-
Question 1
Correct
-
A 7-year-old girl is hit by a car while crossing the street. She is brought to the resus area of your Emergency Department by a blue light ambulance. A trauma call is initiated, and a primary survey is conducted. She is stable hemodynamically, and the only abnormality found is a significantly swollen and deformed left thigh area. An X-ray is taken, which shows a fracture in the proximal femoral shaft. The child is experiencing intense pain, and you prepare to apply skin traction to immobilize the fracture.
What percentage of the child's body weight should be applied to the skin traction?Your Answer: 10%
Explanation:Femoral shaft fractures are quite common among children and have a significant impact on both the child and their family. It is important to carefully examine children with these fractures for any associated injuries, such as soft-tissue injury, head trauma, or additional fractures. In fact, up to 40% of children who experience a femoral shaft fracture due to high-energy trauma may have these associated injuries. Additionally, a thorough neurovascular examination should be conducted.
Rapidly immobilizing the limb is crucial for managing pain and limiting further blood loss from the fracture. For distal femoral shaft fractures, well-padded long leg splints with split plaster casts can be applied. However, for more proximal shaft fractures, long leg splints alone may not provide adequate control. In these cases, skin traction is a better option. Skin traction involves attaching a large foam pad to the patient’s lower leg using spray adhesive. A weight, approximately 10% of the child’s body weight, is then applied to the foam pad and allowed to hang over the foot of the bed. This constant longitudinal traction helps keep the bone fragments aligned.
When children experience severe pain, it is important to manage it aggressively yet safely. Immobilizing the fracture can provide significant relief. The Royal College of Emergency Medicine recommends other pain control measures for children, such as intranasal diamorphine (0.1 mg/kg in 0.2 ml sterile water), intravenous morphine (0.1-0.2 mg/kg), and oral analgesia (e.g., paracetamol 20 mg/kg, max 1 g, and ibuprofen 10 mg/kg, max 400 mg).
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 2
Incorrect
-
A 3-year-old girl is hit by a car while crossing the street. She is brought to the resus area of your Emergency Department by a blue light ambulance. A trauma call is initiated, and a primary survey is conducted. She is stable hemodynamically, and the only abnormality found is a severely swollen and deformed left thigh area. An X-ray is taken, which shows a fracture in the proximal femoral shaft. The child is experiencing significant pain, and you decide to apply skin traction to immobilize the fracture. You also plan to administer a dose of intranasal diamorphine.
The child weighs 15 kg. What is the appropriate dose of intranasal diamorphine to administer?Your Answer: 0.4 mg
Correct Answer: 2 mg
Explanation:Femoral shaft fractures are quite common among children and have a significant impact on both the child and their family. It is important to carefully examine children with these fractures for any associated injuries, such as soft-tissue injury, head trauma, or additional fractures. In fact, up to 40% of children who experience a femoral shaft fracture due to high-energy trauma may have these associated injuries. Additionally, a thorough neurovascular examination should be conducted.
Rapidly immobilizing the limb is crucial for managing pain and limiting further blood loss from the fracture. For distal femoral shaft fractures, well-padded long leg splints with split plaster casts can be applied. However, for more proximal shaft fractures, long leg splints alone may not provide adequate control. In these cases, skin traction is a better option. Skin traction involves attaching a large foam pad to the patient’s lower leg using spray adhesive. A weight, approximately 10% of the child’s body weight, is then applied to the foam pad and allowed to hang over the foot of the bed. This constant longitudinal traction helps keep the bone fragments aligned.
When children experience severe pain, it is important to manage it aggressively yet safely. Immobilizing the fracture can provide significant relief. The Royal College of Emergency Medicine recommends other pain control measures for children, such as intranasal diamorphine (0.1 mg/kg in 0.2 ml sterile water), intravenous morphine (0.1-0.2 mg/kg), and oral analgesia (e.g., paracetamol 20 mg/kg, max 1 g, and ibuprofen 10 mg/kg, max 400 mg).
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 3
Correct
-
A 3-year-old girl is hit by a car while crossing the street. She is brought to the resus area of your Emergency Department by a blue light ambulance. A trauma call is initiated, and a primary survey is conducted. She is stable hemodynamically, and the only abnormality found is a severely swollen and deformed left thigh area. An X-ray is taken, which shows a fracture in the proximal femoral shaft. The child is experiencing significant pain, and you decide to apply skin traction to immobilize the fracture. You also plan to administer a dose of intranasal diamorphine.
