Emergency Medicine Procedures.

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Which of the following about sizing a Nasopharyngeal Airway is correct?

Size from the tip of the nose to the opening of the ear.

Insert with the bevel facing the nasal septum.

Base of skull fractures is not a contraindication.

It is also known as the nasal trombone.

The sizing is from the tip of the nose to the ear lobe. Lubricate the tip first. It is sometimes called a "nasal trumpet".

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Which of the following ankle injuries is NOT suitable to put in a CAM (Moon) boot?

A Weber A fracture (fracture below the level of the syndesmosis).

Avulsion fracture of the 5th Metatarsal.

A lateral ankle sprain.

An isolated medial malleolar fracture.

A CAM (Controlled Ankle Motion) boot allows mobility whilst supporting the injured area. Needs proper fitting.

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Which of the following is TRUE concerning a lateral canthotomy?

It should be performed in the first 4 hours after presentation.

The lateral canthal tendon is cut to decrease the intraocular pressure.

It is a last ditch effort to decrease intraocular pressure and does not tend to work.

Sedation and analgesia is seldom required.

It should be done in the first 60-90min to save the patients sight. It does work to decrease the intraocular pressure and save sight. If you are doing it on me I would like Ketamine IV and local anaesthetic please.

/10

When performing a pericardiocentesis in the ED which of the following is NOT recommended?

If an interventional cardiologist is immediately available let them do it.

When using the apical view, enter the left ventricle then pull back into the pericardial space.

Ideally use ultrasound guidence.

If you are unfamiliar with the pericardiocentesis kit use a central line kit.

Use ultrasound to see which approach would be easiest. Often in line view with a linear probe works in the apical approach. Using a central line kit will work if required and is a good option if you are not used to the pericardiocentesis kit.

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Three out of four of the following statements about treating Priapism are correct. Which is not correct?

Block the 3 dorsal nerves at the base of the penis with local anaesthetic.

Use a "21G butterfly" attached to a syringe at 45 degrees directing distally into the corpus cavernosum and aspirate blood.

The corpus cavernosum on each side are usually connected so only have to go in on one side.

Over 50% of ED presentations with priapism will settle spontaneously.

Over 95% of these patients will need treatment in ED.

This is a link to an excellent video by James Miers and John MacKenzie.

https://vimeo.com/678407727?fl=pl&fe=cm

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In terms of inserting an iGel laryngeal mask which of the following is NOT recommended.

Place the patient in the "sniffing position".

Introduce the iGel towards the hard palate with the cuff outlet towards the chin of the patient.

Before insertion lubricate the back, sides and front with a thin layer of water based lubricant.

Once in position inflate the balloon.

The iGel does not require inflation. Below is a link to a good instructional video.

https://vimeo.com/692897227?fl=pl&fe=cm

/10

Which is the best summary of how to relocate this man's dislocated jaw?

Oxygen. Your thumbs on his lower back molars, Push down then forward.

Conscious sedation, Your thumbs on his lower back molars, Push down then back.

Conscious sedation, Your thumbs on his lower back molars, Push up then back.

Oxygen. Your thumbs on his lower back molars, Push down and wait.

Few additional bits. Place gauze between your thumbs and his back molars. Get someone to apply mild pressure to his forehead so he doesn't move.

/10

Which situation would be the best to use "wound glue"?

A 2cm linear forehead laceration.

A triangular laceration on the elbow.

A ragged 3cm cat bite on the back of the hand.

A laceration crossing the vermilion border.

Wound glue is useful for clean linear lacerations.

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Why is a straight blade laryngoscope often preferred when intubating a child under 3 years?

Because of the child's short neck.

Because you can lift the large floppy epiglottis by going under it rather than in the vallecula.

Because of the large head compared to the rest of the body in the young child.

Because the straight blade gives you a more direct light source.

So the straight blade directly lifts the epiglottis whilst the curved blade sits in the vallecula and "indirectly" lifts the epiglottis. With an infant's somewhat anterior larynx and floppy epiglottis often the straight blade is preferred over the curved blade laryngoscope in intubations.

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Which of the following is UNTRUE?

Maria Carey dislocated her shoulder filming a promo.

Filming of "Die Hard" was delayed for 3 months because Bruce Willis dislocated his shoulder.

Terry Alderman dislocated his shoulder tackling a pitch invader in a cricket test match.

Matt LeBlanc dislocated his shoulder filming an episode of "Friends"

The short video shows the injury to Terry Alderman. It was against England at the WACA in 1982. He ended spending over a year out of the game.