ADVANCED TRAUMA LIFE SUPPORT (ATLS) LATEST 2024 ACTUAL EXAM TESTBANK 300 QUESTIONS AND COR, Exams of Nursing

Download ADVANCED TRAUMA LIFE SUPPORT (ATLS) LATEST 2024 ACTUAL EXAM TESTBANK 300 QUESTIONS AND COR and more Exams Nursing in PDF only on Docsity! 1 ADVANCED TRAUMA LIFE SUPPORT (ATLS) ACTUAL EXAM TESTBANK 300 QUESTIONS AND CORRECT ANSWERS( VERIFIED ANSWERS) ALREADY GRADED A+ Elderly patients may not exhibit tachycardia in response to hypovolemia because of limited cardiac response to catecholamines. Why else might they not get tachy? - ANSWER-On a Beta-Blocker or have a pacemaker A FAST scan in an excellent way to diagnose cardiac tamponade. What signs sugget tamponade - ANSWER-Beck's Triad: JVD, muffled heard sounds and hypotension (will be resistant to fluid therapy). Will also likely be tachycardic Patients with a tension pneumo and patient with cardiac tamponade may present with many of the same signs. What findings will you see with a tension will you NOT see with tamponade? - ANSWER-Absent breath sounds and hyperresonance to percussion over the affected hemithorax. Immediate thoracic decompresion is warrented for anyone with absent breath sounds, hyperressonance to percussion, tracheal deviation, and - ANSWER-Acute respiratory distress & subcutaneous emphysema Can isolated intracranial injuries cause neurogenic shock? - ANSWER-NO 2 How do you calculate total blood volume in an adult? - ANSWER-70 mL per kg. A 70 kg person has about 5 L of circulating blood. (70*70) = 4900 mL How do you calculate TBV in child - ANSWER-BW (kg) X 80-90 mL 5 Each mL of blood loss would be replaced with mL of crystalloid, thus allowing for replacement of plasma volume lot into interstitial and intracellular saces - ANSWER-3 Blood on the floor x four more is mneumonic for occult blood loss where? - ANSWER-Chest, pelvis, retroperitoneum, and thigh For children UNDER 1 year of age, UOP should be mL/Kg/Hr - ANSWER-2 Would patients in EARLY hypovolemic shock be acidodic or alkalotic? - ANSWER-Alkalotic - respiratory alkalosis from tachypnea ......followed later by mild metabolic acidosis in the early phase of shock "Rapid Responders" whose vital signs return to normal (and stay there) after fluid - ANSWER-I or II "Transient responders" are associated with Class hemorrhage - ANSWER- II or III What differential diagnosis shoudl you always consider for "non-responders" following fluid resuscitation? - ANSWER-Non-hemorrhagic causes e.g. tension pneumothorax, tamponade, blunt cardiac injury, MI, acute gastric distention, neurogenic shock 6 Most Patients receiving blood transfusions need calcium replacement - ANSWER-dont How should you position the patient before placing a subclavian or IJ line? - ANSWER-Supine, head down 15 degrees to distend neck neck veins and prevent embolism, only turn head away is C-spine has been cleared first. How long can you keep and IO line in - ANSWER-Intraosseous infusions should be limited to emergency resuscitation and should be discontinued as soon as other venous access is obtained Where do you want to make an incision for a saphenous vein cutdown and how long should your incisions be? - ANSWER-1 cm superior, 1 cm anterior to medial malleolus. 2.5 cm transverse incusion through the skin and SQ, careful to not to inure the vessel. A patient arrives to the trauma bay intubated and there are absent breath sounds over the left hemithorax, where should you place your decompression needle? - ANSWER-This may NOT be a pneumothorax, for intubated patients always suspect a right main-stem before attempting needle decompression. Where would you insert a large caliber needle to decompress a tension pneumo - ANSWER-2nd IC space in the midclavicular line of affected hemithorax For an open pneumothorax, (sucking chest wound) air passes preferentially through the chest wall defect (least resistance) if the diameter of the defect is at least the diameter of the trachea. - ANSWER-2/3 7 Flail chest results from multiple rib fractures - by definition this would be or more ribs, fractured in or more places. - ANSWER-2 or more ribs fractured in 2 or more places Both tension pneumothorax and massive hemothorax are associated with decreased breath sounds on auscultation, so you can tell which it is by . - ANSWER- Percussion - hyperresonant with pnuemo, dull with hemothorax. If a patient doesn't have JVD, does this mean they don't have a tension pneumo or tamponade? - ANSWER-No, they might have a massive internal hemorrhage and be hypovolemic. By definition, how much blood is in the chest cavity to call it a "massive hemothorax"? - ANSWER-1500 mL or 1/3 or more of the patient's total blood volume. (Some also define it as continued blood loss of 200 mL/hr for 2-4 hours- but ATLS does NOT use this rate for any mandatory treatment decisions). What size chest tube might you use to evacuate a massive hemothorax? - ANSWER-#38 French - inserted at the 4th or 5th intercostal space, just anterior to the midaxillary line. What is Kussmaul's sign? - ANSWER-A rise in venous pressure with inspiration while breathing spontaneously, and is a true paradoxical venous pressure abnormality associated with cardiac tamponade. 10 You should use a size 16 or 18 gauge 6" needle for pericardiocentesis. How do you insert it? - ANSWER-Puncture the skin 1-2 cm inferior to the left xiphohondral junction at a 45 degree angle to the skin towards the heart, aiming toward the top of the left scapula. What's a good way to know if you've advanced your needle too far during pericardiocentesis and have entered ventricular muscle? - ANSWER-ECG Changes - extreme ST-changes, widened QRS, PVCs, etc... Withdrawl needle until ECG returns to baseline. What should you do with your needle after you successfully evacuate blood during pericardiocentesis? - ANSWER-Lock the stopcock and leave the catheter in place in case it needs to be reevacuated. If possible, use the Seldinger technique to pass a 14 gauge flexible catheter over the guidewire. This is NOT a definitive treatment. For patients with facial fractures or basillar skull fractures, gastric tubes should be inserted before doing a DPL. - ANSWER-through the mouth You need to do retrograde urethrography PRIOR to foley placement if . - ANSWER-inability to void, unstable pelvic fracture, blood at urethral meatus, scrotal hematoma, perineal ecchymoses, or high-riding prostate. DPL is considered to be % sensitive for detecting intraperitoneal bleeding. - ANSWER-98 What are the four places you should look first when doing a FAST scan? - ANSWER-Mediastinum, hepatorenal fossa, splenorenal fossa, pouch of Douglas. 11 DPL is indicated when a patient with multiple blunt injuries is hemodynamically unstable, especially when they have . - ANSWER-Change in sensorium (brain injury/EtOH or drug intoxication), change in sensation (spinal cord injury), injury to adjacent structures (pelvis, lumbar spine), lap-belt sign (from seatbelt), or if patient is going for long studies (CT, ortho surgery...). What is the only ABSOLUTE contraindication to DPL? - ANSWER-An existing indication for laparotomy. What are some RELATIVE contraindications to DPL? - ANSWER-Morbid obesity, advanced cirrhosis, preexisting coagulopathy, and previous abdominal operations (adhesions). When should you use an open SUPRAUMBILICAL approach for a DPL? - ANSWER-PELVIC FRACTURES (don't want to enter pelvic hematoma) and ADVANCED PREGNANCY (don't want to damage enlarged uterus). When doing a DPL, what INITIAL findings (not from lab) would mandate a laparotomy? - ANSWER-Free blood (>10 mL) or GI contents (vegetable fiber, bile). If you don't get gross blood upon initial DPL aspiration, what do you do next