Dry as a Chip
Ankle Biters
Oww, Charlie Bit Me
Too Hot to Handle
The Sorting Hat
Drugs Not Hugs
Curious Q-ADDS
Rhythm and Blues
100
30 y.o male presents w. 3-day h/o D&V. Feeling weak and dizzy. What could be causing it?
- Dehydration
- Electrolyte imbalance
- Hypoglycaemia
100
4-year-old, weighing 21kg requires paracetamol.
Dosage 15mg/kg.
The paracetamol comes as 240mg in 5ml
15 x 21 = 315mg
315/240 x 5ml = 6.5ml
100
55 y.o. female presents after cat bite sustained the previous day.
O/E- site is red, swollen, hot to touch. HR 110bpm, BP 105/73, Temp 38.5.
Management?
- Care as sepsis pathway; SMO r/v, ABs, cultures etc
- Transfer for washout
- ADT
100
Why is ice not recommended in the treatment of burns?
Increases the zone of stasis which causes;
-decreased tissue perfusion
-damages potential viable tissue
-increases risk of progression
-causes inflammation
100
23 y.o female presents with severe lower abdo pain. LMP 3/52. Has Implanon insitu- overdue for removal.
Tachycardic 110bpm, hypotensive 92/53.
Triage category?
Cat 2
100
65 y.o. female sustains # R) ankle after trip and fall. She weighs 70kg. The SMO has requested 70mg of propofol for the procedural sedation. (200mg/20ml). Calculate how many mLs will be administered.
7mL
100
A 3-week-old baby presents. What Q-ADDS form should be used?
<1 year
100
Name 3 presentations where an ECG should be attended?
- Syncope/dizziness
- Chest Pain
- Sepsis
- Stroke like symptoms
- >65 years old, or Aboriginal people >45 years old
- Upper abdo pain
200
You witness a patient have a massive haemorrhage. EBL 1000ml.
What is first line fluid replacement?
Blood
200
2y.o. child presents at 2200hrs with barking cough, stridor, trach tug, severe WOB.
Management?
- Call SMO for immediate review
- Oxygen
- R/O foreign body
- Steroids, adrenaline NEB
200
A patient reports being bit by a red back spider. What is the treatment?
- Ice pack
- Clean wound wwith soap & water
- ADT
- Analgesia (panadol & nurofen, oxycodone if necessary)
200
5-year-old BIB parents. Parents preparing noodles for lunch. 5y.o. grabs noodles straight out of the microwave and spills contents onto torso. Parents put ice pack on and presented to hospital.
Immediate management?
- Under running water for at least 20mins
- Analgesia
- Maintain normothermia
200
A patient is assigned a triage category 2. What does this mean?
Treatment to commence within 10mins
200
8y.o. female, weighing 26kg, waiting retrieval for meningitis.
RSQ have requested the following antimicrobials be administered:
Aciclovir IV (10mg/kg)
Cefotaxime IV (50mg/kg)
Work out the drug calculation.
Aciclovir IV (10mg/kg)
10mg x 26kg = 260mg
Cefotaxime IV (50mg/kg)
50mg x 26kg= 1300mg (1.3g)
200
24/40 pregnant woman presents with D&V.
What Q-ADDS form should be used?
Antenatal Q-ADDS
200
Name this rhythm:
Complete heart block
Needs pacing
300
9-month-old infant presents with 3-day h/o D&V, decreased PO intake and decreased urine output. Bub weighs 9kg.
What IV fluid bolus would you give?
10-20ml/kg of 0.9% saline
10mlx 9kg= 90ml
20ml x 9kg= 180ml
300
10y.o male presents with RLQ and umbi pain.
What could it be?
- Appendicitis
- Testicular Torsion
- Mesenteric adenitis
300
What is a bite block?
Rolled up guaze to prevent patient biting down on the ETT
300
What is the Parkland Formula?
Estimates the total crystalloid fluid volume required for burns patients in the first 24hrs.