The child weighs 12 kg. What is the appropriate dose of intranasal diamorphine to administer?Your Answer: 1.5 mg
Explanation:Femoral shaft fractures are quite common among children and have a significant impact on both the child and their family. It is important to carefully examine children with these fractures for any associated injuries, such as soft-tissue injury, head trauma, or additional fractures. In fact, up to 40% of children who experience a femoral shaft fracture due to high-energy trauma may have these associated injuries. Additionally, a thorough neurovascular examination should be conducted.
Rapidly immobilizing the limb is crucial for managing pain and limiting further blood loss from the fracture. For distal femoral shaft fractures, well-padded long leg splints with split plaster casts can be applied. However, for more proximal shaft fractures, long leg splints alone may not provide adequate control. In these cases, skin traction is a better option. Skin traction involves attaching a large foam pad to the patient’s lower leg using spray adhesive. A weight, approximately 10% of the child’s body weight, is then applied to the foam pad and allowed to hang over the foot of the bed. This constant longitudinal traction helps keep the bone fragments aligned.
When children experience severe pain, it is important to manage it aggressively yet safely. Immobilizing the fracture can provide significant relief. The Royal College of Emergency Medicine recommends other pain control measures for children, such as intranasal diamorphine (0.1 mg/kg in 0.2 ml sterile water), intravenous morphine (0.1-0.2 mg/kg), and oral analgesia (e.g., paracetamol 20 mg/kg, max 1 g, and ibuprofen 10 mg/kg, max 400 mg).
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 4
Incorrect
-
You intend to utilize plain 1% lidocaine for a ring block on a finger that requires suturing.
Which ONE statement concerning the utilization of 1% lidocaine, in this scenario, is accurate?Your Answer: The maximum safe dose of plain lidocaine alone is 7 mg/kg
Correct Answer: Lidocaine works by blocking fast voltage-gated sodium channels
Explanation:Lidocaine is a tertiary amine that is primarily utilized as a local anesthetic. It can also be employed in the treatment of ventricular arrhythmias. The mechanism of action of lidocaine as a local anesthetic involves its diffusion in the form of an uncharged base through neural sheaths and the axonal membrane. It then reaches the internal surface of the cell membrane sodium channels, where it exerts its effect by blocking the fast voltage-gated sodium channels. This alteration in signal conduction prevents the depolarization of the postsynaptic neuron’s membrane, thereby inhibiting the transmission of pain signals.
In a plain 1% lidocaine solution, each 1 ml contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg, with a maximum limit of 200 mg. However, when administered with adrenaline in a 1:200,000 ratio, the maximum safe dose increases to 7 mg/kg, with a maximum limit of 500 mg. It is important to note that the combination of lidocaine and adrenaline should not be used in extremities such as fingers, toes, and the nose due to the risk of vasoconstriction and tissue necrosis.
The half-life of lidocaine ranges from 1.5 to 2 hours. It exhibits a rapid onset of action within a few minutes and has a duration of action of 30 to 60 minutes when used alone. However, when co-administered with adrenaline, its duration of action is prolonged. It is worth mentioning that lidocaine tends to induce vasodilation, primarily attributed to the inhibition of action potentials in vasoconstrictor sympathetic nerves through the blocking of sodium channels.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 5
Incorrect
-
You intend to utilize 1% lidocaine with adrenaline 1:200,000 for a peripheral nerve block on a 60 kg healthy young female. What is the maximum amount of lidocaine that can be administered in this scenario?
Your Answer: 70 mg lidocaine hydrochloride
Correct Answer: 420 mg lidocaine hydrochloride
Explanation:The maximum safe dose of plain lidocaine is 3 mg per kilogram of body weight, with a maximum limit of 200 mg. However, when lidocaine is administered with adrenaline in a 1:200,000 ratio, the maximum safe dose increases to 7 mg per kilogram of body weight, with a maximum limit of 500 mg.
In this particular case, the patient weighs 60 kg, so the maximum safe dose of lidocaine hydrochloride would be 60 multiplied by 7 mg, resulting in a total of 420 mg.
For more detailed information on lidocaine hydrochloride, you can refer to the BNF section dedicated to this topic.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 6
Correct
-
Your Pediatric Department has implemented a protocol for conducting landmark guided fascia iliaca compartment blocks (FICB) for pediatric patients with a fractured femoral neck.