for an adult? For a child? - ANSWER-Adult - 1,000 mL warm isotonic crystalloid. Kid - 10 mL/kg 12 You've just put a bunch of fluid in the belly and aspirated more fluid for your DPL. No gross GI contents or anything alarming are present, what QUANTATIVE things would make the DPL positive? - ANSWER->100,000 red cells/mm^3, 500 white cells/mm^3, or BACTERIA (on gram stain). Your trauma patient needs an urgent laparotomy, can you take them to the CT scanner first to evaluate injuries? - ANSWER-No, if they need an emergent laparotomy they are unstable - unstable patients should NOT go to the CT scanner! What are some indications for laparotomy in patients with penetrating abdominal wounds? - ANSWER-Unstable, GSW, peritoneal irritation, fascial penetration What percentage of stab wounds to the anterior abdomen do NOT penetrate the peritoneum? - ANSWER-25-33% Does an early normal serum amylase level exclude major pancreatic trauma? - ANSWER-NO Do you need to operate on anyone with an isolated solid organ injury? - ANSWER-No - not if they remain hemodynamically stable (Of all patients who are initially thought to havea ISOLATED solid organ injury, <5% will have hollow viscus injury as well). Which is LESS likely to have a life-threating hemorrhage - an open book or closed book pelvic fracture? - ANSWER-Closed book - the pelvic volume is compressed, so not as much room for blood. 15 the 30 min amnesia makes them HIGH risk for neurosurgical intervention (as would a basillar skull fx). What 2 things do you need to do first for everyone with a MODERATE brain injury (according to ATLS algorithm)? - ANSWER-CT scan, admit to faciolity capable of definitive neurosurgical care (Moderate = GCS 9-12) High levels of CO2 will cause cerebral vasculature to . - ANSWER-Dilate (to increase blood flow) - so you might want to HYPERventilate people with brain injuries. Ideally, you want to wait to perform a GCS on a person with SEVERE brain injury until what? - ANSWER-BP is normalized A FAST scan, DPL, or ex-lap should take priority over a CT scan if you can't get the brain injured patient's BP up to mm Hg. - ANSWER-100 If a patient has a systolic over 100 with evidence of intracranial mass (blown pupil, unequal motor exam) THEN a CT would take first priority. A midline shift of greater than often indicates the need for neurosurgical evacuation of the mass/blood. - ANSWER-5mm Your patient has a dilated pupil and you want to give mannitol on the way to the CT scanner or OR. What is the correct dose? - ANSWER-0.25-1.0 g/kg via rapid bolus 16 A cast cutter should be removed to remove a trauma victim's helmet if there is evidence of a c-spine injury or if . - ANSWER-the patient experiences pain or paresthesias during an initial attempt to remove the helmet. What are the signs of neurogenic shock? - ANSWER-Vasodilation of lower extremity blood vessels - resulting in pooling of blood and hypotension. This loss of sympathetic tone may cause bradycardia or inhibit the tachycardic response to hypovolemia. How do you treat neurogenic shock? - ANSWER-Judicious use of pressors and MODERATE fluid resuscitation. Too much fluid may result in overload and pulmonary edema. What's the difference between types I, II, and III odontoid process fractures? - ANSWER-I=tip of odontoid, II=fx at base, III=base of odontoid and extends obliquely into body of axis. (Odontoid process = dens). What are the indications for c-spine radiographs in a trauma patient? Which x-ray views should be obtained? - ANSWER-Midline neck pain, tenderness on palpation, neurological deficits related to c-spine injuries, altered LOC or intoxication. 1) Lateral, 2) AP, 3) Open mouth odontoid view With the proper views of the c-spine, and a qualified radiologist - what is the sensitivity for finding unstable cervical spine injuries? - ANSWER->97% (CT with 3mm slices >99%). 