Drowning

Definition

Drowning is defined as respiratory impairment due to submersion in liquid. Often associated with hypothermia, trauma and result in multi-organ failure.

  • The aspirate is either hypertonic (sea water) or hypotonic (fresh water) leading to pulmonary oedema; the water may carry bacteria or particulate matter.
  • Initial assessment: precipitating event (alcohol/drugs), water type and temperature, known medical history, ABCDE.

 

Resources


paper Drowning, Carter & Sinclair. CEACCP (2011)

 

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Extracorporeal Membrane Oxygenation

Classification

  • veno-arterial ECMO (VA-ECMO): gas exchange and haemodynamic support
  • veno-venous (VV-ECMO): gas exchange
  • arterio-venous ECMO (AV-ECMO): gas exchange (mainly CO2 removal; no pump)

Resources


paperExtracorporeal membrane oxygenation in adultsMartinez & Vuylsteke, CEACCP 2012

 

ECGs

ECGs are frequently presented to candidates sitting the OSCE element of the exam, a systematic approach is essential.

  • Name, date, calibration (1mv=1cm, 0.2s=1cm [small square 40 msec])
  • Rate = 300/number of big squares between Q-Q
  • Rhythm AF, tachy (>100), brady (<60), sinus, heart block
  • Axis normal = -30° to +110°

P              peaked, tall Dright atrial hypertrophy

notched, broad Dleft atrial hypertrophy

P-R          >5 small squares

I degree block: prolonged PR interval

                II degree block:

                                Wekeneback: sequential ­ of PR interval

Mobitz typ II: fixed PR, dropped QRS (2:1, 3:1…)

                III degree block: disassociation of P and QRS

QRS        wide (<2.5 small squares)

MarroW Dright bundle branch block

WilliM Dleft bundle branch block

Q             1mm wide, 2mm/25% of R-wave

D old MI

Normal in lead I, aVL V6

ST           raised: 1mm 2xconsangious limb-leads, 2mm chest-leads

Depression: myocardial ischemia

Reverse tick: digoxin effect

Saddle shaped elevation: acute constrictive pericarditis

T              peaked hyperkalaemia

Flat, prolonged, hypokalaemia

Ischemia, infarction

Normal in III, V1-2 (and V3 in Negroes)

U             Normal/Hypokalaemia

 

MI: Hyperacute T-waves, ST-elevation T-wave inversion, Q-waves. Inf. (II, III, aVF) Ant. (V1-4), Lat. (I, aVL,V5-6) Post. look at V1-2. New LBBB.

PE: S-I (deep S-waves in I), Q-III (Q-waves in III), T-III (inverted T-waves in III). More generally a sign of R-heart strain.

Hyperkalaemia: tall tented T, wide QRS

Hypokalaemia: flattened T, prominent U, (muscle weakness, cramps, tetany)

 

Resources


On the webECG Wave-Maven – is a resource with many “barn-door” ECGs, presented in a quiz format; large database, expert explanations.