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ALS > chapter 12- resuscitation in special circumstances > Flashcards

chapter 12- resuscitation in special circumstances Flashcards

1
Q

causes of hyperkalaemia?

A

renal failure
drugs - ACE-I, ARB, Kt sparing diuretics, saids, bb
tissue breakdown- rhabdomyolysis, tumour lysis, haemolysis
metabolic disorders
endocrine disorders e.g. addisons
diet

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2
Q

ECG changes associated with hyperkalaemia?

A 
tall tented T waves
first degree heart block
flat or absent P waves
ST depression
ST merging
widened QRS
VT
bradycardia
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3
Q

Management of hyperkalaemia principles?

A

1) cardiac protection
2) shift K into the cells
3) remove K from the body
4) monitor K and glucose
5) prevent from reoccurring

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4
Q

Risks associated with treatment of hyperkalaemia?

A

hypoglycaemia following insulin administration
Tissue necrosis
rebound hyperkalaemia

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5
Q

management of hyperkalaemia in patient not in cardiac arrest?

A

10 ml calcium gluconate 10% IV

10 units of insulin in 25g glucose

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6
Q

management of hyperkalaemia in patient in cardiac arrest?

A

10 ml calcium gluconate 10% IV
10 units of insulin in 25g glucose
50mmol sodium bicarbonate (50ml of 8.4%) IV if severe renal failure
consider dialysis

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7
Q

causes of hypokalaemia?

A 
diarrhoea
drugs - diuretics, laxatives, steroids
renal losses - diabetes insipidus
endocrine disorders - cushings 
metabolic alkalosis
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8
Q

ECG changes hypokalaemia?

A

U waves
T wave flattening
ST segment changes

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9
Q

sepsis 6?

A

HIGH FLOW O2
IV ABX
IVF

URINE OUTPUT
BLOOD CULTURES
LACTATE

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10
Q

Doses of IM, IV, SC and IN naloxone?

A

400 mcg IV
800mcg IM
800mcg SVC
2mg IN

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11
Q

what is the duration of naloxone?

A

45-70 mins

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12
Q

ECG changes in TCA overdose?

A

widening of QRS
RAD
tachycardia

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13
Q

first line management of stimulant overdose?

A

small doses of benzodiazepines

GTN to relieve coronary vasoconstriction

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14
Q

symptoms of stimulant overdose?

A

agitation, symptomatic tachycardia, hypertensive crisis, hyperthermia, MI

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15
Q

what is the definition of anaphylaxis?

A

serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised any potentially life threatening compromise in airway, breathing and/or circulation.

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16
Q

Criteria for anaphylaxis?

A

1) sudden onset and rapidly progressing symptoms
2) life threatening airway and/or breathing and/or circulation problems
3) skin and/or mucosal changes (flushing, urticaria, angioedema)

17
Q

what are some of the airway, breathing and circulation features of anaphylaxis?

A

A: airway swelling, hoarse voice, stridor
B: SOB, wheeze, patient becoming tired, cyanosis, respiratory arret
C: pale, clammy, tachycardia, hypotension, decreased consciousness, MI/cardiac arrest
D:

18
Q

what is the algorithm for management of anaphylaxis?

A

1) AE
2) diagnosis - look out for sudden onset of airway, breathing and/or circulatory problems and usually skin changes
3) call for HELP
4) remove trigger + lie patient flat (if pregnant - lie of left side)
5) give IM ADRENALINE (0.5mg, i.e 0.5ml of 1:1000 adrenaline)
6) establish airway, give high flow O2, apply monitoring
7) if no response - repeat IM adrenaline after 5 mins + IV fluid bolus
8) if no improvement despite 2x doses - follow refractory anaphylaxis algorithm

19
Q

where should IM adrenaline be given in anaphylaxis?

A

anterolateral aspect middle third of thigh

20
Q

what is the refractory anaphylaxis algorithm?

A

1) establish IV/IO access + seek critical care
2) give rapid fluid bolus + start adrenaline infusion - 1mg adrenaline in 100ml of NaCL - ON A SEPARATE LINE and start at 0.5ml/kg/hr and titter according to response
3) give IM adrenaline every 5 mins until adrenaline infusion has been started

if there is partial airway obstruction - nebuliser adrenaline (5mg of 1mg/ml)

if severe/persistent bronchospasm - nebulised salbutamol and ipratropium with O2, and consider infusion of aminophylline or salbutamol

21
Q

what are the timings of mast cell tryptase measuring?

A

initial sample ASAP
second sample 1-2h (but no later than 4h)
third sample 24h - to provide baseline

22
Q

what are the features of life threatening asthma?

A 
altered consciousness 
exhaustion 
arrhythmia 
hypotension 
cyanosis
silent chest
poor expiratory effort 
PEF < 33%
SpO2 < 92% 
PaO2 < 8
normal PaCO2
23
Q

what are the features of near fatal asthma?

A

raised PaCO2

Mechanical ventilation with raised inflation pressures

24
Q

what are the features of severe asthma?

A

PEF 33-55% of best predicted
RR > 25
HR >110
inability to complete sentences

25
Q

what are the causes of cardiorespiratory arrest in asthma?

A

severe bronchospasm and mucous plugging
cardiac arrhythmias caused by hypoxia
dynamic hyperinflation can occur in mechanically vented patients (auto-PEEP is caused by air trapping and breath stacking causing gradual build up of pressure and reduced venous return)
tension pnuemothorax

26
Q

Management of severe asthma attack?

A

O2 to achieve 94-98% SpO2
salbutamol 5mg NEB back to back
ipratropium bromide 500mcg NEB back to back
Hydrocortisone 100mg IV
MgSo4 2g (8mmol) IV 20 mins
consider aminophylline (5mg/kg loading dose)
IVF

27
Q

criteria for considering tracheal intubation in asthma?

A 
deteriorating peak flow 
decreasing conscioussness
worsening hypoxaemia 
deteriorating resp acidosis 
severe agitation, confusion, fighting against the mask 
progressive exhaustion 
resp or cardiac arrest
28
Q

what position should a pregnant woman be placed in during emergency situation to prevent cardiac arrest?

A

left lateral position OR manually displace the uterus to the left

29
Q

where should IV access be ideally placed in a pregnant woman during cardiac arrest?

A

above the diaphragm, as after 20 weeks gestation the uterus can press down on the IVC impeding venous return and cardiac output.

30
Q

what position should a pregnant woman be in during chest compressions?

A

left lateral tilt if possible

manually displace the uterus to the left

31
Q

when should a peri-mortem c section be performed?

A

Foetus older than 20 weeks gestation and no ROSC within 5 mins

32
Q

signs of tension pneumothorax?

A 
respiratory distress prior to cardiac arrest
haemodynamic compromise
absent breath sounds on auscultation 
chest crepitations 
subcutaneous emphysema 
tracheal deviation 
jugular vein distension
33
Q

management of tension pneumothorax?

A

needle decompression- needle is inserted into the 2nd intercostal space (just above third rib), or the 4th/5th intercostal space at the mid axillary line

ALS (12 decks)

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