Emergencies Flashcards
What are the signs of an air embolism?
Decreased CO2
Tachypnoea
Decreased oxygen saturation
Hypotension
Tachycardia
ECG changes
‘Pulmonary wheel murmur’
Pulmonary oedema may develop later
Altered mental status if awake
Cardiopulmonary collapse
What should you do in the event of an Air Embolism?
Call for help
Identify a hands-off leader and delegate roles
Turn FiO2 to 100% and stop any nitrous oxide use
Stop the source of air entry
Inform the surgeon to flood surgical field
Use ETCO2 to monitor progression
What are the main risks for air embolism?
Operative field above the heart
Spinal surgery
Sitting craniotomy
Large bore IV access
Rapid infusions
C section
Gas insufflation procedures
Head up during central line
RRT, ECMO, Bypass
What are the signs of anaphylaxis?
Severe grade reaction
Hypotension
Bronchospasm
High peak airway pressure
Decreased or lack of breath sounds
Tachycardia
Urticara
Cardiac arrest
Oedema
What should you do in the event of a suspected anaphylaxis ?
Call for help
Identify a hands off team leader
Turn FiO2 to 100% and consider reducing anaesthesia depth
Adrenalin bolus of 20-100mcg IV repeat 1-2 minutes
OR
Adrenalin IM 0.5mg every 5 minutes as needed
Remove potential causative agents
Secure the airway with ETT
Ensure large bore IV access
Give 2L fluid bolus and elevate legs
If no pulse or systolic BP <50 start CPR and follow PEA algorithm
Obtain and continue with anaphylaxis box cards
What should you next consider with a suspected anaphylaxis ?
Adrenalin infusion +/- any other vasopressor
Salbutamol +/- magnesium if bronchospams
Arterial line, central line, blood gases
Tryptase levels test 1 / 4 / 24 afters
Can the operation continue?
Referral to ICU
What is the IM adrenalin dose for children?
10mcg [0.01ml/kg] of 1:1000
[min dose 0.1ml]
[max dose 0.5ml]
Repeat every 5 minutes as needed
What is the IM adrenalin dose for adults?
0.5mg [0.5ml of 1:1000]
Repeat every 5 minutes as needed
Main causes of anaphylaxis?
Antibiotics
Muscle relaxants
Chlorhexidine
Latex
Colloids
Patient blue
What do you do in the event of an unstable bradycardia?
Call for help and the resuscitation trolley and attach defib pads
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Stop surgical stimulation
Give atropine 600mcg IV repeat up to 3mg
If atropine ineffective start either adrenalin infusion or transcutaneous pacing
Confirm pulse present if no pulse start CPR and follow cardiac arrest aystole/PEA algorithm
What are the signs of unstable bradycardia?
HR <50bpm with hypotension
Acutely altered mental state
Shock
Ischaemic ECG or acute heart failure
What are the signs of bronchospasm?
Persistant increased peak airway pressure
Wheezing
ETCO2 slowly increasing slope
What should you do during a bronchospasm emergency?
Call for help
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Examine patients chest for wheeze and air entry
Consider other differentials [aspiration, anaphylaxis, ARDS acute respiratory distress syndrome]
Deepen anaesthesia with sevoflurane
Use neuromuscular blocker and consider intubating if LMA
Start drug treatments
Review and adjust ventilator settings [volume control]
What drugs are given during bronchospasm?
Salbutamol inhaled 8-12 puffs
Salbutamol IV bolus 250mcg [100mcg/ml]
Magnesium
Adrenalin
ketamine
What are some additional steps to consider during a bronchospasm?
ICU review and advice
If concerned about aspiration pass suction catheter down ETT
If haemodynamically unstable may have tension pneumothorax, gas trapping or anaphylaxis
Arterial line and serial ABG’s
Chest X-ray / scan
What are the signs of Cardiac Arrest – asystole / PEA?
Non-shockable pulseless cardiac arrest
What should you do in the event of an asystole / PEA?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and turn off anaesthesia
Start CPR and encourage high quality chest compressions
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
Secure airway with ETT and ventilate RR 8
Confirm capnography
Attach defibrillator pads in case of change to shockable rhythm
Review reversable causes 4H’s 4T’s
Pulse and rhythm check every 2 minutes
Use ETCO2 to assess CPR quality
What drug do you give for an adult cardiac arrest?
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
What are the 4 H’s of a cardiac arrest cause stand for?
