Critical Care Concepts Flashcards
During resuscitation, what circumstances (9) mandate contact with clinical advice line within 15min of starting CPR?
What is the general discontinuation criteria?
What is the rapid discontinuation criteria?
Verification of death exam parts?
When deciding to commence or withhold resuscitation, what legal factors need to be considered?
Describe the “Bundles of Care” for cardiac arrest management
What are the expected pre-ductal SpO2 in the neonate?
Describe the neonatal resuscitation algorithm
Describe the paediatric cardiac arrest algorithm
Describe post-ROSC management
Describe the traumatic arrest management algorithm
Describe strategies for managing cardiac arrest with suspected asthmatic/lung disease aetiology
Discuss management of CPR-induced consciousness
Describe management of hypothermic cardiac arrest
Consider prolonging resuscitation until warmed
# Consider transfer to ECMO-available hospital
# If < 30 deg and in PEA, assess for pulse over 1 minute and consider EtCO2 or USS if available to confirm cardiac output. CPR may precipitate VF in this cohort
# WITHHOLD drugs until warmed to > 30 deg
# >30 and <35 deg, double drug intervals ie adrenaline Q8min
# >35 deg revert to normal drug intervals
# If <30 deg & in VT/VF, give 3x DCCS then withhold until >30deg
Discuss issues with ventilation in obese patients
How should an arrest with a PPM/ICD in situ be managed?
Place defibrillator pads >8cm from device
# AP and AL positions both acceptable
What accommodations should be made for a pregnant patient in cardiac arrest?
Tilt to L) lateral to avoid aortocaval compression
# Intubation to facilitate higher Paw and/or PIP
# Downsize tracheal tube by 0.5-1mm due to airway oedema
# Place compressions superiorly due to gravid uterus
Describe approach to tracheostomy/laryngectomy management
What are the (7) contraindications of CPAP?
What is the FiO2 of each CPAP Paw?
What does a this waveform represent?
What does a Curare-cleft represent?
What does a prominent phase IV represent?
What does a dimorphic phase II represent?
What does this waveform represent?
What does this waveform represent?
Discuss EtCO2 values in cardiac arrest
Describe asthma pathophysiology
Bronchospasm
Describe COPD pathophysiology
Describe obstructive lung ventilation strategies
General Strategy
# Aim for largest ETT that can be passed
#Optimise IV & NEB bronchodilators (B2, steroids, Mg2+)
# Smaller tV 6-8mL/kg
# Lower frequency (~6-8/minute)
–> Higher levels of sedation may be required
–> Sustained paralysis may be required for desynchrony
# ZEEP (or PEEP <3-5cmH2O if you absolutely insist)
# Prolonged I:E ratios (1:4-6)
# Short inspiratory times (to prolong I:E ratio)
# Tolerate hypercapnoea
# Monitor for tension pneumonthorax
If on MV
# Tolerate high PIP
# Greater PIP - Pplat difference reflects degree of bronchospasm
#Paw not necessarily indicative of alveolar pressure
Describe restrictive ventilation strategies
General strategy
# Smaller tV
# Higher frequency (14 - 20)
# Higher PEEP to maximise recruitment (>5cmH2O)
What is a normal V/Q ratio?
0.8 (4L ventilation/5L cardiac output)
Describe the concept of dead space
Adequately ventilated spaces of lung that have nil or poor perfusion
Describe the VQ ratios in relationship to areas of lung
Describe the differences between the right and left ventricle, especially in terms of pressure and volume relationships
“The right ventricle is volume-tolerant (preload) and pressure-intolerant (afterload)”
Describe ECG changes in RV hypertrophy/strain
What are the Well’s criteria (7) for pulmonary embolism?
Explain the pathophysiology of obesity hypoventilation syndrome?
What does lung compliance refer to?
What is base excess?
What pulmonary pressure is considered hypertensive?
What is the management of pulmonary hypertension?
Describe the manifestations of serotonin syndrome?
Describe the manifestations of neuroleptic malignant syndrome>
What are the components of the modified Sgarbossa criteria?
What does MOANS stand for (in reference to BVM)?
What does RODS stand for (in reference to SGA)?
What does LEMON stand for?
What happens to alveoli during apnoea?
What are risk factors for aspiration?
What are the issues with obstetric airway management?
Name three causes of intrathoracic airway obstruction?
Explain the oxyhaemoglobin dissociation curve
Explain a rightward shift on the oxyhaemoglobin dissociation curve
Explain a leftward shift on the oxyhaemoglobin dissociation curve
Explain the Haldane effect
What are the risk factors for laryngospasm?
