th May 2017 (answers below) 1. What are the differences in ...What does the ambulance handover...
Transcript of th May 2017 (answers below) 1. What are the differences in ...What does the ambulance handover...
QUIZ10thMay2017(answersbelow)
1. WhatarethedifferencesinpaediatricALScomparedtoadultALS?
2. WhatdoestheambulancehandovermnemonicIMIST-AMBOrepresent?
3. WhatistheYoungandBurgessclassificationofpelvicringfractures?
4. WhatECGchangescanbefoundinacutepulmonaryembolus?
5. DescribeandinterpretthefollowingECG.
QUIZanswers10thMay2017
1. WhatarethedifferencesinpaediatricALScomparedtoadultALS?
ThepaediatricALSalgorithmfollowsthesamepatternastheadultALSalgorithmoftwominutelycycleswithrhythmcheck/pulseassessment,adrenalineevery2ndcycle,amiodaroneforrefractoryVF/VTandworkingthroughthereversiblecauses.TheonlydifferencesthatIcouldthinkofare;
a) Thecauseofcardiacarrestinpaediatricsisoverwhelminglysecondaryto
hypoxiaand/orhypovolaemia,ratherthanaprimarycardiaccause.Oxygenatedbreathsarestartedimmediatelyandtheventilationtochestcompressionratiois15:2ratherthan30:2.
b) Airwayopeninginaninfantrequiresaneutralpositionduetoasoftandsmall
airwaythatcankinkwithflexionorextension.Whensupine,theinfant’srelativelylargeocciputresultsinneckflexion,requiringslightshoulderelevationtoobtaintheneutralposition.
c) Infantsandchildrenaresmalleranddrugdosesandjoulesareweightbased
ratherthanflatdoses.
d) Thereisalmostalwaysaparentorcarerpresent.
2. WhatdoestheambulancehandovermnemonicIMIST-AMBOrepresent?
I IdentificationM Mechanismofinjury/MedicalcomplaintI Injuries/InformationrelatedtothecomplaintS SignsT TreatmentandTrendsA AllergiesM MedicationB BackgroundhistoryO Otherinformation
3. WhatistheYoungandBurgessclassificationofpelvicringfractures?
AnteriorPosteriorCompression(APC)ResultsindiastasisofthepubicsymphysisorverticalpubicramifracturePubicsymphysiswideningmayhavealreadybeenpartlycorrectedbypelvicbinding
LateralCompression(LC)FracturesmorecommoninLCthanAPCResultsinhorizontalorcoronalfractureofpubicrami
VerticalShear(VS)
CombinedorComplexMechanism(CM)Massiveunstableinjurythatdoesn’tclearlyfittheothercategories
APCTypeI<2.5cmsymphysiswideningispossiblewithnoposteriordisruption
APCTypeII>2.5cmsymphysiswideningrequiresthedisruptionofthesacrospinous,sacrotuberousandanteriorsacroiliacligamentcomplex
APCIII Completeposteriorligamentdisruption
LCTypeICompressionattheSIjointwithoutligamentdisruption
LCTypeIIInternalrotationofhemipelvisdisruptingposteriorSIjointandfurtherfractures
LCTypeIIIFurtherinternalrotationwithcontralateraldisruptionandfractures
Thesacrumisdrivendownrelativetoiliacwingresultingincompletedisruption
4. WhatECGchangescanbefoundinacutepulmonaryembolus?
• Sinustachycardia• RVstrainpattern
Twaveinversioninferiorlyandrightprecordialleads(V1-4)• RBBB–completeorincomplete• Rightaxisdeviation• DominantRwaveinV1withclockwiserotation• S1Q3T3sign• Atrialarrhythmias–atrialfibrillation,atrialflutter• Non-specificST-Twavechanges
5. DescribeandinterpretthefollowingECG.
Regulartachycardia125/minPwavesuprightinIIsolikelysinusinoriginQRS Narrow
Normalaxisat60degrees WideSwavesinprecordialleads,persistingtoV6(RVdilatation)
STsegmentsnotsignificantlychangedTwaveinversioninferiorly(II,IIIandaVF)Twaveinversionrightprecordialleads(V1-3) =RVstrainpatternQTc–calculatedmanuallyIget460msec,not577msec
! SinustachycardiawithRVstrain
(ThispatienthadamassivePEwithhypotension)