New content quiz July 2015

The facilitator should: acknowledge the question;paraphrase the question; allow time for participants to respond; encourage someone in the group to answer; summarise and add to the response; check for learner understanding; play “devil’s advocate” to stimulate discussion; use active listening skills. Facilitators should try not to answer the question – instead encouraging the group to find the answer. (link)

Retention techniques most likely to result in the retention of knowledge include;use primacy and recency to emphasis important points; active participation; relaxation; quizzes; using emotions; cases and stories; procedural mimicking, watching; handouts; and acronyms. Sessions should be short as the retention from sessions > 30 minutes tends to decrease substantially. (link)

When conducting a presentation: dim the lights but do not darken them; be gentle with the people who sit at the back of the room as they tend to be less assertive; organise seating in a semicircular pattern if possible as it facilitates greater involvement and discussion; talk slowly; use simple sentences; don’t present in the same format for > 20 minutes; insert images, videos, short breaks, discussions at strategic points; have a definite closure of the session. (link)

The methods usually considered the best for each knowledge type are as follows:
Theory – Narrative
Practical skills – Workshop/simulation
Interpersonal skills – Role play
Interpretation – Small group displays
Factual knowledge – Quizzes, memory exercises
Decision making skills – Sequential learning cases (link)

Techniques that may be of use in managing a disruptive participant include: Issue parking – ‘we’ll come back to that later’; involving (and hopefully exhausting!) their views – ‘that’s interesting, can you explain that in more detail’; controlling traffic – ‘we’ve heard a lot from this side of the room, what does the other side think’; defend the basics – ‘that is very interesting however this session is really about…’; separate tasking – send them out in a small group (or alone) to find out more information. Trying to exert your authority is not usually an effective technique to reduce the level of disruption. (link)

The correct positioning of a REBOA catheter for severe exsanguinating pelvic bleeding is Zone III (aortic bifurcation), The catheter is positoned in the descending thoracic aorta (Zone I)) if FAST positive, however this is not a substitute for resuscitative thoracotomy if a chest injury present. The catheter is allowed to drift downstream to lodge at the aortic bifurcation (Zone III) if major pelvic fracture present and FAST negative.Zone II (abdominal aorta) positioning is unlikely to have greater benefit than harm, so not recommended. There is no Zone IV! (link)

Once the decision to perform a resuscitative thoracotomy has been made, CPR is usually not helpful and resources are usually better deployed in preparing for thoracotomy. If the patient has a thoracic penetration with the implement still in situ but is impairing correct positioning, it is generally acceptable to take it out. Selective lung ventilation is advised, but by no means essential. A post mortem Caesarian section is usually advised prior to the thoracotomy as the removal of the placental circulation requirements may improve haemodynamics alone. (link)

The paralysis that occurs with polio is usually spinal (80% of cases) and asymmetrical. (link)

A serum Lipase > 3 times the normal limit is approximately 95% sensitive and specific, becoming close to 100% specific when > 1000 IUnits/L. It is more sensitive and specific than amylase but does not have a different pattern of elevation in different causes of pancreatitis. (link)

An urgent CT is not required in all cases. CT, when required, is usually performed at 3-5 days to detect early features of complications. An ERCP is recommended within 24 hours if cholangitis suspected or within 72 hours if dilated common bile duct visualised on US or CT or jaundice present (bilirubin > 85 µmol/L). Routine antibiotics are not recommended, but imipenem or ciprofloxacin should be used if infection present. (link)

Mesenteric panniculitis predominantly affects Caucasian males of increasing age. It causes gradual onset central abdominal pain as the bowel mesentry is involved in the vast majority of cases. Detection is usually on CT, demonstrating only fat stranding the bowel mesentry. Episodes are usually self resolving and immunosuppressive therapy is only used if recurrent, severe disease is present. (link)

An os acromiale is the failure of fusion of the acromial epiphyses that normally occurs at 25 years of age. It occurs in 1-15% of people and is bilateral in only 60% of cases. It does not increase the acromioclavicular distance (>6mm is abnormal). (link)

Needle aspiration may be successful if performed prior to the blood clotting and involves using a 20-mL syringe and an 18-gauge needle. Incision and evacuation of the haematoma involves injecting the inferior extent of the haematoma with l% lignocaine and l:l00,000 adrenaline then making a 5-mm (stab) incision with a No. 11 knife blade. The haematoma is then evacuated with suction or massage and a small drain may be placed following evacuation. Oral antibiotic prophylaxis e.g.cephalexin, 500 mg orally four times daily is recommended and a padded bandage applied to prevent haematoma reforming. This is changed at 24 hours and removed after 3 days. (link)

Impact apnoea may be seen by prehospital personnel or bystanders if they get to the scene soon enough. The patient may be apnoeic, hypotensive or hypertensive, may have fixed and dilated pupils and airway obstruction. Despite these early findings, the patient may recover spontaneously and have a good recovery as transient functional, rather than structural, injury may be present. It appears to be associated with a catecholamine surge without increased ICP and alcohol intoxication.
It may explain causes of cardiac arrest following relatively minor injury and survivors, with recovery, from bystander CPR following blunt trauma. (link)

Spontaneous idiopathic intracranial hypotension is rare and mostly affects women 30-50 years of age. It is due to spontaneous CSF loss mostly around the nerve roots of the thoracic spine, and rarely around the skull base, or lumbar region. Investigation with MRI with gadolinium of the entire spine using a short T1 recover (STIR) sequence is sensitive and specific for the detection of intracranial hypotension with linear pachymeningeal (dura-arachnoid) enhancement as the usual feature. Other features include: no enhancement of the sulci or brain surface; enhancement above and below the tentorium; enlargement of the pituitary gland; descent of the brain (low cerebellar tonsils); downward displacement of the iter of the third ventricle below the incisural line) and subdural effusions or haemorrhage may be present in some cases. An LP usually demonstrates an opening pressure of < 6cmH20 and CSF WCC and protein may be elevated. Xanthochromia may occur due to increased permeability of meningeal vessels and decreased CSF flow rates. (link)

95% of cardiac tumours are secondary tumours. Haematogenous spread usually involves the endocardium or myocardium and can occur in melanoma, lymphoma and sarcoma. Lymphatic spread usually involves the pericardium and epicardium in lung and breast cancer. Transvenous spread can occur in renal cell carcinoma and hepatocellular carcinoma. The pericardium is involved in 70% of secondary cardiac tumours. Diagnosis by cardiac CT is the preferred imaging modality although echocardiography may detect some tumours. (link)