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DeAlwisResus Flashcards

1
Q

What is the most reliable method for verifying tracheal intubation?

A

Detection of ETCO2

ETCO2 stands for end-tidal carbon dioxide.

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2
Q

What can hinder the efficacy of ETCO2 detection?

A

Insufficient CO2 exhaled due to reduced pulmonary blood flow

This often occurs during cardiac arrest.

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3
Q

What device might be more accurate in cardiac arrest situations than ETCO2?

A

Oesophageal detector device (EDD)

The accuracy of EDD in emergency situations has conflicting results.

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4
Q

What was the finding regarding waveform capnography in cardiac arrest?

A

100% sensitivity and specificity in identifying correct tracheal tube placement

This was demonstrated in two studies after intubation.

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5
Q

What is the recommendation by ILCOR regarding tracheal tube monitoring in cardiac arrest?

A

ETCO2 monitoring with waveform capnography is the most sensitive and specific way to confirm and continuously monitor tube position

Should supplement clinical assessment.

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6
Q

How does increasing IPAP affect pressure support?

A

Increases the pressure support (IPAP-EPAP) provided by the ventilator

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7
Q

What is the primary goal of mechanical ventilation in acute severe asthma?

A

Avoid excessive airway pressure and minimize lung hyperinflation while maintaining adequate gas exchange

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8
Q

What strategy is often necessary to avoid complications in mechanical ventilation for asthma?

A

Controlled hypoventilation or permissive hypercapnoea

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9
Q

What is a marker of deterioration in acute severe asthma?

A

Rising PaCO2 levels, exhaustion, mental status depression, refractory hypoxaemia, haemodynamic instability

These indicators suggest worsening condition.

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10
Q

What is the recommended PaO2 level maintenance in asthma?

A

Maintain at <25-30 cm H2O

This is to estimate average alveolar pressure.

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11
Q

What does NIV stand for?

A

Non-invasive ventilation

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12
Q

What is a benefit of NIV in patients with acute cardiogenic pulmonary oedema?

A

Decreases the need for intubation and induces a more rapid improvement in respiratory distress and metabolic disturbance

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13
Q

What does PEEP do in patients with acute pulmonary oedema?

A

Improves haemodynamics by reducing preload and afterload

Positive pressure reduces venous return to the left ventricle.

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14
Q

What is the optimal PEEP level that appears safe and effective for most patients?

A

10 cm H2O

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15
Q

What is a risk associated with pressure-controlled ventilation?

A

Variable tidal volume due to fluctuating high airway resistance and intrinsic PEEP

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16
Q

What are the recommendations for ventilation according to the ARDS Network?

A

• Tidal volumes (TV) 6-8 mL/kg ideal body weight
• Plateau pressures <30 cm H2O
• Wean FiO2 to maintain SaO2 88-95%
• Strategic use of PEEP to permit lower FiO2
• Rate 20-25 (<30) per minute
• Permissive hypercapnoea (pH >7.25)

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17
Q

What indicates the quality of CPR in relation to ETCO2 monitoring?

A

Continuous ETCO2 monitoring can indicate CPR quality

An ETCO2 < 10 mmHg is associated with failure to achieve ROSC.

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18
Q

What is the most reliable method for verifying tracheal intubation?

A

Detection of ETCO2

ETCO2 stands for End-Tidal Carbon Dioxide.

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19
Q

What can hinder the efficacy of ETCO2 detection?

A

Insufficient CO2 exhaled due to reduced pulmonary blood flow

This situation often occurs during cardiac arrest.

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20
Q

What device might be more accurate in verifying intubation during cardiac arrest?

A

Oesophageal detector device (EDD)

Conflicting results have been reported regarding the accuracy of EDD.

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21
Q

What did studies show about the accuracy of colorimetric ETCO2 detectors?

A

Accuracy similar to clinical assessment for confirming tracheal tube position

This is especially true for those experiencing cardiac arrest.

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22
Q

What is the recommended method to confirm and continuously monitor tracheal tube position in cardiac arrest?

A

ETCO2 monitoring with waveform capnography

This was recommended by ILCOR in 2010.

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23
Q

How does increasing IPAP affect the ventilator’s pressure support?

A

Increases the pressure support (IPAP–EPAP)

This results in augmented tidal volume during spontaneous breaths.

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24
Q

What does increasing PEEP improve?

A

Oxygenation due to alveolar recruitment

PEEP is also known as EPAP.

