Tuesday [6/7/22]

Question 1

ABCDE assessment

Answer 1

airway
- signs obstruction, treat medical emergency, give oxygen

breathing
- look, listen feel, ascultate, percuss, pattern breathing, RR, oxygen saturations, position trache, ABGs

circulation
- colour, temperature, pulses, BP, ascultate, signs low cardiac output, external haemorrhage signs, insert large 14/16g cannula, blood from cannula, ECG, bolus 500ml warmed crystalloid over less than 15m if hypotensive [250 if HF/trauma], JVP, areat ACS mona if suspected

disability and exposure
- drug chart, pupils, AVCPU, glucose, rashes, exposure, bleeding, DVT

Question 2

Post-resus care

Answer 2

1. Airway and breathing
   - maintain 94-98%
   - insert advanced airway
   - waveform capnography
   - ventilate lungs to normcapnia
2. circulation
   - 12 lead ECG
   - obtain reliable IO access
   - aim for SBP over 100 mmHg
   - fluid [crystalloid]; restore normovolaemia
   - intra-arterial blood pressure monitoring
   - consider vasopressor/inotrope to maintain SBP
3. control temperature
   - constant temperature around 32-36
   - sedation; control shivering
4. likely cardiac cause, then considrer coronary angiography and PCI the admit to ICU
5. if no cardiac cause for arrest, consider brain CT and/or CTPA, then treat as non-cardiac arrest
6. ICU management
   - temperature 32-36 for over 24h, prevent fever for 72h
   maintain normoxia and normcapnia; protect ventilation
   - avoid hypotension
   - echocardiography
   - maintain normoglycaemia
   - diagnose/treat seizures
   - delay prognostication for 72h
7. functional assessment before hospital discharge, structured f/u then rehab. Also, secondary prevention through ICD, screen for inherited disorders, RF management

Question 3

shockale rhythm 1

Answer 3

a

Question 4

shockable rhtyhm 2

Answer 4

a

Question 5

non shockable rhythm

Answer 5

a

Question 6

post-resus care

Answer 6

1. 2.

Question 7

how to use defib

Answer 7

a

Question 8

tachycardia algorithm

Answer 8

1. life threading signs: syncope, MI, cardiac dysfunction etc. -> sedate and then given synchronised shock. Then amiodarone 10-20m -> synchronised shock x3. Then amiodarone 900mg over 24h.
2. narrow complex regular: vagal manoeuvres, adenosine 6mg->12mg->18mg,
3. narrow complex irregular
4. broad complex regular
5. broad complex irregular

Question 9

bradycardia alorigthm

Answer 9

1. A-E
   2.

Question 10

cardiac arrest steps

Answer 10

1. unresponsive
2. call resuscitation/abulance
3. CPR 30:2, attach defib
4. assess rhythm
5. shockable -> 1 shock, then reuse CPR 2m -> assess rhythm
6. non-shockable immediately resume CPR

• give oxygen
• use waveform capnography
• continuous compressions advanced airway [10 per m]
• IV or IO access
• give adrenaline every 3-5m [after 3rd shock]
• amiodarone after 3 shocks
• identify and treat reversible causes

Question 11

MI steps

Answer 11

MONA BASH C

1. 12 lead ECG from history
2. ST elevation or new LBBB = STEMI
3. other changes and troponin normal, think other causes then unstable angina
4. troponin release then NSTEMI
5. PCI if STE/new LBBB -> angiography and PCI [if can’t give in 3h, give thrombolysis]

Question 12

acute asthma attack

Answer 12

1. oxygen
2. salbutamol and tioptropium
3. steroids
4. magnesium sulphate
5. IV salbutamol
6. theophylline [IV]

Question 13

STEMI steps

Answer 13

MONA BASH C

Question 14

hyperkaelamia steps
hypokalaemia

Answer 14

insulin/dextrose infusion
salbutamol
sodium bicarbonate if renal failure
calcium glutinate if ECH changes and over 6.5

Question 15

sepsis steps

Answer 15

sepsis 6

Question 16

4Hs and 4Ts

Answer 16

hypoxia
hypovolaemia
hypokalaemia/hyperkalaeima/hypoglycaemia/hypocalcaemia
hypothermia

thrombus
tamponade
tension
toxins

Question 17

ABG interpretation

Answer 17

a

Question 18

choking

Answer 18

algorithm

Question 19

anaphylaxis

Answer 19

algorithm

Question 20

pneuothorax/tamponade Mx

Answer 20

needle decmpression
pericardiocentesis