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