17 Ten percent of all patients with a c-spine fracture have what? - ANSWER-A second, noncontiguous vertebral column fracture. (So scan the rest of their spine). Attempts to align the spine for the purpose of immobilization on the backboard are not recommended if they . - ANSWER-cause pain Can you clear a c-spine without films? - ANSWER-Yes, if they are awake, alert, sober, neurological normal, have NO pain, and can flex, extend, and move their head to both sides without pain - you don't need films. Should a quadriplegic or paraplegic patient be put on a hard board? - ANSWER- Not for more than 2 hours - get them off ASAP. What's a big difference in a physical finding between hypovolemic and neurogenic shock? - ANSWER-Hypovolemic = usually TACHY, Neurogenic = usually BRADY Partial or total loss of respiratory function may be seen in a patient with a cervical spine injury above . - ANSWER-C6 Why might someone not be able to breathe if they have a long bone fracture - ANSWER-Fat embolism - uncommon though Abnormal arterial blood flow is indicated by an ABI of . - ANSWER-<0.9 20 Leg BSA for adult = %. - ANSWER-18 TOTAL (9 front, 9 back). Baby front or back of leg BSA = %. - ANSWER-7 (TOTAL leg = 14%) If you add up BSA head, chest, back, arms, and legs you get 99% of BSA. What is the remaining 1%? - ANSWER-Perineum Partial/2nd degree burns extend into the whereas full thickness/3rd degree burns - ANSWER-Partial - go into dermis, FULL go all the way through dermis and into/beyond SQ tissue For patients with CO poisoning, the ½ life is when breathing room air and breathing 100% oxygen - ANSWER-4 hours on RA, 40 min on 100% O2 How do you calculate the Parkland formula? (BURNS) - ANSWER-4 * weight (kg) * percent BSA burned = volume in 24 hours (1st half in 8 hrs, 2nd half over 16 hrs).4*70kg*25 percent = 7 liters in 24 hours. ***Use 25, NOT 0.25)*** Partial or full thickness burns of % in patients less than 10 or older than 50 warrants transfer to a burn center. - ANSWER-10% What percent partial/full thickness burns would qualify a 25 year old for a burn center transfer? - ANSWER-20% 21 What anatomical positions with partial/full thickness burns warrant burn center transfer? - ANSWER-Face, eyes, ears, hands, genitalia, perineum, feet, skin overlying joints. Does an inhalation injury warrant transfer to a burn center? - ANSWER-Yes Should you treat frostbite by soaking body part in water or not? - ANSWER-YES, 40 degree (104F) for 20-30 min should suffice. Don't warm if there is risk of REFREEZING. Insofar as hypothermia is concerned, patients are not pronounced dead until they are and dead. - ANSWER-warm What are you thinking if a child has broken ribs? - ANSWER-MASSIVE force and highly likely organ damage (since their ribs are very pliable, a huge amount of force is required to break them, there is often underlying organ damage WITHOUT broken ribs). How should you insert a Guedel in a kid? - ANSWER-Use tongue blade depressor and insert gently without turning - otherwise there is great risk for trauma and resultant hemorrhage. NOT the 180 degree spin trick. The normal systolic BP in kids can be estimated by what? - ANSWER-90 mm Hg + (age x 2) How do you estimate a child's total circulating volume? - ANSWER-80 mL/kg 22 When shock in a child is suspected, how much fluid do you give them? - ANSWER-20 mL/kg warm crystalloid May need to repeat up to 3 times (60 mL/kg) then consider blood products. Optimal UOP for infants is mL/kg/hr. - ANSWER-2 (1.5 for younger kids, and 1.0 for older kids) How much warmed crystalloid should be used for a DPL in kids? - ANSWER-10 mL/kg (up to 1000 mL) What would you see in an infant that would make you suspect very severe brain injury despite normal LOC? - ANSWER-Bulging fontanelles - these allow tolerance for expanding masses/swelling... What is a