Hypovolemia/ Haemorrhage
Hypoxia
Hyper/hypokalaemia / metabolic disorders
Hyper/hypothermia
What are the 4 T’s of a cardiac arrest cause stand for?
Tension pnumothorax
Tamponade
Thrombosis – pulmonary, coronary, air, fat
Toxins [beta blocker, Ca2+ channel blocker, local anaesthetic, drug error]
How do you treat hyperkalaemia?
Sodium bicarbonate
Insulin actrapid
Calcium chloride
What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA
Adrenaline 0.01mg/kg of the 0.1mg/ml concentration
Max dose 1mg
Repeat every 3-5 minutes
What are the steps to take during a Cardiac arrest VF / VT
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and turn off anaesthesia
Start CPR and encourage high quality chest compressions
Defibrillate at 200J then recommence CPR
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
After 3rd cycle consider giving amiodarone 300mg IV
Secure airway with ETT and ventilate RR 8
Confirm capnography
Attach defibrillator pads in case of change to shockable rhythm
Review reversable causes 4H’s 4T’s
Pulse and rhythm check every 2 minutes
Use ETCO2 to assess CPR quality
What are the Defibrillator Instructions?
Attach defibrillator pads to patient in the appropriate way
Select energy 200J and press charge
Once charged stop CPR and assess rhythm
If shock advised ensure all staff stand clear of bed
Pressure shock and immediately restart CPR
What are the non-shockable rhythms?
Asystole/PEA
What are the shockable rhythms?
VF / VT
What are the Starting steps to take with an unanticipated difficult airway?
Call for help and the difficult intubation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Use Vortex approach
Ensure good neuromuscular relaxation and consider TIVA
One person to watch oxygen saturation, declare if <90%
Ask hands off leader to count and say airway attempts
What are the get ready for CICO steps in an uninticpated difficult airway?
Open FONA [front of neck access] kit on the side of the anaesthesia machine for scalpel and or needle technique
Contact ENT senior surgeon to help
What are the steps to take during a CICO event during an unanticipated difficult airway?
Declare CICO if oxygen saturations <90% or rapidly falling and all 3 lifeline best effort attempts not successful
Options are WAKE UP or FONA
For wake up ensure muscle relaxant reversal is complete
What are the signs of an unanticipated difficult airway?
Unsuccessful intubation and oxygenation attempts under optimized conditions
What are the initial steps should you take during a haemorrhage?
Call for help and ask for blood warmer or rapid infuser +/- cell saver
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and consider reducing anaesthesia depth
Confirm source control attempted by surgeon ask if help is needed
Get large bore IV access x 2
Give fluid bolus and vasopressors to maintain organ perfusion
Blood request
What are the signs of High airway pressures?
Persistant increased peak airway pressure >40cmH20
Hypoxaemia
Inadequate ventilation
What steps should you take during a high airway pressure event?
Call for help and ask surgeons to stop stimulation
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Consider TIVA
Exclude ligh anaesthesia or inadequate relaxation
Switch to manual ventilation
Disconnect LMA/ETT from circuit and squeeze bag to assess if the problem is with the airway, breathing or circuit
If pressure is normal now problem is with the airway or breathing
If pressure is still raised problem is with the circuit
Ensure HME filter checked/excluded
What steps should you take if its an airway problem during a high airway pressure event?
Review position, check patency by passing suction catheter, consider change of device
What steps should you take if it’s a breathing problem during a high airway pressure event?
Review cause by examination
Listen to chest
Consider ultrasound or chest X-ray
What steps should you take if it’s a circuit problem during a high airway pressure event?
Ventilate with AMBU bag
TIVA
Review circuit
What common problems could cause a circuit to create high airway pressures?
Blocked HME filter
Water in circuit
Kinked/compressed
Valves sticky
What can cause airway or breathing problems?
Anaphylaxis
Aspiration
Abnormal anatomy
Bronchospasm
Blocked or displaced LMA/ETT
Inadequate depth of anaesthesia
Inadequate muscle relaxation
Malignant hyperthermia
Pneumothorax
Pulmonary oedema
atelectasis
What is atelectasis?
The collapse of part or all a lung
Caused by a blockage of the air passages [bronchus or bronchioles]
What are the signs of hypotension?
