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emq: RESUSCITATION
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Match each clinical vignette to the most appropriate therapy.
Adrenaline infusion Bilateral thoracotomies Noradrenaline infusion Adrenaline 500mcg IM injection Thrombolysis |
High dose steroids Massive transfusion protocol Emergency thoracotomy Dobutamine infusion Dopamine infusion Heparin infusion |
EMQ 1.
A 5 year old child on chemotherapy for leukaemia presents with a fever of 39 degrees and an altered level of consciousness. She has a capillary refill time of 4 seconds, and her serum lactate is 4.8mmol/L. After 60ml/kg of NaCl 0.9% her blood pressure remains 67/32 mmHg and her heart rate is 165.
ANSWER: adrenaline infusion
COMMENT: this paediatric patient has septic shock. In paediatric patients the aetiology of shock is often a hypodynamic heart, rather than a loss of vasomotor tone, and thus adrenaline is preferred as an inotrope over noradrenaline.
EMQ 2.
A 24 year old motorbike rider has presented after a high speed accident. A CT trauma scan identifies a posteriorly displaced T2 fracture, and no other major injuries. Despite 2L of crystalloid his blood pressure remains 60 systolic.
ANSWER: noradrenaline infusion
COMMENT: high spinal injuries are often associated with a loss of vasomotor tone, and restoration of this with a vasopressor is indicated to address the shock.
EMQ 3.
A 16 year old girl presents with stridor and lip swelling after being stung by a bee.
ANSWER: Adrenaline 300-500mcg IM.
COMMENT: Adrenaline 300-500mcg IM is the first line therapy for acute anaphylaxis.
EMQ 4.
A 28 year old drug user presents after calling an ambulance for acute dyspnoea. On arrival he has oxygen saturations of 76% on a NRB mask, and a blood pressure of 75mmHg systolic.
ANSWER: thrombolysis
COMMENT: the incidence of DVT in injecting drug users is high, and with a history suggesting PE thrombolysis is indicated empirically for this unstable patient.
EMQ 5.
A 66 year old woman presents after a motor vehicle accident. She has been intubated by the prehospital team at the roadside, and has become progressively more unstable en route to the hospital. Her BP on arrival is 55mmHg, and on examination she has generalized surgical emphysema across her anterior chest.
ANSWER: bilateral thoracotomies
COMMENT: this patient has a history suggestive of obstructive shock, most probably form a tension pneumothorax. Around a third of blunt trauma patients who arrest recover circulation with decompression of the chest.
A 5 year old child on chemotherapy for leukaemia presents with a fever of 39 degrees and an altered level of consciousness. She has a capillary refill time of 4 seconds, and her serum lactate is 4.8mmol/L. After 60ml/kg of NaCl 0.9% her blood pressure remains 67/32 mmHg and her heart rate is 165.
ANSWER: adrenaline infusion
COMMENT: this paediatric patient has septic shock. In paediatric patients the aetiology of shock is often a hypodynamic heart, rather than a loss of vasomotor tone, and thus adrenaline is preferred as an inotrope over noradrenaline.
EMQ 2.
A 24 year old motorbike rider has presented after a high speed accident. A CT trauma scan identifies a posteriorly displaced T2 fracture, and no other major injuries. Despite 2L of crystalloid his blood pressure remains 60 systolic.
ANSWER: noradrenaline infusion
COMMENT: high spinal injuries are often associated with a loss of vasomotor tone, and restoration of this with a vasopressor is indicated to address the shock.
EMQ 3.
A 16 year old girl presents with stridor and lip swelling after being stung by a bee.
ANSWER: Adrenaline 300-500mcg IM.
COMMENT: Adrenaline 300-500mcg IM is the first line therapy for acute anaphylaxis.
EMQ 4.
A 28 year old drug user presents after calling an ambulance for acute dyspnoea. On arrival he has oxygen saturations of 76% on a NRB mask, and a blood pressure of 75mmHg systolic.
ANSWER: thrombolysis
COMMENT: the incidence of DVT in injecting drug users is high, and with a history suggesting PE thrombolysis is indicated empirically for this unstable patient.
EMQ 5.
A 66 year old woman presents after a motor vehicle accident. She has been intubated by the prehospital team at the roadside, and has become progressively more unstable en route to the hospital. Her BP on arrival is 55mmHg, and on examination she has generalized surgical emphysema across her anterior chest.
ANSWER: bilateral thoracotomies
COMMENT: this patient has a history suggestive of obstructive shock, most probably form a tension pneumothorax. Around a third of blunt trauma patients who arrest recover circulation with decompression of the chest.