11/25 2.0

Question 1

Aneurysmal Subarachnoid Hemorrhage
Aim for a target systolic blood pressure of?

Answer 1

SBP <160 mm Hg

Guidelines recommend a target of SBP <160 mm Hg, but most practitioners target <140 mm Hg if tolerated by the patient.

Question 2

Aneurysmal Subarachnoid Hemorrhage
Oxygen goal

Answer 2

Provide supplemental O2 if SaO2 is <94%

Question 3

Aneurysmal Subarachnoid Hemorrhage
BP medication

Answer 3

vailable agents include:

Nicardipine 5 mg/h IV –> infusion

Labetalol IV 10-20 mg bolus –> infusion

Question 4

Aneurysmal Subarachnoid Hemorrhage
Disability Prevention

Answer 4

seizure prophylaxis

levetiracetam 20 mg/kg IV
or
phenytoin / fosphenytoin

Oral Nimodipine also shown to improve mortality

Question 5

Aneurysmal Subarachnoid Hemorrhage
Disposition

Answer 5

Disposition to a Neurology or Neurosurgery ICU is optimal for these patients.

Question 6

AMPLE Hx

Answer 6

Allergies
Medications
Past medical history
Last meal and menses
Events leading to the injury.

Question 7

The cricothyroid membrane is too small for an open cricothyrotomy in children who are ____________ age.

Answer 7

under 10-12 years

Therefore, needle cricothyrotomy is recommended for infants and children after failed endotracheal intubation and supraglottic airway placement.

Question 8

ATLS maintains recommendation for needle decompression where?

Answer 8

2nd intercostal space, midclavicular line for children

5th intercostal space at the midaxillary line for adults.

Question 9

If increased ICP/impending herniation is suspected take these actions

Answer 9

-head of the bed to 30°
-hypertonic saline or mannitol
-avoid hypotension and hypoxia.

Question 10

ATLS chest tube size

Answer 10

28-32 French

Question 11

Trauma Blood pearls

Answer 11

Transfuse blood products in a 1:1:1 ratio of PRBCs : FFP: platelets

Give blood products through a blood warmer

first 3 h after injury should receive tranexamic acid