possible mistake about a blood pressure of 120/80 in a 87 year old man? - ANSWER-Assuming that normal blood pressure = normovolemia. Many geriatric patients have uncontrolled hypertension, and if their normal systolic is 180, then 120/80 is relative HYPOtension for them. How well do geriatric patients do with non-operative management of abdominal injuries compared to younger people? - ANSWER-Not as well - the risks of non- operative management are often worse than the risks of surgery. Why would geriatric patients be MORE susceptible to head bleeds when there is increased space around a shrinking brain to protect them from contusion? - 25 Resuscitation fluids should be warmed to 39 Celsius - ANSWER-Only for Cyrstalloids, NOT for blood Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might precent you from inserting one - ANSWER- Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non- palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on? - ANSWER-The arm with the BP cuff 2 anatomical things that can interfere - ANSWER-Obesity and intraluminal bowel gas When should radiographs be obtained? - ANSWER-During the Secondary survey! How do get an ample patient history? - ANSWER-Allergies Medications PMH/Pregnancy Last meal Events/Environment Why might you want a Bair Hugger for a patient who smells of Alcohol? - ANSWER-Vasodilation can lead to hypothermia 26 What things are you looking for when you do a DRE in trauma - ANSWER-Blood, high riding prostate, sphincter tone, What should be done for every female patient - ANSWER-Pregnancy test Adult patients should maintain UOP of at least mL/kg/hr. Kids should have at least mL/kg/hr - ANSWER-Adults 0.5 mL/kg.hr Kids 1.0 mL/kg/hr Preventing hypercarbia (hypercapnia) is critical in patients who have sustained a injury - ANSWER-head What two places would you LOOK at a patient if you suspect hypoxemia? - ANSWER-Lips and fingernail beds Patients may be abusive and belligerent because of -, so don't just assume its due to drugs, alcohol, or the fact they they are just inherently a jerk - ANSWER-hypoxia Can a patient breath on their own after complete cervical cord transection - ANSWER-Yes if the phrenic nerves (C3-C5 are spared. This will result in 'abdominal' breathing. The intercostal muscles will be paralyzed though Can you use an OPA (Guedel) in a conscious patient - ANSWER-No, it could make them vomit. An NPA (trumpet) would be okay. 27 Bougies are typically inserted blindly, how do you know you are in the trachea and not the esophagus? - ANSWER-You can feel the clicks as the distal tip rubs against the cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus (at 50 cm) What do yo NOT want to hear if you auscultate a patient after placement of an ET tube? - ANSWER-Borborygmi - rumbling or gurgling noices suggest esophageal insertion. What is the RSI dose for etomidate - ANSWER-0.3 mg/kg (usually 20 mg) What is the RSI dose for succinylcholine - ANSWER-1-2 mg/kg (usually 100 mg) How does etomidate affect blood pressure - ANSWER-it doesnt -it shouldnt have any effect on BP. Ketamine will increase BP, and propofol and thiopental will both drop BP. A RSI dose of succinylcholine usually lasts about minutes - ANSWER-5 What hypnotic/sedative/induction agent do you NOT want to use for a severely burned patient? - ANSWER-Sux - patients with severe burns, crush injuries, hyperkalemia, or chronic paralytic/neuromuscular disease should NOT get Sux because of hyperkalemia risk 30 Why does shock actually reduce the total volume of circulating blood? - ANSWER-Anaerobic metabolism --> cant make more ATP --> endoplasmic then mitochondrial damage --> lysosomes rupture --> sodium and water enter the cell, which SWELLS and dies Which vasopressors should you use to treat hemorrhagic shock? What are the drug doses - ANSWER-Never use pressors hypovolemic