GCS 16



Fellowship course Week 3 - ResusWRITTEN EXAMINATIONSHORT ANSWER QUESTIONS EXAMINATION TIME: 66 MinutesQuestion 1 (15 marks) 6 minutesA 23-year-old man presents with a complaint of palpitations and dizziness. His vital signs on presentation include:BP 70/50mmHgRR 16/minTemp 37°CGCS 15An ECG is taken on presentation.State seven (7) abnormal findings for this ECG. (7 marks)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 1 (continued)List three (3) possible causes for this condition in this patient. (3 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________What is your first line treatment for this patient? (1 mark)_________________________________________________________________________State four (4) possible additional treatments for this patient, following your first line treatment. (4 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 1Question 2 (12 marks) 6 minutes An 87-year man presents from a nursing home with acute deterioration.An ECG is taken.What is the most likely diagnosis? (1 mark)___________________________________________________________________________List three (3) features of this ECG that support this diagnosis. (3 marks)_______________________________________________________________________________________________________________________________________________________________________________________________________________________List four (4) likely causes for this diagnosis. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 2 (continued)List four (4) treatments that you would consider for this patient. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 2-1586230156505100Question 3 (15 marks) 6 minutesAn 80-year-old female presents to ED with palpitations and shortness of breath. She has undergone coronary artery bypass grafting 2 weeks earlier.An ECG is taken.5962651841500Question 3 (continued)State five (5) abnormalities shown on this ECG. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List six (6) likely causes for her symptoms in the setting of this ECG. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 3 (continued)List four (4) investigations that you would perform to assist with your diagnosis. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 4 (12 marks) 6 minutesA 25-year-old male is intubated for decreased conscious state following a polydrug overdose. The patient remains in your emergency department overnight. Following your ward round in the morning you assess the patient as being suitable for extubation.List four (4) patient factors that are required to allow safe extubation of this patient. For each factor, state how you would ensure adequacy. (8 marks)Patient factor (4 marks)How would you ensure adequacy of the factor?(4 marks)1.2.3.4.Question 4 (continued)You perform extubation.List four (4) steps in your post- extubation care for this patient. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 5 (12 marks) 6 minutesA 26-year-old female presents with an unconscious collapse.She appears unwell and significantly underweight.Her relevant vital signs are:GCS 15BP 105/50mmHgRR20bpmTemperature36.8°CAn ECG is taken.State two (2) abnormal ECG findings. (2 marks)________________________________________________________________________________________________________________________________________________List four (4) medications that may lead to these ECG changes. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 5 (continued)Whilst you are assessing the patient, she loses consciousness and loses her output.She is moved to a resuscitation cubicle with full external monitoring applied.ACLS is commenced.A rhythm strip is taken.List six (6) immediate treatments that may be indicated for this patient. (6 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 512 lead ECG-2062480213233000Question 5Rhythm strip-1538605299275500Question 6 (25 marks) 9 minutesA 25 year old requires intubation following a drug overdose. Demonstrate your failed intubation algorithm. (17 marks)Question 6 (continued)List eight (8) checks that you would perform in the 10 minutes after establishing appropriate position of an Endotracheal Tube with ETCO2 monitoring. (8 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 7 (12 marks) 6 minutes A 67-year-old woman who lives independently has been brought in after being found by her daughter on the floor of her shower. It appears that she has been there all night. She was well the day before. Initial observations:BP 70/40 mmHgRR 6/minGCS 7/15(E-1 V-2 M-4)Temperature27° C (aural)SaO2 95%. 8L by Hudson maskList four (4) positive ECG findings that you may expect at this stage. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 7 (continued)List four (4) methods that you would use to rewarm this patient. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other than for airway protection, state two (2) pros for intubating this patient. (2 marks)______________________________________________________________________________________________________________________________________________State two (2) cons for intubating this patient. (2 marks)______________________________________________________________________________________________________________________________________________Question 8 (14 marks) 6 minutesYou are preparing to perform a rapid sequence intubation for a 65-year-old female.State five (5) clinical features that you would review to determine whether she will be a difficult intubation. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________State five (5) steps that you would take if a difficult airway is identified. (5 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 8 (continued)State four (4) methods that you may utilise to confirm correct endotracheal tube position post intubation. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 9 (12 marks) 6 minutesA 35-year-old female presents with sudden onset of difficulty with breathing.A photograph is taken soon after arrival.List three (3) different medications that you would use for her condition in the first 30 minutes. State the route and dose for each medication. (6 marks)Drug(3 marks)Route(1.5 marks)Dose(1.5 marks)1.2.3.Question 9 (continued)The patient responds poorly to your above medications and has marked stridor.Other than drugs used to facilitate rapid sequence induction, list three (3) further, different medications that may be utilised in this setting. State the route and dose for each medication. (6 marks)Drug(3 marks)Route(1.5 marks)Dose(1.5 marks)1.2.3.Question 9Question 10 (17 marks) 9 minutesA 64-year-old man presents to your Emergency Department with dyspnoea and palpitations. His past history includes COPD, chronic renal failure, obesity, IHD and hypertension.Vital signs on presentation are:BP 88/60mmHgRR20bpmO2 sats 88%RAGCS 15Temperature36°CAn ECG is taken.State six (6) abnormal ECG findings. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 10 (continued)A venous blood gas is performed.List three (3) key abnormalities in this blood gas. State one (1) point to demonstrate the significance of each abnormality for this patient. (6 marks)Abnormality(3 marks)Significance(3 marks)1.2.3. Question 10 (continued)List five (5) medications that you may prescribe for this patient. (5 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Venous blood gasesReference rangepH 6.9 (7.35 – 7.45)pCO2 60 mmHg (35 – 45)pO2 28 mmHgHCO3 10 mmol/L (22 – 33)Base Excess -10 (-3 – +3)K+ 8.6 mmol/L (3.5 – 5.5) ................
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