Retrieval
Radiology
Paediatrics
Christmas in the ED
General EM Knowledge
100
Which 2 hospitals make up the state's adult ECMO referral hospitals providing 24/7 coverage?
Royal Prince Alfred
St Vincent's
100
Interpret this Xray and outline your management
Despite the report stating 1 ovoid FB, there's actually 2 magnets > concerning for potential separation then causing bowel/pressure necrosis.
Currently well and asymptomatic, therefore admitted for serial exams, rpt Xray.
Initially referred to gastro, but as they have passed he stomach > referred to ASU
100
What is Bluey's sister called?
Bingo
100
Rudolph the Red-nosed Reindeer presents with epistaxis after a particularly enthusiastic dash through the snow. Which nasal packing method is most appropriate for a bleeding magical reindeer?
A. Use reindeer antlers for external compression
B. Cauterize with a glowing nose-friendly device
c. Apply anterior nasal packing
D. Ice pack on the nose to dim the glow
For full marks, explain to your colleagues how you would manage an anterior epistaxis (assuming a human patient, not a reindeer!)
C - apply anterior nasal packing
Sit upright
Apply firm pressure to Little's area
Only cauterise if you can see the bleeding point (doesn't work in active bleeding)
Analgesia
Test balloon, "activate" then insert rapid rhino and inflate
100
What is this called? And when would you use it?
McCoy Laryngoscope blade
Like a standard Macintosh blade but the lever adjacent to the handle allows control of the flexible tip. Hinged tip allows elevation of the distal structures (epiglottis) in a difficult intubation.
200
According to the NSW Burn transfer guidelines, give me 4 criteria that warrant TIME CRITICAL retrieval of a burns patient.
200
53yr old male presents with painful L foot and getting it caught in his bedding and falling 3 days prior.
Describe and interpret this L Foot Xray:
There is an acute Lisfranc fracture dislocation of the left foot. There is a comminuted fracture noted involving the base of the left 2nd metatarsal. The 2nd, 3rd and 4th tarsometatarsal joints appear subluxed with lateral displacement of the metatarsals. The Lisfranc joint is widened by up to 14mm.
The CT looked a lot worse!!
200
Name 3 dog characters from Paw Patrol
200
Mrs Claus is triaged with wrist pain after a marathon gift wrapping session. What is the most likely diagnosis?
A. Christmas Carpal Tunnel Syndrome
B. De Quervain's Holiday Tenosynovitis
C. Jingle Bell Joint Pain
D. Reindeer-related radiculopathy
B. De Quervain's holiday tenosynovitis
200
Since July 2024 - what snake antivenoms do we now stock?
Brown
Tiger
Polyvalent
300
What is the maximum patient weight a normal retrieval stretcher can accommodate?
(Bonus marks if you also know the maximum width)
130-140kg
(width = 57cm)
300
14 month old, BIBA after ?inserting a pen into his mouth. Spat out blood initially but nil active bleeding.
Please interpret this Xray and outline your management
Bonus points if your management plan aligns with Nic Alley's
Child started bleeding again in paeds ED
Moved to resus, suctioned
Penetrating injury to R posterior pharynx with active bleed
Anaesthetics and ENT called
IVC gained, bloods incl G&H sent
Adren neb, TXA IV (+/- neb), analgesia
ENT r/v: minimal bleeding, conservative Rx, IV ABx, IV analgesia, NBM, IVF
??? safe to managed here ???safe to transfer unintubated in an ambulance
Xray report:
300
What is the main in-game currency of Fortnite called?
V-bucks
300
What festive pathology is demonstrated by the arrows?
Turkey bone foreign body
300
Interpret this ABG (FiO2 0.21):
pH: 7.15
pO2: 115
pCO2: 20
HCO3: 8
BE: - 16
Na: 135
K: 6.5
Cl: 95
glucose: 6.2
urea: 8.1
lactate: 5.2
osmolality: 320
What are some differentials for this?
Metabolic acidosis
With Respiratory compensation (expected pCO2 = 1.5 x HCO3 +8 = 20
There is a high anion gap: Na - Cl - HCO3 = 32
Delta Ratio = (AG - 12) / (24 - HCO3) = 1.25 (this is 0.8-2.0 so a pure HAGMA).
Calculated osmolality = 2 x Na + urea + glucose = 284.3
Osmolar gap = osmolality - calc osm = 320-284.3 = 36
Differentials = CATMUDPILES
Given large osmolar gap = toxic alcohol!
