Acute Care Flashcards
What are the ways to ensure good quality CPR?
- On a firm surface
- Push hard (1/3 anterior diameter)
- Compress at rate 100-120
- Allow full chest recoil
- Switch compressors Q2min with <5s between change
- <10s for pulse check
- Avoid excessive ventilation
How do you manage bradycardia (if < 60 bpm + impaired perfusion)?
- Epinephrine 1:10,000 (0.01 mg/kg)
- Pacing
How do you manage bradycardia +pulseless (PEA)?
- Epinephrine 1:10,000 (0.01 mg/kg)
- No electricity indicated
How do you manage SVT (narrow complex)?
- Meds: Adenosine 0.1mg/kg, 2nd line procainamide or amiodarone
- Synchronized cardioversion (0.5-1.0 J/kg)
How do you manage Ventricular tachycardia + pulse?
- Meds: Adenosine (stable), 2nd line is amiodarone or procainamide
- Unstable: synchronized cardioversion (0.5-1.0J/kg)
How do you manage V tach no pulse or V fib?
- Epinephrine 1:10,000 (0.01mg/kg), 2nd line lidocaine or amiodarone (equally effective)
- Defibrillation 2J/kg then 4J/kg (max 10J/kg)
What are the indications for intubation?
- Patient can’t ventilate or oxygenation or impending failure (lung, airway, CNS, PNS)
- Reduction of LV afterload
- Need to decrease metabolic demand or regulate physiology (e.g. TBI)
Other:
- GCS < 9 in the trauma patient
- Inability to maintain a patent and protected airway
- Refractory hypoxia and/or respiratory acidosis
- Inadequate respiratory drive
- Severe WOB
- Potential for deterioration (e.g. inhalation burn, Stevens-Johnson Syndrome)
- As needed for procedures/imaging
How do you determine ETT size?
- <1yo: 3.0, 1-2yo: 3.5 ETT
- 2y +
- 4 + (age/4) uncuffed
- 3.5 + (age/4) microcuffed
- Broselow tape!
What are 5 differences in the pediatric airway?
- Larger tongue → more upper airway obstruction
- Epiglottis is narrow and angled posteriorly over the glottic opening
- Glottic opening is directed posterio-inferiorly
- Cricoid cartilage → narrowest part of the airway
- Larynx sits higher in an infant at C3-4 (vs. C4-5)
What are injuries with an increased risk of intracranial injuries?
Fall from > 3 ft, MVC or impact from high-velocity projectile
What are clinical signs associated with an increased risk of intracranial injuries?
- Prolonged loss of consciousness or impaired level of consciousness
- Disorientation or confusion; amnesia
- Worsening headache
- Repeated or persistent vomiting
What are the absolute and relative indications for performing a CT head after a head injury?
- Absolute indications: moderate-to-severe head injury (GCS 13 or lower), focal neurological deficit on exam, suspected open or depressed skull # or diastatic skull # seen on x-ray
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Relative indications:
- Abnormal mental status: GCS < 14 at any point from time of initial assessment onward, or GCS < 15 at 2 h after injury
- Clinical deterioration over 4 h to 6 h of observing a symptomatic patient in the ED, including worsening headache or repeated vomiting
- Signs suggestive of a basal skull fracture
- Large, boggy scalp hematoma in child ≥ 2 years of age; in younger children, consider performing a skull x-ray first
- Mechanism of trauma raising suspicion for serious injury (eg, falling from a height, a motor vehicle collision in which speed was a factor, or impact with a projectile, such as a gunshot or a metal fragment)
- Persistent irritability in a child < 2 years of age
- Seizures at the time of the event or later
- Known coagulation disorder
What are risk factors for post-traumatic seizures?
Younger age, severe head trauma (GCS < 9), cerebral edema, SDH, open or depressed skull #
What creating a rapid response system, special attention should be paid to which areas during implementation?
- Special attention should be paid to the following details of implementation:
- Composition (skills and disciplines) and member availability
- Calling criteria
- Awareness of and interface with hospital staff
- Methods of activation
