Acute Care Flashcards
Motor findings for GCS
- None
- Extends to pain
- Flexion to pain
- Withdraws form pain
- Localises to pain
- Obeys commands
Verbal findings for GCS
- None
- Sounds
- Words
- Confused
- Orientated
Eye findings for GCS
- None
- To pain
- To speech
- Spontaneous
Max GCS
15
Min GCS
3
CPR of < 1 year old
Dry baby first
3 chest compressions : 1 breath
CPR of child
5 rescue breaths
15 chest compressions : 2 breaths
CPR of adult
30 chest compressions : 2 breaths
- check for femoral and brachial pulse
Shockable rhythms
Ventricular Fibrillation (VF) Ventricular Tachycardia (VT)
Non-shockable rhythms
Asystole
Pulseless Electrical Activity (PEA)
Management for VT/VF
Defibrillation: 3 shocks first
1mg of adrenaline (repeat every 3-5 mins)
- witnessed: 3 stacked shocks
- un-witnessed: 1 shock + CPR (2mins) x 3
Management of Asystole/PEA
1mg of adrenaline ASAP (repeat every 3-5mins)
CPR
Reversible causes of cardiac arrest
5Hs + 4Ts
Hypoxia Hypovolaemia Hypothermia Hypoglycaemia/calcaemia/kalaemia Hyperkalaemia
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins
Management of hypothermia
Bring to 30 degrees
CPR + 3 x shocks
Specifics of chest compression in all children
100-120 compressions per min
1/3 depth of sternum
Acute fluid management for children
IV bolus of 20ml/kg 0.9% NaCl in < 10 mins
When to give fluids in burns
Adults: > 15% surface area burn
Children: > 10% surface area burn
Parkland formula for fluid resus in burns
Surface area (%) x weight (kg) x 4ml First 50% given in first 8 hours
What fluid to use in burn management
Crystalloid fluid (Hartman’s/Ringer’s)
Superior fluid to be used in resuscitation
Crystalloid
Risk of using colloid fluid
Risk of anaphylaxis
Signs of too much fluid
Increased JVP
Ascites
Lung crackles
Tachypnoea
Signs of too little fluid (negative fluid balance)
Tachycardia Hypotension Oliguria Sunken eyes Decreased skin turgor
Risk of using large volumes of 0.9% NaCl
Hyperchloraemic metabolic acidosis
Maintenance fluid management for children
0.45% NaCl + 5% Dextrose
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for next 10kg
Contraindications for Hartmann’s fluid
Don’t use in hyperkalaemia as it contains potassium
Daily requirements of maintenance fluid management in adults
Water: 25-30ml/kg/day Potassium: 1mmol/kg/day Sodium: 1mmol/kg/day Chloride: 1mmol/kg/day Glucose: 50-100g/day
Maintenance fluid management for adults (70kg man)
1L normal saline + 40ml potassium
or
1L 5% dextrose + 40ml potassium
Contents of 1L bag of normal (0.9%) NaCl saline solution
1L water
154 mmol sodium
154 mmol chloride
Contents of 1L bag of 5% dextrose solution
1L water
50g glucose
Total fluid in 70kg male
42L (100%)
Total intracellular fluid
28L (60-65%)
Total extracellular fluid
14L (35-40%)
Extracellular fluid is made up of
Interstitial Fluid = 10L (24%)
Plasma = 3L (5%)
Transcellular fluid = 1L (3%)
5 types of shock
Septic Anaphylactic Neurogenic Cardiogenic Haemorrhagic
Types of shock that cause cold peripheries
Cardiogenic
Haemorrhagic
Types of shock that cause warm peripheries
Distributive shocks:
- Septic
- Anaphylactic
- Neurogenic
Decreased SVR
Increased HR
Normal/increased CO
Decreased BP
Septic shock
Temp < 36 or > 38
Hr > 90
RR > 20
WBC < 4000 or > 12,000
Septic shock
Septic shock can lead to
Systemic inflammatory response syndrome (SIRS)
Multi organ failure
Neutropenic sepsis
Sepsis with neutrophil count < 1 x 10(9)/L
Why may you test a clotting screen in sepsis
To test for DIC
Management for Sepsis
BUFALO - “Sepsis Six”
Blood cultures Urine output Fluids (IV) Antibiotics Lactate Oxygen
What is Starling’s law?
Reduced preload = reduced cardiac output = reduced peripheral tissue perfusion
Shock occurring following a spinal cord transection
- often trauma/ RTA
Neurogenic shock
Pathophysiology of neurogenic shock
Increased parasympathetic tone
Decreased sympathetic tone
= reduced peripheral vascular resistance mediated by vasodilation
= hypotension + bradycardia
Increased SVR Increased HR Decreased CO Decreased BP Hx of IHD
Cardiogenic shock
Increased SVR Increased HR Decreased CO Decreased BP Recent Hx of Blood loss
Haemorrhagic “Hypovolaemic”
Volume of blood in average 70kg male
5L
- 7% of body weight in adult
- 9% of body weight in children
- less in elderly
4 Classifications of Haemorrhagic shock
I: <750ml loss
II: 750-1500ml loss
III: 1500-2000ml loss
IV: >2000ml
Secure airway at what GCS
= 8
igels (supra glottic airway) are used to intubate in
emergencies, especially cardiac
- cannot protect against aspiration
Trachea tube is used to intubate when
there is risk of aspiration
Guedel (oral airway) is used to
maintain airway
