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viva Flashcards

1
Q

What are the precautions for methoxyflurane?

A

Renal disease

Diabetes

Caution if pt unable to self-administer

Use in post-delivery phase of labour and with PPH; may induce uterine atonia

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2
Q

Dose of glucagon for 18kg pt:

A

<20kg = 0.5IU IM

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3
Q

What are the four types of shock, and a cause of each?

A

Hypovolaemic shock: haemorrhage or non-haemorrhagic (burns, dehydration)

Cardiogenic shock: caused by heart not pumping effectively (AMI, dysrhythmias)

Distributive shock: caused by excessive vasodilation and impaired fluid distribution resulting in third spacing (sepsis, anaphylaxis, burns, spinal cord or brain injury, Addisonian crisis)

Obstructive shock: physical obstruction of great blood vessels (PE, cardiac tamponade, tension pneumothorax)

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4
Q

What is the dose of IMI morphine? + calculate dose and volume for paediatric patient

A

0.1mg/kg

Repeat 1x, after 30-45 mins if required.

Do not exceed 20mg.

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5
Q

What is the dose and volume of IV morphine for a 5yo who has already had fentanyl?

A

Up to 0.05mg/kg

Half dose because post-fentanyl

5x2+9= 19kg

19 x 0.05mg = 0.95mg/2 = 0.475mg

Can round to 20kg to make calculations easy

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6
Q

What are the contraindications of paracetamol?

A

Known or suspected allergy

Previous paracetamol in last 4hrs (oral)

Previous paracetamol in last 6hrs (IV)

Children who do not have sufficient gag reflex to swallow measured dose.

Not to be given to children <1 month

Diagnosed liver failure.

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7
Q

What are the contraindications for aspirin?

A

Known or suspected allergy

Known or suspected active bleed

Known bleeding tendency

Chest pain associated with psychostimulant use

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8
Q

What is the management of seizures during pregnancy?

A

IV magnesium sulphate as first line agent: 2.5g over 30-60secs

ICP: follow initial IV dose with springfusor infusion

High flow oxygen therapy

Treat symptomatically as per appropriate CMG

Urgent transport and early notification to ED (not birth suite)

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9
Q

Name 4 signs and symptoms of ACS:

A

Chest pain/pressure/fullness/discomfort

Pain/discomfort in one or both arms, jaw, neck, back or stomach

SOB

Dizziness/light-headedness

Nausea

Sweating/clamminess

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10
Q

3 adverse effects of adrenaline:

A

Tachycardia

Tachyarrhythmias

Hypertension

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11
Q

Indications for pelvic binder + demonstrate application:

A

Patients suspected of having a pelvic fracture, particularly if hypotensive

Patients with significant ALOC where pelvic fracture cannot be excluded

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12
Q

What is the dose of ceftriaxone for 6yo and how do you administer it?

A

Weight: 21kg

Dose = 50mg/kg to total of 2g

50 x 21 = 1.05g

2x 1g vials, reconstituted with 10mL, administer 10mL + 0.5mL of 2nd 10mL IV preferred

If administering IM – reconstitute 2x 1g vials with 3mL

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13
Q

What are the 3 steps in the “stepwise” approach to pain management and give an example of each?

A

Non-pharmacological: splinting, positioning, reassurance

Enteral/Inhalation: methoxyflurane, paracetamol, ibuprofen, GTN

Parenteral: morphine, ketamine, IV paracetamol, midazolam, fentanyl

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14
Q

What signs and symptoms indicate organophosphate poisoning

A

Salivation

Lacrimation

Urination

Defecation

GI Upset

Emesis

Bradycardia

Bronchospasm

Bronchorrhea

Miosis (pin point pupils)

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15
Q

Actions of Ibuprofen:

A

Analgesic

Anti-pyretic

Anti-inflammatory

Inhibits prostaglandin synthesis via inhibition of COX-1 and COX-2

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16
Q

Adverse effects of Droperidol:

A

May lower seizure threshold

ECG Changes – prolonged QT and torsades de pointes

Extrapyramidal effects

Neuroleptic malignant syndrome

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17
Q

What should you do if you have made a medications error?

A

nil answer

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18
Q

What medications can you administer through an IO?

