VS - Adult Medical Scenario Knowledge Q's

Question 1

Name the “Four T’s” causes of PPH

Answer 1

1. Tone (uterine atony) Most Common
2. Trauma (to genital structures)
3. Tissue (retention of placenta or membranes)
4. Thrombin (coagulopathy)

Question 2

True or False?

“An empty and contracted uterus does NOT bleed”

Answer 2

True

Question 3

List five high risk factors for PPH

Answer 3

1. multiple pregnancy (e.g. twins)
2. > 4 pregnancies
3. PHx PPH
4. PHx APH
5. Large baby ( > 4 kg)

Question 4

What are the four steps of Mx for a FIRM fundus in the PPH guideline?

Answer 4

1. High flow O2 rx
2. Pain Relief PRN
3. SBP < 90: consider N/S IV at 40mL/kg TTR. Consult/additional 20mL/kg TTR.
4. Mx visible laceration with dressing + firm pressure

Question 5

If the fundus is NOT firm, what are the five actions as per PPH CPG?

Answer 5

1. Mx as per firm fundus
2. Avoid fundal massage prior to placental delivery. Check for PV bleed and monitor VSS
3. Massage fundus until firm
4. Encourage mother to empty bladder
5. Encourage baby to suckle breast

Question 6

What action needs to be taken if the fundus REMAINS NOT firm?

Answer 6

Administer Oxytocin 10 IU IM.
If bleeding continues:
Repeat dose of 10 IU IM @ 5/60

DO NOT ATTEMPT
PLACENTAL DELIVERY:
RISK OF UTERINE INVERSION

Question 7

What action needs to be taken for an intractable (life-threatening) haemorrhage in PPH?

Answer 7

> Perform external abdominal aortal compression!

• Locate point slightly above and to the left of the umbilicus
• Apply downward pressure with a closed fist
• Palpate femoral pulse to assess effectiveness of compression

Question 8

List four S/S of an unstable and rapidly deteriorating patient with narrow complex tachycardia (SVT)

Answer 8

1. Inadequate perfusion / shock
2. Acutely altered conscious state / loss of consciousness
3. Ischaemic chest pain
4. APO

Question 9

True or False?

The Valsalva manoeuvre is reserved exclusively for patients with SBP >= 100.

Answer 9

False.

SBP >= 90

Question 10

What are the maximum attempts the Modified or Standard Valsalva can be performed in a Stable SVT patient?

What time intervals?

Answer 10

Maximum of 3 attempts.

@ 2/60 intervals.

Question 11

Fill in the blanks:

The Valsalva involves a forced expiration by blowing for _ seconds into a _ mL syringe to move the _ .

Answer 11

15 seconds
10 mL syringe
plunger

Question 12

What are the three other stable rhythms (non-SVT) and what action/s do they require as per the NCT CPG?

Answer 12

Atrial fibrillation
Atrial flutter
Multifocal atrial tachycardia

Action: Pain relief as per A501 CPG

Question 13

What action/s is required for an SVT patient with SBP < 90 or no reversion with Valsalva?

What action/s is required for an unstable and rapidly deteriorating SVT patient?

Answer 13

MICA: Administer Adenosine IV.
+/- Pain relief CPG

MICA: Synchronised cardioversion +/- Midazolam IV and Fentanyl IV.
+/- Pain relief CPG

Question 14

Prior to MICA arrival, what should ALS crew aim to prepare for a patient in SVT?

Answer 14

IV access (18G or bigger) in large vein (ACF) with a 3-way tap (for adenosine and saline flush)