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25
What is the impact of increasing both PEEP and IPAP proportionally?
May improve oxygenation but not ventilation ## Footnote Pressure support remains unchanged.
26
What does NIV stand for?
Non-Invasive Ventilation ## Footnote NIV is effective in reducing the need for intubation in acute cardiogenic pulmonary edema.
27
What is the evidence regarding NIV's impact on mortality?
Conflicting evidence; most studies suggest no effect on short-term mortality ## Footnote NIV improves respiratory distress and metabolic disturbance more rapidly than standard oxygen therapy.
28
What is BiPAP particularly indicated for?
Acute exacerbation of COPD with persistent respiratory acidosis ## Footnote Defined as pH < 7.35 despite maximum medical treatment.
29
What is the recommended saturation level for patients on oxygen therapy?
Between 88 and 92% ## Footnote The British Thoracic Society recommends even lower levels of 85–90%.
30
What are markers of deterioration in acute severe asthma?
* Rising PaCO2 levels * Exhaustion * Mental status depression * Refractory hypoxaemia * Haemodynamic instability
31
What is the primary goal of mechanical ventilation in acute severe asthma?
Avoid excessive airway pressure and minimize lung hyperinflation ## Footnote Adequate gas exchange must be maintained.
32
What is the recommended plateau pressure in asthmatic patients?
< 25–30 cm H2O ## Footnote This is to avoid ventilator-induced lung injury (VILI).
33
What are the acceptable initial ventilator settings for the intubated asthmatic?
* Mode: Volume-controlled ventilation * Minute ventilation: < 10 l/min * Tidal volume: 6–10 mL/kg ideal body weight * Respiratory rate: 10–14 cycles/min * Plateau pressure: < 25–30 cm H2O * Inspiratory flow rate: 60–80 l/min * Expiratory time: 4–5 sec * PEEP: 0–5 cm H2O * FiO2: To a SaO2 of >90%
34
What ventilation mode is usually preferred for asthmatic patients?
Volume-controlled ventilation ## Footnote Pressure-controlled ventilation carries risks of variable tidal volume.
35
What are the recommendations for ventilation in ARDS according to the ARDS Network?
* Tidal volumes: 6–8 mL/kg ideal body weight * Plateau pressures: <30 cm H2O * FiO2: Maintain SaO2 88–95% * Strategic use of PEEP * Rate: 20–25 per minute * Permissive hypercapnoea: pH > 7.25
36
What does an ETCO2 < 10 mmHg indicate during CPR?
Failure to achieve ROSC and need for improved chest compressions ## Footnote ETCO2 monitoring can indicate CPR quality.
37
What is the recommended compression ratio for CPR in adults?
30:2 (30 compressions followed by 2 ventilations) ## Footnote This applies regardless of the number of rescuers present.
38
What is the default energy level for biphasic defibrillation in adults?
200 J for all shocks ## Footnote This can be adjusted based on clinical data for specific defibrillators.
39
What should be done immediately after delivering a shock during CPR?
CPR should be restarted ## Footnote A pulse check should not be performed immediately after a shock.
40
What waveform is preferred for elective cardioversion of atrial fibrillation?
Biphasic waveforms ## Footnote They have greater overall success rates and less cumulative energy use.
41
What is the initial treatment for VF?
Defibrillation with a shock at 200 J followed by 2 minutes of CPR ## Footnote If VF persists, a second shock should be delivered after 2 minutes.
42
What is the role of adrenaline in cardiac arrest?
Increases ROSC but not shown to improve survival to hospital discharge ## Footnote Atropine is no longer routinely recommended during pulseless electrical activity.
43
What should be considered early in maternal cardiac arrest?
A perimortem caesarean ## Footnote Best if delivery occurs within 5 minutes of maternal arrest.
44
What is the evidence regarding post cardiac arrest hypothermia?
Insufficient evidence to support or refute its use ## Footnote A single case report suggests it may be safe and effective in early pregnancy.
45
What is the efficacy of manual left uterine displacement compared to left lateral tilt?
Manual left uterine displacement is as good as or better than left lateral tilt ## Footnote This finding is based on some evidence despite a lack of comprehensive studies.
46
What is the current recommendation regarding defibrillation attempts in severely hypothermic patients?
Attempt defibrillation (up to 3 shocks) without regard for core temperature ## Footnote It may be impossible to achieve conversion to normal rhythm if core temperature is <30°C.
47
Under what core temperature should defibrillation be withheld?
Core temperature <30°C ## Footnote Defibrillation should be withheld until the temperature rises above 30°C.
48
What is the recommended core temperature range for therapeutic hypothermia in comatose adults after out-of-hospital VF cardiac arrest?
32–34 °C for 12–24 hours ## Footnote This recommendation is based on studies suggesting improved neurological outcomes.
49
What are reliable predictors of poor neurological outcomes after cardiac arrest in patients not treated with therapeutic hypothermia?
Absence of both pupillary light and corneal reflexes after 72 hours ## Footnote Other factors include the absence of vestibulo-ocular reflexes at ≥24 hours and a GCS motor score of ≤2 at >72 hours.
50