A

nil answer

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19
Q

Demonstrate insertion of OPA in paediatric

Application of CAT

Demonstrate COACHED

Demonstrate application of traction splint

Demonstrate CPAP application

Demonstrate Valsalva manoeuvre

Demonstrate 12-Lead ECG application/discuss the landmarks

A

Discuss. nil answer

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20
Q

Demonstrate and discuss 15-Lead ECG:

A

Indicated for suspected posterior MI

Reciprocal changes in V3, V4

V4 moves to V4R: 5th intercostal, right midclavicular line

V5 moves to V8: Posterior 5th intercostal space, mid scapular

V6 moves to V9: 5th intercostal space, left paraspinal border

Mark movements on ECG once printed

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21
Q

Treatment of 4y/o with BGL 22mmol/L:

A

Aim is to bring BGL down: ideally done with insulin, but no access = fluids

Fluid replacement as per CMG 14 for dehydration: up to 10mL/kg to maintain BP >90mmHg (adults).

Normal BP for 4YO = 70-110mmHg, consider other indicators of perfusion.

4yo = 17kg = up to 170mL NS

Symptomatic management

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22
Q

Mechanism behind autonomic dysreflexia:

A

Cutaneous or visceral noxious stimuli below level of injury

Afferent signals travel up the spinal cord, triggering sympathetic response.

In an intact autonomic NS, increased BP activates baroreceptors, leading to parasympathetic response - slows HR and causes vasodilation

Normal parasympathetic compensatory response unable to travel below the level of injury, resulting in the characteristic symptoms of AD.

Diffuse vasoconstriction and consequent rise in BP below level of injury while normal parasympathetic response occurs above level of injury (bradycardia and vasodilation).

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23
Q

What is the dose of ketamine for an agitated pt and what should be considered when administering this?

A

200mg IMI initial dose

100mg IMI initial dose if >65 years or with general debility

Repeat 1mg/kg IMI (after 5 mins if require)

Must have ICP back-up attend

In the shocked patient, consider a smaller dose than full dose and onset of action will be prolonged

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24
Q

Explain effect of CPAP on respiratory function:

A

Provides constant, fixed positive end expiratory pressure throughout inspiration and expiration which maintains adequate functional residual capacity within the alveoli to prevent alveoli collapsing, thus reducing gas trapping.

Increases volume of air available gas exchange, thus decreasing V/Q mismatch

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25
Q

3 examples of when the cease resuscitation policy would not apply:

A

Episodes of sustained cardiac output (>4 mins) during resuscitation

Sustained or recurrent VF/VT

Cardiac arrest in advanced pregnancy (>22 weeks)

Significant hypothermia (<33 degrees)

Apparent reversible cause

Persistent narrow complex PEA

Difficult patient situation

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26
Q

When should pts with GI bleed be transported to TCH?

A

Pts with significant GI bleed as indicated by GI bleed + signs of shock (tachypnoea, ALOC, cap refill >2sec, pallor, diaphoresis, tachycardia, hypotension) should be transported directly to TCH.

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27
Q

When is PEEP contraindicated?

A

Suspected pneumothorax

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28
Q

A pt presents with significant blood vessel injury (post trauma) and is hypotensive. What should you monitor for throughout treatment?

A

Monitor for tachypnoea, ALOC, and skin findings such as cap refill, pallor, and diaphoresis which may indicate worsening state of shock.

Reassess haemorrhage control measures (torniquets, pelvic binders, packed wounds, wounds with pressure applied) to ensure bleeding has ceased (or slowed)

Reassess neurovascular obs as required/as relevant.

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29
Q

What are the contraindications for ondansetron?

A

Known hypersensitivity

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30
Q

What are the contraindications for LMA insertion?

A

Active vomiting (excl. passive regurgitation)

Gag reflex (incl. ketamine sedation only)

Epiglottitis

Facial fractures where you cannot visualise the landmarks

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31
Q

Dose of adrenaline for paediatric asthma:

A

0.01mg/kg up to 0.5mg IM

Max. 3 doses, with 5 mins between each

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32
Q

Management of cord prolapse:

A

Urgent transport without delay + early prenotification

Assess if the cord is pulsating
Pulsating:

Minimal handling to prevent vasospasm

Position in exaggerated sims (left lateral with hip raised)

Gently place cord back into vagina

If unable to place into vagina, support with warm, moist dressings

Non-pulsating:

Minimal handling to prevent vasospasm

Position in exaggerated sims

Using fingers, gently apply pressure on foetal presenting part to alleviate compression of cord.

