Apls Algorithm Flashcards
Glucose lower threshold + management
Less than 2.8mmol/L or 50mg/dl - give glucose 10% 3ml/kg
ph for DKA severity and % dehydration
Ph < 7.1 severe dka (10% dehydration)
Ph < 7.2 moderate dka (5%)
Ph < 7.3 mild dka (5%)
Fluid resus ml/kg + escalation threshold
10 ml/kg, by 40ml/kg discuss inotropes w senior
Insulin in DKA how long after starting fluids
0.05 or 0.1u/kg/hr 1-2h after starting fluids
Signs of cerebral oedema in DKA
Headache, irritability, slowing HR, reduced GCS/coma, signs of raised ICP
DKA managing cerebral oedema
5ml/kg 2.7% NaCl OR 20% mannitol 2.5-5ml/kg
Call senior
Restrict IVF by 50%
DKA blood glucose <14mmol/L
Change fluids to 5% Glc
DKA blood glucose <6 mmol/L
Change fluids to 10% glc
Do not reduce insulin below 0.05u/kg/hr if ketones>1mmol/L
Mnemonic for complications of intubated pt
D displaced (endobronchial or oesophageal)
O obstructed (kink or plug)
P pneumothorax
E equipment
S in the stomach
Hyperkalaemia associated with arrhythmia
Calcium 0.1 mmol/kg IV
Hyperkalaemia remains high after nebulised salbutamol
Ph > 7.35 glucose 10% 5ml/kg and insulin 0.05 u/kg/h IV
PH < 7.34 sodium bicarbonate 1-2mmol/kg IV
Hyperkalaemia potassium falling after salbutamol or after insulin gluc
Calcium resonium 1g/kg PO or PR
Hypothermic non shockable how to give adrenaline?
<30 degrees withhold adrenaline
30-35 degrees adrenaline every 8 mins
Hypothermia shockable rhythm
3 DC shocks
2min CPR between shocks
W/h adrenaline and amiodarone until temp >30
Target temp rise to reduce haemodynamic instability
0.25-0.5 degrees/hr
When to declare massive haemorrhage protocol
Haemorrhagic shock + no response to 20ml/kg fluid
TXA in massive haemorrhage
15mg/kg (max 1g) bolus IV/IO within 3h of injury
TXA infusion 2mg/kg/hr (max 125mg/h) if bolus already given
What to transfuse in massive haemorrhage
RBC and plasma 10ml/kg 1:1 ratio
Platelets 10ml/kg
Cryoprecipitate 10ml/kg
Thresholds of Hb, platelets APTT, PT, fibrinogen, lactate, pH, temp for bleeding controlled
Hb 80, platelet 75, APTT < 1.5, PT <1.5, fibrinogen > 1.5, lactate < 2.0, ph > 7.35, temp > 36
Symptoms organophosphate poisoning
Respiratory symptoms, salivation, sweating, pinpoint pupils
First line symptomatic organophosphate poisoning
Atropine 20 micrograms/kg can be repeated once after 2nd line
Symptomatic organophosphate poisoning second line
Pralidoxime 30mg/kg IV over 20 mins
Followed by 8 mg/kg/hr (max 12g in 24h)
Urgent interventions in seizures
Hypoglycaemia, hyponatraemia < 125mmol/L, meningoencephalitis,
3ml/kg 10% glc, 3-5ml/kg 3% NaCl, IV ceftriaxone and aciclovir, check ammonia
When to move away from status protocol and anaesthetise?
Airway compromise, respiratory failure despite basic manoeuvres, shock unresponsive to fluid resuscitation, raised ICP or trauma
Indications for CT scan
New prolonged or focal seizure
Refractory seizure
New neuro deficit
Suspected raised ICP
Suspected space occupying lesion
VP shunt in situ
Trauma
Possible NAI
Reduced consciousness, hypoglycaemia management
3ml/kg of 10% dextrose
Reasons for fixed dilated pupils (6)
Hypothermia
Anticholinergic drugs
During and post seizure
Severe hypoxia
Barbiturates(late sign)
Brain stem herniation
Small or pinpoint pupils (4)
Metabolic disorder
Narcotic ingestion
Medullary lesion
Organophosphate ingestion
Unilateral dilated pupil (4)
Third nerve lesion
Rapidly expanding ipsilateral lesion
Focal epileptic seizures
Tentorial herniation
4 components of D
Conscious level
Posture
Pupils
Glucose
Contraindications of nitrous oxide
Possible intracranial or intrathoracic air