4mL x weight x % total body surface area (TSBA) burned
300
Traveller passing through requesting script for normal medications- antihypertensive. Vitals normal.
Triage catergory?
Cat 5
300
An 80y.o. patient presents. Known afib. Has been on digoxin for the last 20 years to manage this.
She's confused, has blurred vision, feels nauseous and is experiencing palpitations.
What is causing her symptoms?
Digoxin Toxicity
300
24y.o. 5 weeks post NVB presents feeling faint and weak. She reports a significant increase in PVB with offensive smell.
What Q-ADDS form for this patient?
Postnatal Q-ADDS
300
Pt presents & is found to have a potassium (K+) level of 2.0mmol. What ECG changes could be seen?
- Flattened T-wave
- ST segment depression
- U-Wave
- Prolonged QT interval
- VF or Torsades de Pointes (normally when medications/toxins involved e.g. digoxin)
400
What is permissive hypotension?
Intentionally maintaining a BP that is lower than normal to prevent blood loss in trauma
400
13y.o. female presents with 3/52 h/o excessive thirst, lethargy, weight loss, polyuria, abdo pain and D&V.
Treatment priorities?
- BGL & ketone
- Full set vital signs, ECG & cardiac monitor
- SMO review
- IV access, strict fluid balance
- RSQ support/retrieval
400
A patient presents with QAS. Concerned has been bit by something- unknown what.
He reports nausea, headaches, abdo pain. You notice blood around his eyes.
What has bit him?
Brown snake
400
What does this picture show?
The rule of 9's
400
A 3y.o. female represents to ED after being seen 2 days ago. She is on POABS for cellulitis. She is now febrile, tachycardic and confused. Her parents are concerned.
How would you triage?
Cat 2
400
55y.o. male referred by GP with potassium of 8.5.
SMO requests 1mmol/kg of sodium bicarbonate (100mmol in 100ml). Pt weight 85kg.What are we giving?
1mmol x 85kg = 85mmol
85/100x10= 8.5ml
400
What do 3 circles on the front Q-ADDS form mean?
To be seen in 10 mins...
400
A 47y.o. female presents with neck and jaw pain. She's feeling SOB. Using your clinical judgement, you decide to do an ECG. The ECG shows this. Now what?
-Call for help (SMO, RSQ)
-Apply defib pads
-Assign roles
-Prepare drugs (Tenecteplase)
500
24y.o. 5 weeks post NVB presents feeling faint and weak. She reports soaking pads (2 per hour) with offensive smell.
She is pale and diaphoretic. HR 100bpm, BP 92/53, temp 35.5.
What is going on?
Secondary Post Partum Haemorrhage (likely retained products)
Also consider sepsis
500
35kg child arrests. Work out how many joules you would shock them with.
4J/KG
35x4 = 140J
500
10y.o. female presents post bee sting. She has NKA.
She is tachycardic, reports SOB. You notice lip and tongue swelling.
What's happening?
Anaphylaxis
500
What are the characteristics of a 3rd degree burn?
Ranges from cherry red, mottled, white, non-blanching to leathery, charred, brown
500
21 y.o male walks into ED. Reports riding motorbike in full protective gear. Hits kangaroo at 90km/hr.
Reports RUQ pain, c-spine tenderness, L) flank pain
HR 100bpm- all other obs WNL.
What triage category?
Category 1
500
You are caring for a septic adult requiring vasopressors. SMO requests adrenaline infusion. How do you prepare an adrenaline infusion?
6mg of adrenaline (1:1000) so 6 vials.100mL N/Saline or 5% glucose. Remove 6mL from the bag, then add the adrenaline. (This makes a concentration of 60mcg/mL)
Start the infusion at 1mL/hr
500
What do the red triangles on the Q-ADDS form mean?
To be reviewed by medical officer immediately
500
You're in the middle of a cardiac arrest resus. Rhythm check comes around and it's the below rhythm... What do you do?
Check for a pulse
Continue CPR