400
After Chris T's talk last week, how do you make up a dobutamine infusion?
Either peripheral or central accepted.
Bonus points: What is its action and indications?
Central: 250mg in 100ml glucose 5%
Peripheral: 500mg in 500ml glucose 5%
Commence at 2.5mcg/kg/min and titrate
Usual dose range: 2.5-10mcg/kg/min (up to 40mcg/kg/min)
Action: inotrope - stimulates cardiac beta receptors but has comparatively mild chronotropic and vasodilatory effects
Indication: low cardiac output states, e.g. acute cardiac failure, cardiogenic shock, added to vasopressor in sepsis induced myocardial dysfunction
400
What is the red arrow showing?
Bonus marks: what is the eponymous name?
Gas under the R hemidiaphragm with associated haustra.
Chilaiditi's sign (or pseudopneumoperitoneum)
Refers to the interposition of the bowel between the inferior surface of the R hemidiaphragm and the superior surface of the liver. It may be misinterpreted as a true pneumoperitoneum, resulting in unnecessary further Ix.
400
How many career goals has Christiano Ronaldo scored?
He scored his 900th goal on 5th Sept 2024.
His career now spans over 22years.
400
Grandma got run over by a reindeer and presents to your ED with pelvic pain. A CT Pelvis is performed:
How would you describe this fracture to the friendly orthopod on call? What "zone" does it involve? What neurological deficit might grandma have from this injury?
Acute undisplaced fracture through the right sacral ala extending to involve S2 and S3.
400
19yr old male, GCS 4, T36.2, HR 155, RR 36, BP 92/38 - looks peri-arrest.
Describe and interpret his ECG on arrival to your resus bay and give 3 possible differentials:
1. Electrolyte disturbance: HyperK (his K was 8.9, and HypoCa 2.0)
2. Toxic agents: prolonged QRS and ?terminal R in AVR consistent with sodium channel blockade, ?prolonged QT consistent with K channel blockade (??cocaine, ?antipsychotics/antdepressants/TCAs, amphetamine).
Others: Channelopathy/cardiomyopathy, ischaemia myocarditis
(Arrival VBG: pH 6.89, CO2 15, bicarb 3, BE -27, sugar >40, lactate 7)
ECG after 30mins of resus:
500
What is the maximum weight of the bariatric stretcher that the NSW Retrieval Helicopter can accommodate?
260kg (accept 250-275kg)
500
83yr old Male, fall from standing height.
Describe this CT image, what is the name of this type of fracture? (see firstnet for more images - 0951578):
1. Comminuted 3 columns Chalk stick type fracture through the L1 vertebral body with prevertebral haematoma and gas.
Chalk stick #s = fractures of a fused spine. When several contiguous segments of the spine a fused, the fused column acts as a lever arm. This places greater than normal stresses on the spine. These #s often occur following minor trauma due to altered biomechanics of the spine.
500
What year was the first State of Origin NRL match played?
Bonus points if you also know who was named Man of the Match
1980
Man of the match = Wally Lewis
500
Santa, after climbing down a chimney, experiences crushing central chest pain radiating to his jaw.
Interpret this ECG:
Where is the most likely culprit lesion and why?
What is your immediate management?
Bonus marks: what is a common complication of this? how common?
Inferior STEMI. Hyperacute T waves in II, III, aVF with relative loss of R wave height. Early ST elevation and Q wave formation in III. Reciprocal ST depression and T wave inversion in aVL. ST elevation in III > II suggests an RCA occlusion - subtle STE in V4R would be consistent with this.
Cath lab activation. Load with aspiring, clopidogrel/ticagrelor, 5000 units IV heparin, pain relief. NO/cautious use of GTN.
Bonus marks: bradycardia and AV block (either 2nd or 3rd degree) in up to 20% of inferior STEMI patients. 2 presumed mechanisms:
1. Ischaemia of the AV node due to impaired blood flow to the AV nodal artery (arising from the RCA 80% of the time)
2. Bezold-Jarisch reflex = increased vagal tone secondary to ischaemia
500
A white precipitate forms within a cannula when what medication is administered after thiopentone?
A. Suxamethonium
B. Rocuronium
C. Midazolam
D. Fentanyl
For full marks - what is the dose of thiopentone for induction of anaesthesia for RSI?
B. Rocuronium
Dose of thiopentone 3-7mg/kg IV