THE WRITTEN EMERGENCY MEDICINE FELLOWSHIP COURSE
ROADBLOCK 1 Examination
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QUESTION 1: A 58 year old man presents to your department by ambulance from a construction site after being hit in the chest and face by a large concrete block swinging from a pulley. He has sustained no other injuries. His vital signs on arrival are: HR 115 /min BP 99/66 mmHg RR 28 /min O2 sats 95% 6L via mask GCS 7 i. (4 marks) Give 4 signs on chest examination that may indicate the possibility of a pneumothorax. (4 marks)
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Question 2. The patient’s chest xray is taken just after arrival. Give 2 major abnormalities from the film and the underlying diagnosis diagnosis.
iii. (2 marks) After the patient’s xray returns he suffers increasing respiratory distress, de-saturates and has a cardiac arrest. What two actions would you immediately undertake?
iv. (1 mark) After your actions above the patient regains immediate output but remains hypotensive with a systolic BP of 78mmHg. What volume resuscitation will you administer to this patient?
v. (5 marks) Give 5 endpoints you would use to judge the efficacy of your volume resuscitation.
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