Ch. 1 Resuscitation Flashcards
What is a more sensitive indicator for inability to protect airway than gag reflex?
inability to swallow
How do you measure correct OPA size?
the flange of the OPA should be placed at the mouth and the tip should
reach the angle of the mandible.
How do you place an OPA?
rotate 180° once well into the mouth
(in order to avoid pushing the tongue posteriorly) → advance distal end
into the hypopharynx.
What are five ways to trouble shoot BVM?
(1) consider two-handed technique;
(2) make sure an OPA or NPA is in place;
(3) make sure proper
mask size is being used;
(4) if patient has dentures that have been removed consider replacing dentures;
(5) if patient has a beard, considering
lubricating with KY jelly.
How do you calculate pediatric cuff size?
cuffed: (age/4)+3.5
How do you determine blade size?
■ Premature infants: Size 0
■ Normal infants: Size 1
■ Older children: Size 2
■ Adults: Sizes 3-4
What is the best way to confirm ETT placement?
Detecting end-tidal CO2 (ETco2) (yellow color change or 5% CO2) after 6
manual breaths is the best single means of confirming ET tube placement.
What pretreatment medication can be given to prevent elevation in ICP during RSI? and what is the dose?
Lidocaine
1.5 mg/kg
In pediatric patients, what pretreatment medication can be given to decrease symptomatic bradycardia during RSI? and what is the dose?
Atropine
0.02 mg/kg
When should you avoid Ketamine as induction med for RSI?
known CAD, because it causes tachycardia which can worsen demand ischemia
Which induction medication is good for awake intubations?
Ketamine because it preserves respiratory drive
RSI Meds: What is the dose for etomidate?
0.3mg/kg
RSI Meds: What is the dose for Ketamine?
1-2mg/kg
RSI Meds: What is the dose for Midazolam?
0.1-0.2mg/kg
RSI Meds: What is the dose for Propofol?
1.5-3mg/kg
Awake intubation: What meds and respective doses?
Lidocaine 4% nebulized
topical benzocaine 4+ccs
Ketamine 10-20 mg/dose
Needle cricothyroidotomy is performed up to age _____.
10-12 yrs old
What size needle catheter do you use for needle cric in peds?
12 or 14 gauge, connected to 3mL syringe
In a choking patient, in whom abdominal/back thrusts fail, what is the next step?
consider using an ET tube to
push the foreign body into the right main-stem bronchus, then withdrawing
the tube several centimeters to allow ventilation of the left lung.
What are examples of low V/Q ratio?
COPD, asthma, hepato-pulmonary syndrome, and pulmonary edema
Whats an example of a high V/Q ratio?
pulmonary embolus
The oxyhemoglobin dissociation curve describes ________.
The strength with which Hgb binds O2
What does a right shift of the oxyhemoglobin dissociation curve represent?
Hgb more readily gives up O2 to the tissue
What are some causes of a right shift of the oxyhemoglobin dissociation curve?
Acidosis, hyperthermia, increased 2,3-diglycerophosphate
(2,3-DPG), increased Paco2
What are some causes of a left shift of the oxyhemoglobin dissociation curve?
Alkalosis, hypothermia, abnormal hemoglobin,
decreased 2,3-DPG, decreased Paco2
What are contraindications to NIV?
- Apnea
- Inability to protect airway
- copious secretions
- Recent OMFS surgery
- Untreated pneumothorax
When it comes to ventilation in patients with head injury, it is important to avoid ____capnia. Why?
HYPERcapnia – bc causes cerebral vasodilation and increased ICP (Goal PaCO2=35)
What are some causes of Mobitz II heart block?
ACS – commonly anteroseptal MI
hyperkalemia
fibrosing disease (Lenegre Disease)
Infiltrative myocardial disease (sarcoidosis, amyloidosis)
Structural Heart Disease (Congenital or surgical)
Autoimmune Disease (eg lupus)
What medication is CONTRAINDICATED in Mobitz II or INFRAnodal Type III heart block (<40BPM and wide complex)?
ATROPINE – MAY WORSEN conduction ratio
How many joules are needed for cardioversion in Aflutter?
25-50J – much more sensitive than Afib
How many joules should be used for cardioversion in Afib present for greater than 24-48h?
200J or 360J (instead of 50-100J)
In unknown duration of Afib, target rate control. How do you decide if anticoagulation is necessary?
CHADS2 score
What is the CHADS 2 scoring?
C - CHF - 1 point
H - HTN - 1 point
A - age >75 - 1 point
D - DM - 1 point
S - prior TIA or Stroke - 2 points
0: nothing or full-dose ASA
1: full-dose ASA
>1: warfarin with INR goal between 2 and 3
What are ECG findings of SVT?
narrow QRS, rate between 140-280, with NO visible p waves
inverted p waves - representing retrograde conduction - are buried in QRS complex and therefore typically not seen. If visible, typically seen in II, III, and AVF
What is the treatment for unstable SVT?
synchronized DC cardioversion (100-200J), unless adenosine immediately available
What does Brugada syndrome look like on ECG?
Coved/downward humped ST segment in V1-V3, that can simulate a right bundle branch block
(RBBB), and history of symptoms (eg, syncope)
What is the treatment for Brugada syndrome?
implanted defibrillator; if asymptomatic, but findings on ECG – refer to cardiology
What is the treatment for stable VTach?
Amiodarone 150 mg IV over 10 minutes followed by infusion 1mg/min for 6 hours and 0.5 mg/min for 18 hours
What is the accessory pathway in WPW?
Bundle of Kent (bypasses the AV node, bypassing the atrium directly to the ventricle)