Which of the following two landmarks should be utilized?Your Answer: The anterior superior iliac spine and the pubic tubercle
Explanation:The fascia iliaca compartment is a space within the body that has specific boundaries. It is located at the front of the hip and is surrounded by various muscles and structures. The anterior limit of this compartment is formed by the posterior surface of the fascia iliaca, which covers the iliacus muscle. Additionally, the medial reflection of this fascia covers every surface of the psoas major muscle. On the posterior side, the limit is formed by the anterior surface of the iliacus muscle and the psoas major muscle. The medial boundary is the vertebral column, while the cranially lateral boundary is the inner lip of the iliac crest. This compartment is also continuous with the space between the quadratus lumborum muscle and its fascia in a cranio-medial direction.
The fascia iliaca compartment is important because it allows for the deposition of local anesthetic in sufficient volumes. This can be achieved through a straightforward injection, which targets the femoral and lateral femoral cutaneous nerves. These nerves supply sensation to the medial, anterior, and lateral thigh. Occasionally, the obturator nerve is also blocked, although this can vary from person to person.
To perform a fascia iliaca compartment block (FICB), specific landmarks need to be identified. An imaginary line is drawn between the anterior superior iliac spine (ASIS) and the pubic tubercle. This line is then divided into thirds. The injection entry point is marked 1 cm caudal (inferior) from the junction of the lateral and middle third.
However, there are certain contraindications to performing a FICB. These include patient refusal, anticoagulation or bleeding disorders, allergy to local anesthetics, previous femoral bypass surgery, and infection or inflammation over the injection site.
As with any medical procedure, there are potential complications associated with a FICB. These can include intravascular injection, local anesthetic toxicity, allergy to the local anesthetic, temporary or permanent nerve damage, infection, and block failure. It is important for healthcare professionals to be aware of these risks and take appropriate precautions when performing a FICB.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 7
Incorrect
-
A 7-year-old girl is brought to the Emergency Department by her father after falling at a park. Her ankle appears to be deformed, and it is suspected that she has a fracture in her distal fibula. Her pain is evaluated using a numerical rating scale, and the triage nurse informs you that she is experiencing moderate pain.
According to the RCEM guidance, which of the following analgesics is recommended for managing moderate pain in a child of this age?Your Answer: Oral paracetamol 5 mg/kg
Correct Answer: Rectal diclofenac 1 mg/kg
Explanation:A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.
To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.
The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.
To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 8
Incorrect
-
A 32-year-old trauma patient needs procedural sedation for the reduction of an open fracture in his tibia and fibula. Your plan is to use ketamine as the sedative agent.
What type of receptor does ketamine act on to produce its effects?Your Answer:
Correct Answer: N-methyl-D-aspartate (NMDA)
Explanation:Ketamine stands out among other anaesthetic agents due to its unique combination of analgesic, hypnotic, and amnesic properties. This makes it an incredibly valuable and adaptable drug when administered correctly.
The mechanism of action of ketamine involves non-competitive antagonism of the Ca2+ channel pore within the NMDA receptor. Additionally, it inhibits NMDA receptor activity by interacting with the binding site of phencyclidine.
In summary, ketamine’s multifaceted effects and its ability to target specific receptors make it an indispensable tool in the field of anaesthesia.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 9
Incorrect
-
A 3-year-old girl is brought to the Emergency Department by her father after she accidentally spilled a cup of hot tea on her legs and feet. Her upper body is unaffected, but she is crying in agony. Her pain is evaluated using a numerical rating scale, and the triage nurse informs you that she has 'intense pain'.
Which pain relief method is most suitable to be used as a temporary measure until more effective pain relief can be given?Your Answer:
Correct Answer: Inhaled entonox
Explanation:A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.
To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.
The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.
To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.
-
This question is part of the following fields:
- Pain & Sedation
-
-
Question 10
Incorrect
-
You provide nitrous oxide to a child who has experienced a significant injury for temporary pain relief.
Which of the following is NOT a reason to avoid using nitrous oxide?Your Answer:
Correct Answer: Sepsis
Explanation:The prolonged use of nitrous oxide (Entonox) in patients with sepsis may have a negative impact on DNA synthesis, and it is not recommended to use it in this situation. However, sepsis itself does not prevent the use of nitrous oxide.
There are several conditions that make the use of nitrous oxide inappropriate. These include a reduced level of consciousness, diving injuries, pneumothorax, middle ear disease, sinus disease, bowel obstruction, a documented allergy to nitrous oxide, hypoxia, and violent or disabled psychiatric patients.
It is important to note that the use of nitrous oxide should be avoided in patients with sepsis due to its potential effects on DNA synthesis. However, there are other contraindications to its use that should be considered in different clinical scenarios.
-
This question is part of the following fields:
- Pain & Sedation
-
00
Correct
00
Incorrect
00
:
00
:
0
00
Session Time
00
:
00
Average Question Time (
Mins)