shock - use VOLUME replacement. Pressors will worsen tissue perfusion in hemorrhagic shock Compensatory mechanisms may preclude a measurable fall in systolic blood pressure until up to % of the patient's blood volume is lost. - ANSWER-30 Any patient who is cool and is tachycardic is considered to be until proven otherwise. - ANSWER-in shock The definition of tachycardia depends on patients age. What heart rate is considered tachycardic for infants, toddlers/PS, schoolage/prepubescent, and adults - ANSWER-Infants >160 toddlers/PS > 140 schoolage/prepubescent >120 Adults > 100 What are the four Hs? - ANSWER--Hypoxia, Hypovolaemia, Hypothermia, Hypo- kalaemia (metabolic) 31 What are the four Ts? - ANSWER--Thrombosis, Tamponade, Tension Pneumothorax, Toxins % of Cardiac Arrests which are shockable? - ANSWER--25% % of Cardiac Arrests which are Non-shockable? - ANSWER--75% (50% Asystole & 25% PEA) How many Cardiac Arrests reach ROSC? - ANSWER--25-30% How many Cardiac Arrests are discharged hospital? - ANSWER--8% (Out of hospital) 20% (In hospital) What are the chain of survival steps? - ANSWER--Early recognition & Call for help Early CPR Early Defibrillation (within 3 mins) Post resuscitation Care (starts after ROSC) Which rhythms are shockable? - ANSWER--V-fib and Pulseless VT During CPR how often should adrenaline be given? - ANSWER--3-5 mins 32 During CPR how often should amiodarone be given? - ANSWER--1 x after 3 shocks Which rhythms are non-shockable? - ANSWER--PEA/ASYSTOLE What does SBAR stand for? - ANSWER--Situation Background Assessment Recommendation What does RSVP stand for? - ANSWER--Reason Story Vital Signs Plan What are the stages of the chain of prevention? - ANSWER--Education Monitoring Recognition Call for help Response Talk through A-E assessment and what it involves. - ANSWER--As per usual A-E. 35 In which leads would you see an inferior infarct? Which artery effected? - ANSWER--II, III, aVF (RCA or circumflex) In which leads would you see a lateral infarct? Which artery effected? - ANSWER- -V5/V6 and/or I and aVL (circumflex or diagonal branch of LAD) In which leads would you see a posterior infarct? Which artery effected? - ANSWER--ST depression in anterior chest leads (V1-V4). Dominant R wave in V1/V2 reflects posterior Q wave development. RCA occlusion commonly. Dominant circumflex artery lesion. What variables are in the cardiac score GRACE? - ANSWER--age, signs of hear failure, heart rate, blood pressure, serum creatinine, ECG changes, troponin and if cardiac arrest at presentation. Name a bleeding risk score? (Context bleeding in ACS leads to a worse prognosis) - ANSWER--CRUSADE Immediate medical treatment in ACS consists of... - ANSWER--MONA Morphine IV (+ ANTI EMETIC) Oxygen Nitrates (GTN) - not if hypotensive Aspirin 300mg 36 What is the - call to balloon time - in context of ACS and how long is it? - ANSWER--x < 120 mins. Time to get ACS patient to PCI. Name ((3) anti-platelet drugs, one of which will be loaded post PCI - ANSWER-- Clopidogrel 600mg Prasugrel 60mg (Not if > 75 years , x<60kg or historyof bleeding/stroke. Ticagrelor 180mg. Name (3) Indications for re perfusion therapy for AMI - ANSWER--ST segment elevation > 0.2mV in 2 adjacent chest lease or >0.1mV in 2 or more adjacent limb leads. Dominant R waves and ST depression in V1-V3 (posterior infarction). New onset LBBB What should all patient's receiving fibrinolytic agent for STEMI recieve? - ANSWER--Additional anti-thrombotic therapy ie. LMWH (IV and then SC). Or fondipareinex. If their are enough attenders, how often should the CPR provider be changed? - ANSWER--Every 2 mins Should pulse checks be routinely carried out during rhythm assessment? - ANSWER--No. Pulse checks should be performed only when organised electrical activity compatible with a pulse is seen. 37 Treatment for NSTEMI - ANSWER--SC