Emergencies

Question 1

Commonly identified causes of anaphylaxis

Answer 1

Food (e.g. nuts)
Drugs
Venom (e.g. wasp sting)

Question 2

What should you give in adult anaphylaxis?

Answer 2

500 micrograms adrenaline (0.5ml 1 in 1,000)

Question 3

What should you give in anaphylaxis of a child age 6-12?

Answer 3

300 micrograms adrenaline (0.3ml 1 in 1,000)

Question 4

What should you give in anaphylaxis of a child age 6 months to 6 years?

Answer 4

150 micrograms adrenaline (0.15ml 1 in 1,000)

Question 5

What is the definition of refractory anaphylaxis?

Answer 5

Defined as respiratory and/or cardiovascular problems despite 2 doses of IM adrenaline

Question 6

When should you refer to secondary care for burns?

Answer 6

• All deep dermal and full-thickness burns
• Superficial dermal burns of more than 3% TBSA in adults or more than 2% TBSA in children
• Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure
• Any inhalation injury
• Any electrical or chemical burn injury
• Suspicion of non-accidental injury

Question 7

What are the shockable rhythms?

Answer 7

• Ventricular fibrillation
• Pulseless Ventricular tachycardia

Question 8

What are the non shockable rhythms?

Answer 8

• Asystole
• Pulseless-electrical activity

Question 9

When should you give amiodarone in cardiac arrest?

Answer 9

Amiodarone 300mg should be given to patients who ate in VF/Pulseless VT after 3 shocks have been administered

Question 10

What are the reversible causes of a cardiac arrest?

Answer 10

The ‘Hs’
- Hypoxia
- Hypovolaemia
- Hyperkalaemia, Hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia
- Hypothermia

The ‘Ts’
- Thrombosis
- Tension pneumothorax
- Tamponade
- Toxins

Question 11

Mild hyperkalaemia?

Answer 11

5.5-5.9mmol/L

Question 12

Moderate Hyperkalaemia?

Answer 12

6.0-6.4mmol/L

Question 13

Severe Hyperkalaemia?

Answer 13

> 6.5mmol/L

Question 14

What do you use to stabilise the cardiac membrane in Hyperkalaemia?

Answer 14

IV Calcium gluconate

Question 15

What do you use to short term shift the potassium from ECF to ICF?

Answer 15

• Combined insulin/dextrose infusion
• Nebulised salbutamol

Question 16

What do you use to remove potassium from the body in hyperkalaemia?

Answer 16

• Calcium resonium (orally or enema)
• Loop diuretics
• Haemodialysis

Question 17

What is the definition of massive haemorrhage?

Answer 17

This is the loss of one blood volume in a 24 hour period or the loss of 50% of the circulating blood volume in 3 hours.
A blood loss of 150ml/min is also included.

Question 18

Management for paracetamol overdose?

Answer 18

Management
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation

Question 19

Management for Salicylate overdose?

Answer 19

Management
- Urinary alkalinization with IV bicarbonate
- Haemodialysis

Question 20

Management for opioid overdose?

Answer 20

Naloxone

Question 21

Management for cyanide poisoning?

Answer 21

Hydroxocobalamin

Question 22

What is Sepsis?

Answer 22

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 23

What is the Sepsis Six?

Answer 23

Blood cultures
Urine output monitoring
Fluids
Antibiotics
Lactate
Oxygen

Question 24

What are the different groups of shock?

Answer 24

• Septic
• Haemorrhagic
• Neurogenic
• Cardiogenic
• Anaphylactic

Question 25

What does a palpable femoral pulse equate to?

Answer 25

In order to generate a palpable femoral pulse an arterial pressure of >65mmHg is required

Question 26

When does Neurogenic shock most commonly occur?

Answer 26

Following a spinal cord transection

Question 27

What is Beck's triad?

Answer 27

Elevated venous pressure, reduced arterial pressure, reduced heart sounds Indicates Cardiac tamponade

Question 28

What the first-line treatment for bradycardia?

Answer 28

Atropine (500mcg IV)

Question 29

What is the management of Magnesium sulphate?

Answer 29

IV Magnesium Sulphate

Question 30

Risk factors for Necrotising fasciitis?

Answer 30

- Skin factors: Recent trauma, burns or soft tissue infections - Diabetes mellitus - Intravenous drug use - Immunosuppression

Question 31

How do you treat Acute COPD?

Answer 31

- Sit-up - 24% O2 Venturi mask (Aim 88-92%) - Vary FiO2 and SpO2 target according to ABG - Neb Salbutamol 5mg/4hr/Ipratropium 0.5mg/6h - Steroids Hydrocortisone 200mg IV or Prednisolone 40mg PO for 7-14 days

Question 32

When should you consider escalation in exacerbation of COPD?

Answer 32

Repeat nebulisers and consider aminophylline IV Consider NIV (BiPAP) if pH <7.35 and/or RR >30 Consider invasive ventilation if pH<7.26

Question 33

What is the most appropriate perimeter to measure in suspected Carbon monoxide poisoning?

Answer 33

Carboxyhaemoglobin

Question 34

What features in examination or history are suspicious for smoke inhalation in burns

Answer 34

Burning sensation in the nose / throat - Productive cough - Stridor - Dyspnoea - Rhonchi - Wheezing - Hoarse voice - Accessory muscle usage - Tachypnoea - Cyanosis - Odynophagia - Headache - Delirium - Hallucinations - Decreasing consciousness / comatose - Convulsions / seizures - Hypertonia - Facial burns / loss of facial or intranasal hair - Soot in mouth or sputum

Question 35

What effect does carbon monoxide have on the oxyhaemoglobin dissociation curve and how does this cause symptoms of carbon monoxide poisoning?

Answer 35

Carbon monoxide has a greater affinity for haemoglobin than oxygen (so readily binds to Hb) Causing the curve to shift to the left Left shift → increased affinity of haemoglobin for oxygen / so haemoglobin holds onto oxygen more tightly Reducing the release of oxygen to tissues, causing hypoxia and the associated symptoms (eg inadequate oxygenation to brain because oxygen held tightly to Hb instead → headaches / confusion / decreased consciousness)

Question 36

What is the difference between stridor and wheeze?

Answer 36

Stridor occurs when there is obstruction in the upper airway, wheeze occurs when there is obstruction in the lower airway/stridor more likely heard on inspiration and wheeze on expiration

Question 37

What position should be encouraged in anaphylaxis and why?

Answer 37

Flat with legs raised, to maximise venous return to the heart

Question 38

What direction does carbon monoxide shift the bohr curve and why?

Answer 38

Carbon monoxide has a high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia.