chapter 12 pt2 Flashcards
other than patient with electrolyte imbalance who in the population are at high risk for cardiac arrest out of hospital
hemodialysis- predominantly witnessed and most occur during treatment
how can cardiac arrest risk in hemodialysis patients be minimised ?
patient sticking to their diet and fluid restriction and dialysis prescriptions are carefully managed
resus for hemodialysis patients ?
same ALS protocol with :
1) stop dialysis by trained dialysis nurse - return patient blood volume with fluid bolus
2) disconnect from dialysis machine
dialysis access open for drug administration
prompt management for hyperkalemia
cardiorespiratory arrest from what has poor survival outcome ?
sepsis
sepsis differentiated from from normal homeostatic response to pathogens through ?
SOFA - sequential organ failureassesment
if SOFA is 2 or more mortality risk of 10 percent
40 percent mortality rate of lactate above 2 and MAP is maintained at 65 with use of vasopressors
what is the hour 1 care bundle for sepsis ?
action 1 - high flow oxygen
aim for oxygen sat of 94-98 percent
action 2 - blood culture
action 3 - broad spectrum antibiotics through IV
action 4 - fluid resuscitation
200-500ml of crystalloid
max of 30ml per kg in patients with hypotension and serum lactate of 2
or low urine output
if MAP is still lower or is at 65mmhg after fluid bolus challenge - escalation and start vasopressors
action 5 - lactate levels
action 6 - measure urine output
leading cause of cardiac arrest in those aged under 40 ?
toxins (benzodiazepines, alcohol, opioids , tricyclics , barbiturates)
also cause of non traumatic coma
accidental poisoning most common in children with wrong dose
common cause of death in toxin poisoning ?
respiratory arrest secondary to decreased conscious level
prevention of cardiac arrest in toxin poisoning ?
early tracheal intubation of unconscious patients
hypertensive emergencies - managed with benzodiazepines and vasodilators and alpha antagonists
measure electrolytes particularly potassium
modification of resus for toxin and poisonings ?
avoid mouth to mouth rescue breaths in presence of chemicals such as cyanides , hydrogen sulphide , corrosive and
orgsnophophates
treat life threatening tachyarrythmia with cardioversion
once resuscitation started try to find the toxin or chemical from friends and relatives and ambulance crew
diagnostic clue - from pupil size , corrosion in mouth , needle marks
temp measurement v important as over dose patients can quickly become hypo or hyperthermic
prepare to continue resus for prolonged period particularly in young as the poison maybe metabolised or excreted during extended resus
consider extracorporeal life support
look at TOXBASE FOR TREATMENT
treatment for toxin or poisonings ?
always first A-E
correction of hypoxia
hypotension
acid base imbalance
electrolyte disorder
hypo and hyperthermia
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skin exposures = removing clothes
routine gastric lavage and gastrointestinal decontamination not recommended
activated charcoal absorbs certain drugs - little evidence this improves clinical outcome and efficacy decreases
= given to patients with protected airway
=single dose given
=known to have consumed this drug extractable by charcoal 1hr before
=multiple doses can be given incase for certain toxin/drug overdose
whole bowel irrigation - can reduce drug absorption - enteral administration of polyethylene glycol
urine alkalisation - IV SODIUM BICARBONATE
ph >7.5
hemodialysis
specific antidotes
to which drug over dose and poisoning can activated charcoal be given multiple times ?
in life threatening cases
carbamazepine
dapsone
phenobarbitural
quinine
theophylline
to which drugs or toxins do we use bowel irrigation
enteric coated drugs
oral iron poisoning
ingested packets of illicit drugs
any toxic ingestion with sustained release
are laxatives are recommended in toxin or poisoning ?
NO
when is urine alkalisation recommended ?
moderate to severe salicylate poisoning -who do need hemodialysis
