Apls Flashcards
What checks do you need to do post intubation?
Connect Capnometer + pulse oximeter
Auscultate both axillae and the stomach
What is the most concerning complication of intubation?
Accidental oesophageal intubation
What are the causes of a gradual fall in expired CO2 in a ventilated patient?
Cardiac arrest
Inadequate chest compressions
Pulmonary embolism
What are the causes of a a sudden drop in expired CO2 in a ventilated patient?
Disconnection of breathing system
Extubation
Ventilator Failure
What is appropriate dose for IV morphine?
0.1mg/kg bolus
Wait 10 minutes
Then titrate upwards
Define situational awareness
The cognitive process for building and maintains awareness of a workplace situation or event
What are the pre-terminal signs of hypoxia?
Bradycardia
Cyanosis
Drowsiness
What are the causes of a bounding pulse ?
Increased cardiac output (e.g. septicaemia)
Arterio-Venous systemic shunt (e.g. PDA)
Hypercapnia
What should be your initial fluid resuscitation?
10ml/ kg of crystalloid
How do you treat DKA?
Treat shock (if present) with 10ml/kg fluid bolus
Rehydration fluid > 48 hours
Insulin infusion 0.05-0.1 unit/kg/hour 1-2 hours AFTER initiating rehydration and maintenance fluid
Glucose infusion once BM <14
In DKA what does sodium do? And what does it do after treatment?
It’s low
Goes up as glucose goes down
What are feature of cardiac cause for breathing difficulties?
Cyanosis not correcting with O2
Tachycardia out of proportion with respiratory symptoms
Raised JVP
Gallop rythm
Enlarged liver
Absent femoral pulses.
What causes cardio genie shock?
Arrhythmias
Cardiomyopathy
Myocardial contusion
Heart failure
What causes distributive shock?
Spinal cord injury
Anaphylaxis
Vasodilatory drugs
Sepsis
What causes obstructive shock?
Flail chest
Pneumothorax
Pulmonary embolism
Cardiac tamponade
What causes hypovolaemic shock
Intussusceptions
Gastroenteritis
Haemorrhage
Burns
Peritonitis
What is clinical picture for toxic shock syndrome?
Fever. Diffuse erythema. Headache, confusion, conjunctival and mucosal hyperaemia, vomiting, water diarrhoea +- history of infected wound/ burn/ surgery/ deep seated infection
What is management of toxic shock syndrome
IV fluclox and vancomycin!
What are the causes of yacht arrhythmias?
Metabolic disturbance
Long QT
cardiomyopathy
Poisoning
Re-entrant congenital conduction pathway abnormality
How to treat SVT in context of no clinical shock
Bagel manoeuvre
Adenosine 0.1-0.2 mg/kg
After 1 min adenosine 300mcg/kg
How to treat SVT with clinical shock and defib available
Synchronous DC shock 1J/kg
Synchronous DC shock 2J/ kg
Consider amiodarone
How to treat SVT with clinical shock and no defibrillator available?
Vagal manoeuvre
Adenosine 0.1-0.2 mg/kg
After 2 mins adenosine 200mcg/ kg
After 1 min adenosine 300mcg/kg
Describe decerebate posturing
Both arms and legs are rigid and extended, head arches backwards, toes point down
Describe decorticate posturing
Rigid with flexed arms , clenched fists and extended legs
What in posturing is sign of impending herniation?
Progression from decorticate ( flexed arms ) to decerebrate (extended posture )
Barbiturates poisoning causes what?
Hypothermia
After x2 doses of benzodiazepines, what comes next in seizure management ?
Phenytoin,
Whilst it’s being drawn up give Paradehyde 0.8ml/kg of 50:50 mixture with oil.
What are the conditions that should be checked for during primary survey and treated immediately in chest injuries
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade
What is the volume of resuscitated blood given in emergency as first bolus?
5ml/kg
What are the components of a secondary survey?
Respiration, circulation, nervous system, metabolism, host defence
In head injuries what are the indications for immediate intubation?
Coma/ GCS <8
Hypoxemia OR hypercapnia on blood gas
Spontaneous hyperventilation
Respiratory irregularities
Unstable facial fractures
Seizure
Copious bleeding from mouth
What is the formula for estimating a child’s weight?
(Age + 4) x2
What is the formula for calculating ETT tube insertion depth?
Age/2 +12
What is acronym for information communicated to pre alert team?
ATMISTER
age
Time of incident
Mechanism
Injury suspected
Signs
Treatment
ETA
Requirement
What is acronym for safe transfer and retrieval?
Assessment
control
Communication
Evaluation
Preparation and packaging
Transport