May also position mother in knees-to-chest, head down – not ideal for transport

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33
Q

Dose of prochlorperazine for a 10y/o (30kg) child:

A

Not used in anyone aged <18yrs

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34
Q

Why is GTN precautioned in RVI? What precautionary action should you take?

A

Poor RV contractility = preload sensitivity and dependence on preload to maintain BP.

Nitrates cause systemic vasodilation; venous dilation decreases preload, while arterial dilation decreases systemic vascular resistance, and therefore, afterload.

Have fluids running and use nitrates with caution.

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35
Q

What is the management for an open sucking chest wound?

A

Cover wound with commercial chest seal if available

If signs of tensioning, peel back seal and “burp” the wound to encourage air to escape

In absence of commercial chest seal, use 3-sided dressing (defib pads with cables removed, sterile packaging and tape etc.

Have a low threshold for decompression – Have ICP back-up coming

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36
Q

Where should the umbilical cord be clamped and cut if necessary?

A

Following normal delivery, once the cord has stopped pulsating: clamp three times, 10cm from neonate, 15cm from neonate, and third clamp close to the mother’s perineum. Cut between the 1st and 2nd clamps.

If cord is around neck, and cannot be delivered through the cord and the cord cannot be slipped over the neonates head; clamp in two places and carefully cut the cord.

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37
Q

What should you do if you suspect a child has been involved in a non-accidental injury?

A

Provide care to patient as required including transport to hospital if needed

If the child is at immediate risk, request AFP attendance

Contact DOO to arrange temporary release from duties to complete report.

Contact CYPS via phone or complete the online report form

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38
Q

What is the dose of MDI salbutamol for an adult with asthma?

A

Mild-Moderate: 4-12 puffs, repeat after 20-30mins

Severe: 12 puffs, repeat after 20 mins

Life-threatening: 12 puffs, repeat after 10 mins

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39
Q

What temperature range is considered mild hypothermia and what is the management?

A

32-35 degrees

More rapid warming acceptable

Warm oral fluids (sweet if possible)

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40
Q

What are the contraindications for fentanyl administration?

A

Bilateral bleeding or occluded nostrils

ALOC

Children <1yo

Known allergy or previous reaction to fentanyl

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41
Q

What size LMA would be appropriate for a 25kg pt?

A

Size 2.5

42
Q

Discuss the management of a complete foreign body upper airway obstruction in a conscious pt:

A

5 back blows

If fails: 5 chest thrusts (if possible, position with head down to utilise gravity

If fails: repeat the sequence above

If fails: urgent transport and 100% oxygen

43
Q

What time frame should crush be considered?

A

Development of crush syndrome is time and pressure dependent

Even if force not sufficient to mangle muscle tissue, muscle death may occur within an hour

44
Q

What is the dose of normal saline for a 70kg patient with anaphylaxis?

A

Up to 20mL/kg with aim to maintain SBP >90mmHg

45
Q

When is an OPA contraindicated?

A

Patients who have a gag reflex

46
Q

When should a CAT be applied?

A

Uncontrolled, life-threatening haemorrhage of a limb

47
Q

Once bleeding has ceased, should the CAT be released?

A

CAT should remain in situ until it can be released in theatre at hospital

48
Q

What is the dose of aspirin for a pt taking warfarin?

A

150mg (half of 300mg tablet)

Does not apply to any other anti-platelet therapy

49
Q

When should CPAP be applied?

A

Conscious patients who are able to follow instructions with:

Respiratory distress (increased HR, decreased SpO2, using accessory muscles)

APO, severe asthma, COPD exacerbation

CO Poisoning, smoke inhalation, near drowning, anaphylaxis

50
Q

How many doses of ondansetron may be administered to a pt with nausea?

A

Adult: single dose only

Paediatric: IV/IM weight-based dose can be repeated 1x if required after 10 mins

Paediatric: PO single dose only

51
Q

Contraindications of oral glucose gel?

A

Impaired or absent swallow/gag reflex

52
Q

Can 3 paramedics travel in the back of an ambulance travelling P1?

A

No – it would not be appropriate for 3 paramedics to travel in the back of an ambulance travelling P1 due to lack of restraints.

53
Q

What is the recommended flow rate for a nebuliser mask?

A

8L/min

54
Q

When should a traction splint be applied?