LMWH Aspirin 75mg (Post loading 300mg) +if high TROP OR due revascularisation therapy for: Clopidogrel 300mg, then 75mg post loading Prasugrel or ticagrelor. +bblocker or diltazem +nitrate infusion if persistent What does AF in the context of AF indicate? - ANSWER--Left ventricular failure AV node block in arrest usually present on ECG as.. - ANSWER--Broad QRS, slow rate resistant to atropine. May require temporary cardiac pacing. What is the commonest cause of cardiac arrest? - ANSWER--Coronary heart disease SCDeath in adults. What symptom/sign suggests a patient is at risk of sudden cardiac death? - ANSWER--Syncope What reason would you avoid use of head tilt chin lift? - ANSWER--Any chance of Cspine injury - use jaw thrust. 40 Eye opening 4Spontaneous 3 To speech 2 To pain 1 None What investigations should be done in the post resuscitations period? - ANSWER-- ABG Bloods - FBC, Trop, UsEs ECHO 12 LEAD ecg car What MAP should you aim for post resuscitations? - ANSWER--One which produces a urine output of 1 mL-1kg-1h-1 and normal or decreasing plasma lactate values What Glucose range should be maintained post Resuscitation? - ANSWER-- Maintain glucose in the range of 4 - 10 mmol L-1 What CO2 level post resuscitation is the aim? - ANSWER--Aim for normocarbia (PaCO2 4.7-6.0 kPa). 41 What temperature do you aim for post resuscitation? - ANSWER--X < 37 degrees. But...Evidence suggests 32-36°C for 24 h, avoiding rapid fluctuations in temperature. Following this, the patient should undergo a controlled rewarm at a rate of 0.25-0.5°C h-1. At 72 hours post resuscitations in comatose patients, which tests predict poor outcome? - ANSWER--The absence of both pupillary light and corneal reflex at ≥ 72 h predicts poor outcome reliably. The bilateral absence of N20 peaks on somatosensory evoked potentials (SSEPs) as seen on an EEG. A GCS motor score of 2 or less - which is extension or no response to pain - at ≥ 72 h is less reliable. Stages of assessing an ECG... - ANSWER--Any electrical activity? Rate? Rhythm? QRS width? Atrial Activity? Atrial activity linked with ventricle activity? Where should electrodes for 3 lead monitoring be attached over? - ANSWER-- Bone How long is the normal PR interval? - ANSWER--X < 0.2s Energy setting for AED - ANSWER--Minimum 150 J 42 When is the first dose of adrenaline given? - ANSWER--In the 2 minutes after the 3rd shock What is an alternative to amiodarone? - ANSWER--Lidocaine 1mg/kg (But never use as an adjunct to amiodarone). When to use a precordial Thump? - ANSWER--Whilst awaiting arrival of defib in cases of PVT/VF arrest. Delivered from 20cm above chest wall. Quickly recoil. What three sites can be used for IO access? - ANSWER--Proximal and distal tibia and humerus. Contraindications to IO access? - ANSWER--Trauma, infection, prosthesis, recent IO access, failed attempts, or failure to identify anatomical landmarks. Peripheral drugs given IV should be followed with.. - ANSWER--Minimum of 20mls Flush. When assessing airway which added sounds are you looking for? - ANSWER-- Inspiratory Stridor, Expiratory wheeze, Gurgling, snoring. Process of assessing and treating choking? - ANSWER--Ask pt to cough. 5 back blows. 5 abdominal thrusts. Check if any debris dislodged on each blow. Continue until dislodges or pt besoms unresponsive and requires CPR. 45 What is the normal PR interval? - ANSWER--The normal PR interval is 0.12-0.20 s (or 3-5 small squares). Treatment of bradycardia - ANSWER--If SYMPTOMATIC, give ATROPINE 500mcg IV, increased to 3mg MAX. If ineffective, use TRANSCUTANEOUS PACING, Adrenaline, Isoprenaline, How many J does an inplantable ICD give on deployment? - ANSWER--40j (80 if implanted) Where is the tip of a pacing lead supposed to be located? - ANSWER--Apex of R ventricle. how to treat torsades de pointes - ANSWER--magnesium sulfate 