All of it Flashcards
Signs of an aortic dissection? (3 key things)
- Hypotension
- Hoarseness + swallowing difficulties
- Nil ECG changes
+ pain that radiates to the back
Do we need the cath lab? What is PPCI
Primary percutaneous coronary intervention
STEMI > Cath lab
or
STEMI > Thrombolysis (in or out of hospital) + Angio (blood thinners) - if this fails t/f to PCCI hospital
What medication do you give to chest pain < prior to cath lab >
Anti thrombolytic therapy
Clopidogrel 300-600
Tricgrelor 180
Drasurel 60
ACS includes (3) + management
Angina
NSTEMI
SETMI
1st line - asprin
2nd line - GTN
ALS Rythym
CPR 30:2 > attach defib + monitor
SHOCK - shock, CPR 2 min, 2nd shock 1 mg adrenaline then every 2 loop + Amido. 300 mg after 3 shocks
NON SHOCK - CPR 2 min, 1 mg adrenaline immediately then every 2nd loop
What do you charge the defib to?
200 biphasic
Can go up to 360
Etco2 during CPR & what is considered a poor outcome?
Etco2 decreases during CPR as cardiac output in low and output is generated by compressions
> Failure to achieve > 10 mmHg after 20 min is linked to poor outcomes
Normal Capnography? + Inspiratory & Ex
35-45 mmHg
Inspiratory = flat line
Ex = wave
Potential complications of IO access?
Heamotoma
Compartment syndrome
Narrow pulse pressure?
arterial vasoconstriction
e.g. Cardiogenic / hypovolemic shock
Normal PP?
35-45
Wide PP?
arterial vasodilation e.g. anaphylaxis or sepsis
Calcium Significance with the Heart
stabilises the <3 membranes
Heat exhaustion vs heat stroke
Exhaustion - under 40*
Stroke - over 40*
Naloxone dose
100 mcg increments
Tricyclic (anti-depressant) antidote?
sodium bicarb bolus
Cyanide positioning - antidote?
causes <3 toxicity
* B12 Injection 5mg
Choking
encourage coughing
OR
5 x back blows + 5 x chest thrusts
Defib or CPR?
DEFIB AS SOON AS POSSIBLE
Odds game - % of a good outcome
every 1 min wasted = decrease 7-10%
Post resus care?
ABCDE
12 Lead
Treat causes
Aim sp02 94-98%
Normoglycemia + normocapnia
Targeted temp range
Define syncope
Transit LOC due to a global reduction of blood flow to the brain
Heart failure 2 classic signs
elevated JVP
pulmonary edema
Synchronised cardioversion - why?
- Broad complex Tachy
- AF
- A flutter
- Reg Narrow complex
SVT treatment
Vagal manoeuvres
+ adenosine
Torsades
Stop all QT prolongation drugs
Correct electrolysers
GIVE Mag Sal 2g IV (10 min)
If cardioverting an AF - what are the considerations
NOT until over 48 hours anti coag
> Try metoprolol 1mg first
Can also do an IV infusion of 300 mg over 20-60 min
What increases the risk of secondary brain injury post resus?
Hypoxaemia + hypercarbia
Where will an ETT tube go that is down too far?
Right main bronchus
Tachyarrhythmia algorithm
- Unstable? Syndromnised DC Shock (3 attempts) with sedation and amiodarone
- Stable? A>Broad vs B>Narrow
- irregular in either is probable AF (Dig. or amiodarone)
- Narrow & regular (SVT) 6 mg adenosine IV
Bradycardia Algorithm
Adverse features e.g. shock, syncope, MI
YES = or if the risk of asystole =
Atropine 500 or 600 mcg IV
If not can sometimes monitor
Local Anaesthetic Toxicity
Signs ; LOC, Seziures
TREATMENT = Lipid Emulsion
Arrest pathway for scans
CARDIAC > Angio
NON CARDIAC > CTB + CTPA
Inotropes vs pressors
Ino - increases myocardial contractility
Pressors - increase vasoconstriction, increase systemic resistance (MAP)
ABG during an arrest - what does it show us?
There is decreased perfusion during a arrest which will result in metabolic acidosis
= decreased bicarb
= <> base deficit (TREAT UNDERLYING CAUSE as opposed to giving bicarb)
** The rate at which this resolves in an indicator of tissue perfusion
When to stop CPR
Asystolic for more than 20 minutes
PaC03 + HC03 ?
Pac02 = REP
HC03 = Metabolic
Bicarb - what does it show us?
- kidneys
VBG in arrest - what does it reflect?
acid balance of tissues
Principles of medical ethics
Autonomy
Beneficence
Non-malefience
Justice
ASTHMA - Life treat
Increased PaC02 +- Mechanical vent with raised inflammatory pressures
VENT rate 10
ASTHMA ;
Life treat
Acute Severe
Life treat = 1 x LOC, <3’s, Hypotension, silent chest
Acute = RR > 25 , HR 110, can’t complete sentence in one breath
Wheezing in asthma?
Doesnt correlate to the severity of obstruction
ASTHMA PATHWAY
AIM sp02 94-98%
1st line - salbutamol (5mg via nebs continous)
2nd line - ipratropium (every 20 min)
3rd line - mag sulfate (single infusion 10 mmol 20 min)
+ Steriods IV Hydracort 100 mg
ASTHMA PATHWAY POST
1st line - salbutamol every 5-30 min
2nd line - ipratropium every 4-6 hours
+ Steriods
Pred 40-50 mg oral