A

Patient with suspected mid-shaft femur fracture

55
Q

Calculate dose of Glucose 10% for a 5y/o:

A

Up to 2.5mL/kg

5yo weight = 2x5 + 9 = 19kg

Max. dose = 47.5mL

56
Q

What is the landmark for IO insertion and locate it?

A

Proximal tibia, 2cm medial to the tibial tuberosity

Located distal aspect of patella, 2cm distally, then medial to locate flat aspect of bone

Distal tibia, 3cm superior to the medial malleolus

57
Q

What are three complications of IV access?

A

Extravasation

Thrombophlebitis

Haematoma formation
Venous air embolism

Dislodgement

58
Q

When should a BP not be performed on am arm and why?

A

Pts who have had mastectomies are at risk of lymphoedema if BP taken on the same arm as surgery

Avoid taking BP on fistula arms of dialysis patients.

59
Q

Calculate GCS for a patient who opens eyes to voice, localises to pain, and is confused:

A

Eyes: 3, Verbal: 4, Motor: 5

GCS: 12

60
Q

What colour represents deceased pt in triage tag system?

A

Black

61
Q

What are for the indications for fundal massage?

A

Placenta delivered

Significant vaginal haemorrhage (>500mL)

Fundus not firm (uterus spongey/soft on palpation)

May be performed if placenta insitu in case of torrential haemorrhage with signs of haemodynamic compromise – THIS IS A LAST RESORT

62
Q

What is maximum PEEP that can be applied to an adult patient post drowning?

A

15cm H2O, only if desaturating with 10cm H2O

63
Q

What is the dose of adrenaline and how many repeats for anaphylaxis?

A

Adult: 0.5mg IM, repeat up to 3x, 5 mins between each

Paediatric: 0.01mg/kg (up to 0.5mg) IM, repeat up to 3x, 5 mins between each

64
Q

What are two medical causes of upper airway swelling?

A

Anaphylaxis

Croup/epiglottitis

Oral/pharyngeal infection

65
Q

What is the management of upper airway swelling for am 8kg child?

A

Nebulised adrenaline: 0.5mL/kg 1:1000, make up to 5mL with saline, single dose

8kg x 0.5 = 4mL + 1mL NS

66
Q

What is the most common type of diabetes seen in children?

A

Type 1 Diabetes Mellitus

67
Q

What is Cushing’s Triad?

A

A set of signs indicative of increased ICP

Consists of bradycardia, irregular respirations, and widened pulse pressure reflected by increasing SBP

68
Q

How should suspected decompression illness be postured? Why?

A

Posture supine, do not sit pt up

If unconscious, position left lateral

Supine positioning has been shown to increase rate of inert gas elimination as well as decreasing likelihood of arterial bubbles travelling to the brain.

69
Q

What is the correct size for a BP cuff?

A

A BP cuff should cover approx. 2/3 upper arm

Alternatively, in children, the BP cuff should cover 40% of the upper arm

70
Q

What are the contraindications for morphine?

A

Respiratory depression

BP <70mmHg systolic

Acute asthma attacks

71
Q

Why should PEEP be avoided in a patient with TBI?

A

PEEP should be avoided in patients with TBI (or other intracranial pathology) due to the risk of hypotension and decreased cardiac output; the goals of management for head injury are to maintain adequate perfusion and oxygenation of the brain.

72
Q

What are the lateral leads on an ECG?

A

V5, V6, I, aVL

73
Q

What are the contraindications for NPA insertion?

A

Resistance during insertion/unable to insert easily.

74
Q

When should transport of the deceased person be considered?

A

Person is in public place and police have requested ACTAS provide transport

Resuscitation is ceased while a patient is being transported to hospital or after being loaded in the ambulance.

Deceased persons are to be transported to FMC and are not to be transported under UDD conditions.

75
Q

State management of a patient in rapid AF (160bpm):

A

Establish diagnostic criteria: AF or atrial flutter with rapid rate (>150/min in adults, >180/min in paeds) + recent onset (no evidence of pre-existing AF)

Management dependent on symptoms

No significant compromise: monitor

Hypotension: no LVF – treat with IV fluids

Ischaemic chest pain: treat as appropriate

Pulmonary oedema: treat as appropriate

Apparently secondary to acute cerebral event: no LVF – IV fluids

ICP - can manage with amiodarone in certain circumstances.

76
Q

STEMI identified on 12-Lead ECG – what should you do next?