What is the indication for emergency transcutaneous pacing (TCP)?
Haemodynamically significant bradycardia unresponsive to atropine or other chronotropic drugs ## Footnote TCP was previously recommended in asystolic cardiac arrest but is no longer routinely supported.
51
What is the definition of lactic acidosis?
Increased blood lactate concentration >5 mmol/L and acidaemia (arterial blood pH < 7.35) ## Footnote Hyperlactaemia is defined as a blood lactate level ≥2 mmol/L.
52
What is the recommended mean arterial pressure (MAP) to achieve minimal perfusion pressure in septic shock management?
MAP ≥65 mmHg ## Footnote This is essential to maintain adequate flow and perfusion.
53
What is the effect of dopamine at low doses (<5 μg/kg/min)?
Causes vasodilation at vascular D1 receptors ## Footnote It might produce diuresis but does not reduce the likelihood of renal failure.
54
What is the recommended first-line vasopressor agent in septic shock?
Noradrenaline ## Footnote This is based on pathophysiological principles, although there is no evidence that adrenaline is worse in terms of mortality.
55
What is the purpose of passive leg raising (PLR) in fluid responsiveness?
Transiently increases venous return and cardiac output in preload responsive patients ## Footnote PLR mimics a 300 mL blood bolus effect.
56
What is the recommendation for the use of steroids in septic shock management?
Intravenous hydrocortisone should be considered when hypotension remains poorly responsive to fluid resuscitation and vasopressors ## Footnote Recent trials showed hydrocortisone did not improve survival or reversal of septic shock.
57
What is the impact of adrenaline on blood lactate measurements?
Adrenaline can cause hyperlactataemia ## Footnote This should be taken into account when interpreting blood lactate levels.
58
What are the potential risks associated with the Trendelenburg position in hypotensive patients?
May increase intracranial pressure and have negative effects on pulmonary gas exchange ## Footnote Current evidence does not support its use for improving blood pressure.
59
What does goal-directed resuscitation aim to restore in sepsis management?
Systemic perfusion and vital organ function ## Footnote This includes predefined physiological endpoints such as urine output and MAP.
60
What is the role of metaraminol in hypotension management?
Potent and selective α-agonist for short-term treatment of hypotension ## Footnote It may induce reflex bradycardia and increased ventricular afterload.
61
What is the significance of a GCS motor score of ≤2 at >72 hours in cardiac arrest patients?
Potentially unreliable prognosticator of a poor outcome ## Footnote This score alone may not consistently indicate a poor prognosis.
62
What is the current evidence regarding hypertonic saline for fluid resuscitation in TBI patients?
There is currently no evidence to recommend hypertonic saline over isotonic saline for fluid resuscitation and restoration of the intravascular volume.
63
What is hypotensive resuscitation also known as?
'Permissive hypotension' or 'small volume resuscitation'.
64
In which type of trauma is hypotensive resuscitation primarily advocated?
In patients with a strong potential for ongoing internal haemorrhage until rapid surgical control can be achieved.
65
What is the survival rate reported for penetrating trauma with resuscitative thoracotomy?
>40% in traumatic arrest, specifically precordial stab wounds.
66
What are the indications for immediate resuscitative thoracotomy?
Unresponsive hypotension with systolic BP <70 and FAST positive for pericardial tamponade.
67
What is the controversy surrounding the role of resuscitative thoracotomy in blunt trauma?
It has a relatively low survival rate of <3%.
68
What does TRALI stand for?
Transfusion-Related Acute Lung Injury.
69
What are the typical symptoms of TRALI?
Acute respiratory distress, diffuse bilateral alveolar and interstitial infiltrates on chest X-ray, and varying degree of hypoxaemia.
70
What is the death rate from pulmonary embolism (PE) among haemodynamically unstable patients?
Nearly 58%.
71
What is the recommended fluid loading limit for patients with massive PE?
Generally not exceed 1 L unless dehydration or hypovolaemia is suspected.
72
What is the only approved thrombolytic agent for acute pulmonary emboli?
tPA (Tissue Plasminogen Activator).
73
What is the optimal approach for pericardiocentesis according to recent findings?
The apical position at the point of maximal impulse on the left lateral chest wall.
74
How can pericardial effusions be categorized?
By maximal width: small (<10 mm), moderate (10–15 mm), and large (>15 mm).
75
What volume of fluid can cause cardiac tamponade in acute pericardial effusions?
As little as 150 mL.
76
What echocardiographic signs indicate cardiac tamponade?
* Right atrial collapse during ventricular systole * RV diastolic collapse * Lack of respiratory variation in IVC and hepatic veins.
77
What occurs first in cardiac compression due to tamponade?
Compression of the right side of the heart.
78
What should be closely inspected for diastolic collapse in cases of cardiac effusion?
Both the right atrium and right ventricle.
79
True or False: Cardiac tamponade depends on the amount of fluid in the pericardial sac.
False.

Resuscitation (2 decks)

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