ALERT JEOPARDY

Please review

100

Your patient has a SBP 180, what do you chart? NKDA

PO Amlodipine 5mg

200

Your patient has a temperature >38...what do you do?

Sepsis 6

Take lactate, blood cultures, FBC, urine output/MCS and CXR

Give IV Abx, fluids and O2 

300

Causes for tachycardia (5)

Arrythmia - AF, flutter, sinus VT, VT, VF, ectopics

Cardiorespiratory disease - PE, cardiac ischaemia (new or old)

Systemic disease - Anaemia, infection, endocrine disease

Drugs - Sympathetics (eg. adrenaline), vasodilators (eg. beta blockers), anticholinergics (eg. atropine, oxybutynin)

Anxiety/pain response - Adrenaline cycle

400

K >7, how do you manage? (5)

ECG, medication review

Calcium gluconate IV 10ml (2.2mmol) over 5 mins

Repeat VBG after 5 mins if ECG changes persist

Frusemide 20-80mg IV push 

Salbutamol nebs 10mg (if HR <100)

Insulin 5units in 50ml glucose 50%

Patriromer 8.4-16.8g PO

500

55F 1wk post kidney transplant commenced on tacrolimus needs review for new eye pain. This is her. Dx and acute mx.

Herpes Zoster Ophthalmicus

- Aciclovir 10mg/kg IV 8hrly 

- Call Ophthalmology 

Spot Dx

100

ECG and key features (2)

Atrial fibrillation 

- Irregular rhythm 

- Absent P waves 

200

ECG and key features (3)

Hyperkalaemia 

- Peaked T waves

- P wave widening/flattening

- PR prolongation

- Bradyarrythmias 

- QRS widening 

300

CXR (Dx and potential cause 3)

R sided pneumothorax 

- Secondary to anterior R rib fractures likely due to trauma

400

CXR (Dx and key features 5)

Acute Pulmonary Oedema

Alveolar (Batwing) Oedema (confluent areas and interstitial oedema)

Kerley B Lines

Cardiomegaly 

Dilated upper lobe vessels and hilar plump

Pleural effusion 

500

Abdo XR (Dx, key features and potential cause 3)

Small bowel obstruction 

- Plicae circularis, air fluid levels and dilation of the bowels 3:6:9 rule)

- Adhesions, blockage (hernia/volvulus/intusussception), cancer

MET!!

100

What are 3 symptoms that mean AF is complicated?

SOB, light headedness, chest pain 

200

Asymptomatic BP 73/50, mx?

Hypovoleamia (not enough in/too much out = dehydration, poor oral intake, vomiting/diarrhoea/polyuria, bleeding, third spacing)

IVC, VBG, FBC, UEC, Ca, Mg, Phos

IV fluids bolus +/- maintenance) - Stat crystalloids (CSL, Na Saline) or colloid (Albumin 20%, Albumin 5%, Plt/PRBC/FFP)

Inotropes - Adrenaline, dobutamine

Vasopressors - Metaraminol, vasopressin

ICU

300

DDx for unresponsive patient (10)

Metabolic - B12, thiamine deficiency, serotonin syndrome 

Oxygen - Hypoxia

Vascular - HTN emergency, CVA (ischaemic/haemorrhagic)

Electrolytes - UEC/Ca/Mg/Phos + Endocrine

Seizure - Status epilepticus + postictal state

Tumour, Trauma, Temp, Toxins

Uremia - Renal or hepatic +- encaphalopathy

Psychiatric

Infection 

Drugs - Overdose, withdrawal

400

You're called about a 77F admitted for elective cholecystectomy with PMHx HTN, CCF and T2DM, in acute respiratory distress with RR 30 and desaturating...working diagnosis and mx? (5)

Dx: APO

Mx = 

ABCDE Resus + LMNOP

Lassix - Frusmide

Morphine - If in pain

Nitrates - GTN if BP >90

Oxygen - via NIV for pressure

Positioning - Sit upright

500

Indication for NIV/BiPAP (3) and CPAP (3)

NIV/BiPAP (Bi-level positive airway pressure)

- COPD with respiratory acidosis (pH <7.35)

- Hypercapnic respiratory failure secondary to chest wall deformity (scoliosis, thoracoplasty) or neuromuscular disease

- Weaning from tracheal intubation

CPAP (constant fixed pressure)

- Hypoxia in context of chest wall trauma despite adequate anaesthesia and high flow oxygen (pneumothorax should be ruled out using a chest x-ray prior to commencing CPAP)

- Cardiogenic pulmonary oedema

- Pneumonia

- Obstructive sleep apnoea

Resus

100

How many joules on the defib?

200J

200

Post resus care (6)

Re evalutate ABCDE

12 lead ECG

Treat precipitating cause

Aim for O2 >94%, normocapnia and normoglycaemia

Haemodynamic stability 

Targeted temp mx

300

What are two important meds we give in CPR? (2x name, dose, timing in cylce)

Adrenaline 1mg IV (after 1st non shockable and every second thereafter OR after 2nd shockable, every 2nd thereafter)

Amiodarone 300mg IV after 3rd cycle

400

What are reversible causes of arrest?

4Hs and 4Ts

Hypoxia, Hypo/hyperthermia, Hypo/hyperkalaemia, Hypovolaemia

Thrombosis, Tamponade, Toxins, Tension pneumothorax

500

COACHED acronym 

Compressions continue

Oxygen away 

All others away

Charging defib

Head clear, middle clear, bottom clear

Evaluating the rhythm 

Defib deliver/dump the shock