A

Transmit STEMI to TCH cardiology and be prepared for phone call from registrar

Do not delay transport for treatment

Prenotify receiving hospital (TCH)

Aspirin

GTN

Antiemetic

Analgesia (morphine)

Oxygen only if SpO2 <94% or shocked

Fluids as per CMG 14 if hypotensive

ICP for heparin: do not extend scene time waiting for ICP

77
Q

What is the dose of midazolam for a 45kg fitting pt?

A

0.1mg/kg

45 x 0.1 = max. 4.5mg IMI

Repeat 1x after 10 mins if still seizing

78
Q

What are the adverse effects of GTN?

A

Hypotension

Headache

Flushing

Occasionally bradycardia

79
Q

Name two potential calls to dialysis patients:

A

Bleeding

Hypotensive episode

Haemolysis

Venous air embolism

Chest pain

80
Q

How would you draw up to adrenaline dose for a 7kg child in cardiac arrest?

A

Dose = 0.01mg/kg = 7 x 0.01 = 0.07mg or 70mcg

Use 1:10,000 preparation (100mcg/1mL): draw up 0.7mL

81
Q

What are the indications for GTN?

A

Relieve ischaemic chest pain

Relieve acute pulmonary oedema

Management of autonomic dysreflexia

82
Q

When performing CPR on a pregnant woman, what should be considered?

A

Gravid uterus will compress IVC and abdominal aorta when supine = prop patient left lateral if possible. May need to manually displace uterus to the left.

Early consideration of transport to definitive care if advanced pregnancy (>22weeks) to allow for emergency caesarean section

83
Q

What are the contraindications for CPAP?

A

Unconscious

Hypoxia due to trauma

Cardiac/respiratory arrest

Facial trauma

Pneumothorax

Note: ALOC may receive CPAP if responding to voice and cooperative

84
Q

What are the actions of salbutamol?

A

Beta 2 receptor agonist causing bronchodilation

Smooth muscle relaxation

Moves K+ from extracellular to intracellular space

85
Q

Differentiate between minor heat syndromes and heat stroke:

A

Minor Heat Syndromes:

Normal or transient disturbance in mentation

Sweating

Core temp <40
Heat stroke:

ALOC and/or abnormal neurological signs

No sweating: hot, dry skin

Core temp >40

86
Q

What is the management of heat stroke?

A

Prompt transport

Rapid, active cooling – aggressive as possible

IV resuscitation – cool fluids if possible

12-Lead ECG and ICP back-up for management of arrhythmias

Check BGL

Aggressively manage seizures and shivering

87
Q

What are the actions of GTN?

A

Arterial and venous vasodilation

Dilation of collateral coronary vessels

88
Q

Can a patient with a dislocated prosthetic hip be transported to Calvary hospital?

A

Yes

89
Q

Explain the rule of 9’s:

A

The rule of 9’s is a method of estimating total body surface area affected by burns in adult patients.

It assigns 9% to different sections of the body to allow for a more structured estimation of burns.
9% to head

9% to front and back of chest

9% to front and back of abdomen

9% to each arm

9% to front and back of each leg

1% to genitals

90
Q

How long is a baby considered a newborn?

A

First 24hrs of life

91
Q

What is your management of a pt with HR 42 and BP 75/30?

A

IV normal saline, up to 20mL/kg to increase and maintain SBP >90mmHg

If caused by TBI, aim for SBP >100mmHg

ICP back-up: atropine, adrenaline infusion, or external pacing

92
Q

What size gastric tube would you place in a size 3 LMA?

A

14FG

93
Q

What are the actions of adrenaline?

A

Alpha: peripheral vasoconstriction

Beta 1: increased rate of sinus node, increased myocardial contractility, increased AV conduction, increased myocardial irritability

Beta 2: bronchodilation, vasodilation of skeletal muscle

94
Q

What is the maximum dose of methoxyflurane per week?

A

15mL/week

95
Q

How much normal saline would an adult trauma receive?

A

Up to 20mL/kg unless TBI, then aim for SBP >100mmHg, no limit on volume of fluid

96
Q

What colour triage tag does a walking patient receive?

A

Green

97
Q

What size LMA would a 6kg child receive?

A

1.5

98
Q

What are the contraindications of Magill forceps?

A

Epiglottitis

Conscious patient

99
Q

What is the weight of an 11y/o?

A

33kg

100
Q

What is the dose of glucagon for a child weighing 22kg?

A

> 20kg = 1IU IM

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