Resus. & Anaes. 1 ~ Short Answer

Question 1.

A 35 year old man is flown in by air ambulance after being found unconscious in a remote area of bushland in winter. He is in asystole and the ambulance officers are currently performing CPR. His temperature is 28.6° C.

A.  What is the current advanced life support algorithm?

Show Answer

ALS-Adult

 

3 marks total

• Detail in yellow box required to pass:

  • Adrenaline doses
  • Reversible causes

B.  What are the major modifications need to be made to this algorithm in the case of unintentional (environmental) hypothermia?

Show Answer

  • Start and continue ALS until patient is rewarmed (Temp ? 32°C) unless other obvious lethal injuries present
  • Withhold drugs until temp ? 30° C then double interval between giving drugs until temp ?32°C
  • Can defibrillate initially 3 x if in VF/VT but then cause (as no effect) until temp ?30°C
  • Main therapy is re-warming

C.  Name 2 methods of each:

  • Passive external rewarming
  • Active external rewarming

Show Answer

 Passive external rewarming

  • Warm environment
  • Remove wet clothes and dry patient
  • Insulation blankets
  • Warm blankets

Active external rewarming

  • Warmed and humidified air/O2
  • Warm forced air blanket
  • Heat packs to torso/armpits/groin

4 marks (2 each)

D.  Describe 3 methods of active internal rewarming

Show Answer

  • Warmed IV fluids (43°C) – 1-1.5°C/hr
  • Lavage
    o Gastric – NGT warmed fluid
    o Bladder – IDC warmed fluid
    o Peritoneal – warmed fluid in/out peritoneal cavity
    o Pleural – warmed fluid in/out of pleural cavity same side; one ICC upper chest, one lower
  • Extracorporeal warming – ECMO 8-12°C/hr

3 marks (must includes at least 1 method of lavage)

Author: J Haire


 

Question 2.

A 25 year old man sustains facial injuries in a high speed motor vehicle crash in which he was the unrestrained driver.

Facial Trauma

His observations are:

  • GCS = 15
  • HR = 100 beats/minute
  • Supine BP = 130/75 mmHg
  • Oxygen Saturations = 97% on Room Air

A.  Describe the abnormalities shown in this photograph.

Show Answer

  • Periorbital bruising bilaterally
  • Facial swelling especially over the right zygoma
  • Haemoserous nasal discharge
  • Possible swollen tongue
  • Chipped right upper incisor

3 marks (3 out of 5)

B.  What underlying injuries could there be?

Show Answer

  • Facial bone fractures
  • Mandibular fracture
  • Base of skull fractures
  • Intracranial haemorrhage

3 marks (3 out of 4) 

C.  What are the risks to his airway?

Show Answer

  • Swollen tongue – haematoma
  • Direct trauma to airway
  • ICH causing depressed GCS
  • Blood loss into airway from facial fractures
  • Mandibular fracture
  • Small mouth
  • Bull neck

5 marks (at least 5) 

Author: J Haire

One Comment:

  1. DR ANIRBAN RASHID

    Very Good Model answers but need more questions and answers to help us prepare for the exams!

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