54
Q

Septicaemia signs

A

fever, rigor, joint and muscle pain
cold hands and feet
tachycardia, hypotension
tachypnoea

55
Q

Why is morphine precautioned for respiratory tract burns?

A

Nausea Vomiting would be detrimental in the setting of respiratory tract burns

Allergic reactions further oedema of airway

56
Q

What body temperature do you stop cooling burns

A

35 degrees

57
Q

Wallace Rule of Nines

A

estimates percentage of total body surface area burned in adults

58
Q

Paediatric Rule of Nines

A

10 year old- same as adult // head 9 // body 18 // arms 9 // legs 18 // groin 1

9 year old // +1 head // NIL groin

8 year old // +1 head // - .5 legs

Continue same pattern to age 1

1 year old // head 18 // body 18 // arms 9 // legs 14

59
Q

Why is “respiratory tract burns” a precaution for morphine?

A

There is more likely to be a histamine release and further occlusion of the airway. Hence why morphine is more commonly seen as an allergy rather than fentanyl.

60
Q

Jackson’s burn model

A

Surrounding the central zone of necrosis is a zone of ischemia in which there is a reduction in the dermal circulation. This is damaged but potientially viable tissue. This ischemic zone may progress to full necrosis unless the ischemia is reversed. If the ischemia is not relieved, for example when resuscitation and wound care are suboptimal, then persisting ischaemia will worsen, and the burn depth will increase.
At the periphery of the burn is a third zone of hyperaemia characterised by a reversible increase in blood flow and inflammation.

Zone of coagulation: dead tissue, irreversible loss.
Zone of stasis: decreased tissue perfusion, potentially salvageable
Zone of hyperaemia: will recover unless added insult to wound

61
Q

Why don’t we walk anaphylactic patients

A

Empty vena cava syndrome. Drop in blood pressure

Module 5 (4 decks)

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