2g IV over 10 mins If adenosine fails to terminate narrow complex tacycardia you should... - ANSWER--Consider verapamil 2.5-5mg IV over 2 mins Management of anaphylaxis - ANSWER--Oxygen, 0.5 mg IM adrenaline, fluids and bronchodilators. Antihistamines and hydrocortisone are second line drugs. Management of hyperkalaemia - ANSWER--10% IV Calcium Chloride (Cardiac protection) 46 IV Glucose/Insulin Salbutamol Nebs - If no tachycardia. How should you position pregnant women who are requiring CPR? - ANSWER-- Uterine Displacement if obvious or > 20 weeks. Left lateral Tilt. Early consideration for intubation. Increased risk of aspiration. If no ROSC in 5 mins, then peri-mortem Csection should be performed as an emergency and then transfer to ICU required. If fetes > 20 weeks. An infusion of IV lipid may be required if cardiac arrest occurs after an epidural infusion has been started and local anaesthetic toxicity is suspected. Hypercalcaemia Treatment - ANSWER--IVI Furosemide 1mg/kg IV Pamidronate 30-90mg iV Hydrocortisone 200-300mg Tx underlying cause - malignancy? Sarcoid? Primary or tertiary hyperparathyroidism. Drugs etc. Treating Hypocalcaemia. - ANSWER--Calcium Chloride 10% 10-40ml iv Magnesium Sulphate IV Hypermagnesemia - ANSWER--Calcium Chloride 10% 5-10ml Haemo-dialysis. 47 Ventilatory support Hypomagnesemia - ANSWER--give mag sulfate 1-2g 50% preparation. Sepsis 6 - ANSWER--Oxygen ABX IVI Blood Cultures Lactate Urine Output How to manage severe local anaesthetic toxicity? - ANSWER--IV bolus of 20%lipid emulsion. 1.5ml/kg over 1 min. IV infusion of 20% lipid emulsion at 15ml/kg/hr. (Can double rate after 5 mins) Max of 3 bolus. 5 mins between embolismPE Suicide Cardiac Disease - congenital Vs aquired Ectopic Pregnancy. Reason for the left lateral tilt in CPR in pregnancy? - ANSWER--Due to pressureon IVC and aorta impairing venous return. Left uterine displacement is also an option.Increased risk of aspiration in pregnancy. Emergency C section in CPR of pregnant women 20-23 weeks aim is to... -ANSWER--Aid mother's survival Emergency C section in CPR of pregnant women 24 and above weeks aim is to... -ANSWER--Save mother and child. What is commotio cordis? - ANSWER--V-fib triggered by blow to the anteriorchest wall during cardiac repolarization Many be caused by contact sports. In drowning ant8ibiotic therapy is always indicated? - ANSWER--false Is amiodarone indictated in a PEA arrest? - ANSWER-- NO. Only in VF or PVTarrest. Should a ICD be deactivated when a DNAR is put in place? - ANSWER--No. Does adrenaline have any long term benefits in CPR/resus attempt? - ANSWER--Although there is no evidence of long-term benefit from the use of adrenaline, the Higher defibrillation energies may be required in patients whose cardiac arrest has been caused by asthma. True or false? - ANSWER--True: Hyperinflation increases thoracic impedance. Higher energies should be considered if the first shock fails. The amplitude of the VF waveform is irrelevant in decisions on whether to shock? - ANSWER--False. If there is doubt whether the rhythm is asystole or extremelyfine VF, do not attempt defibrillation; instead, continue chest compressions and ventilation as continuing high quality CPR may improve the amplitude and frequency of the VF and improve the chance of subsequent successful defibrillation to a perfusing rhythm. If the rhythm changes from asystole to VF, a shock should be given. True or false. - ANSWER--False. CPR should be continued until the end of the cycle and then ashock delivered. How long is thrombolysis contraindicated in post surgical patients? - ANSWER-- Major surgery within three weeks is an absolute contraindication. How do you tell if a tachycardia is ventricular in origin? - ANSWER--If the QRScomplex is < 0.12 s (3 small squares) it therefore originates above the ventricles.