Unexplained drop in blood pressure refractory to initial treatment
Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}
It extends the shelf life of RBC up to 42 days of increased functional viability
What steps should you take during a hypotension emergency?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and consider reducing the anaesthesia depth
Check pulse, BP, ECG and equipment
If Bradycardia, Tachycardia or Cardiac Arrest see specific checklist
Open IV / Pressurised fluid bolus / consider blood products
Optimize venous return with Trendelenburg positioning / low PEEP
Vasopressor treatment
Mild hypotension - phenylephrine, ephedrine, metaraminol
Severe / refractory – adrenaline, noradrenaline or vasopressin
Identify cause of hypotension
What additional steps should be taken during a hypotension emergency?
Arterial line
CVC
ABG
Hourly urine output monitoring
Consider echo
Referral to ICU
What surgical events can cause a hypotension emergency?
Mechanical / surgical manipulation
Insufflation during laparoscopy
Retraction and vagal stimulation
Vascular compression
Can sepsis cause a hypotension emergency event?
Yes
What are the signs of hypoxia?
Low oxygen saturation <92% or cyanosis
What should you do during a hypoxia emergency?
Call for help
Identify a hands-off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Confirm ETCO2 capnography and morphology
Confirm pulse oximeter position and patient colour
Hand ventilate and assess patient / circuit
Check;
Airway – Examine device +/- suction tube, laryngoscopy
Breathing – chest sounds, movement and lung compliance
Circulation – blood pressure, pulse and rhythm
Circuit – HME filter, tubing, one-way valves, anaesthesia machine
Depth and relaxation
What are the signs of laryngospasm?
Sustained closure of the vocal cords resulting I the partial or complete loss of the patients airway
What steps should you take during a laryngospasm emergency?
Call for help
Identify a hands off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Stop any stimulation
If has LMA remove and clear airway using suction if needed
Apply mask, jaw thrust and CPAP 30Cm H20
+/- Oropharyngeal airway
Deeping anaesthesia using propofol
Relaxation using IV suxamethonium
Plan to intubate if sats are <92%
Can laryngospasm break with sufficient time and hypoxia?
yes
Does ongoing laryngospasm increase the risk of negative pressure pulmonary oedema, bradycardia, cardiac arrest and aspiration?
yes
What is the intubation dose of propofol for adults?
1-2mg/kg
What is the intubation dose for suxamethonium IV?
2mg/kg
What is the intubation dose for suxamethonium IM?
4mg/kg
How much propofol do you give to break a laryngospasm event?
20% of an induction dose 0.25-0.5mg/kg
What are the signs of local anaesthetic toxicity?
Sudden alteration in mental status
Tonic clonic seizure
Arrhythmias or cardiovascular collapse
Sinus bradycardia
Conductional blocks
Asystole
Ventricular tacharrthymias
What’s steps should you take for a local anaesthetic toxicity emergency event?
Stop giving the local anaesthetic
Call for help and the resuscitation trolley and intralipid
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Assess airway, breathing, circulation and treat accordingly
If haemodynamically unstable consider intralipid
Hyperventilation may be helpful
Treat seizures with propofol
What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?
1.5mg/kg over 1 minute [100ml for 70kg]
If remains unstable Repeat 2 more doses at 5-minute intervals max
What is the infusion dose of 20% intralipid?
15ml/kg/hr [1000ml/hr for 70kg]
If remains unstable double infusion rate
Is propofol a substitute for intralipid?
No
What can trigger a Malignant Hyperthermia?
Volatile anaesthetic agents
Suxamethonium
What are the signs for malignant hyperthermia?
Unexpected increase in ETCO2
Unexplained tachycardia
Unexplained tachypnoea
Arrhythmias
Prolonged masseter muscle spasm after suxamethonium
Hyperthermia is a late sign
What steps should you take during a Malignant hyperthermia emergency?
Call for help and the MH box / Trolley
Identify a hands off leader and delegate roles
Remove precipants
Stop volatile anaesthesia and start TIVA
Hyperventilate with 100% oxygen at high flow of 15L/min
Consider changing soda lime if quick and easy
Do not waste time changing the circuit, machine or filter if event is actively happening
Start dantrolene
Obtain and continue with the MH box cards
What are additional consideration steps to take during a MH event?
IV access, central line, arterial line
Blood tests every 30 minutes
Temperature probe and commence active cooling
Catheter – urine output aim should be 2ml/kg/hr
Discuss with ICU
How do you prepare the dantrolene?
20mg vial mixed with 60mls sterile water
What is the bolus dose of dantrolene?
2.5mg/kg [60kg = 8 vials]
How long after immediate treatment of dantrolene should you consider giving another repeat bolus?
10 minutes if still symptomatic
How does dantrolene work?
Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells
preventing electrical impulses traveling to muscles and preventing muscle contractions
What complications can MH cause?
Acidosis – treat with hyperventilation, sodium bicarbonate
Arrhythmias
Disseminated intravascular coagulation [DIC] -abnormal blood clotting
Hyperkalaemia – high potassium levels in blood
Hyperthermia – cold fluids, ice
Hypotension – fluid bolus, vasopressor
Cardiovascular collapse and cardiac arrest
What are the signs of unstable tachycardia?
Shock
Syncope – loss of consciousness
Severe heart failure
Myocardial ischaemia [obstructed blood flow to heart]
Altered mental status
Heart Rate > 150 BPM
Mean arterial pressure <65
What are the signs of stable tachycardia?
Mean arterial pressure >65 and no adverse features
What steps should you take with a tachycardia emergency?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Stop surgery and perform DRABCDE review
Identify any reversible causes and tailor treatment to patient
What steps should you take with an unstable tachycardia emergency?
If conscious use gentle sedation
Cardioversion with synchronised shock
Review rhythm and confirm cardiac output
If problem persists repeat cardioversion up to 3 times
Amiodarone 300mg IV over 10-20 minutes
What steps should you take with a stable tachycardia emergency?
Review rhythm and check underlying causes
Arterial line and bloods
Consider drug treatment
Seek expert help from cardiology or ICU
How to set up a cardioversion with synchronised shock
Apply pads and select DEFIB
Select 50-150J energy
Press SYNC button
Check SYNC success – confirm marking ^ on R waves
Charge and deliver shock safely
If synchronisation not possible use high energy unsynchronised shocks
What is SVT?
Supraventricular tachycardia
What is PEA?
Pulseless electrical activity
When is amiodarone given and what dose?
After third shock for VF and VT that is unresponsive to shock delivery, CPR and vasopressor
300mg
How can you raise concerns of ideas during the crisis?
Your input may be crucial
Probe – make observation or ask clarifying question
Alert – suggest problem and offer possible alternative
Challenge – address person using their name, directly question plan or decision
Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient
What should your checks be during any crisis?
Oxygen delivery FiO2, FGF, bellows or bag moving
Airway – ETT or LMA patent
Breathing – Sats ETCO2 waveform, tidal volumes and rate
Circulation – Rate, rhythm, ischaemia, BP, Peripheries
Depth – MAC or TIVA value, BIS or entropy
Surgery – ask how is the operation going? Review blood loss
What does BCIS stand for?
Bone cement implantation syndrome
What are the patient signs of BCIS?
Hypoxia
Hypotension
Or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion
True or False: a small current may be sufficient to induce ventricular fibrillation
True
True or false: macro shock cannot cause ventricular fibrillation
False
What is the adult cardiac arrest adrenaline dose? Include units
1mg
What is the adult anapahylaxis adrenaline dose? Include units
0.5mg
What is the paediatric cardiac arrest adrenaline dose? mcg/kg
10 mcg/kg
What is the paediatric amiodarone cardiac arrest dose? mg/kg
5 mg/kg
What is the energy dose for paediatric defibrillation? J/kg
4 J/Kg
What is the energy dose for adult defibrillation?
200J
What is the intralipid bolus dose in ml/kg?
1.5ml/kg
Which emergency causes tachycardia, hypotension, urticaria and bronchospasm?
Anaphylaxis
Which emergency causes visual disturbances, confusion, bradycardia and hypotension?
Local toxicity
What emergency causes tachycardia, tachypnoea, hypotension, and hyperkalaemia?
Malignant hyperthermia
Which medication can be used to increase potassium uptake in malignant hyperthermia, reducing hyperkalaemia?
Insulin
Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?
Sodium Bicarbonate
True or false – nitrous oxide is a triggering agent for malignant hyperthermia
False
Which blood test is used to confirm anaphylaxis after the incident?
Tryptase
When should tryptase be taken after an anaphylaxis event?
A - Immediately and after 24 hours
B- 1 hour, 4 hours and 24 hours
C - Immediately, 2 hours and 6 hours
D - When I can be bothered doing a blood gas
B
MTP box 1 contains what?
A) 4 RBC, 4 FFP
B) 2 RBC, 2 FFP
C) 4 RBC, 4 FFP, 3 Cryo
D) 4 RBC, 4 FFP, 1 Platelets
B
MTP box 2 contains what?
A - 4 RBC, 4 FFP, 3 Cryo
B - 2 RBC, 2 FFP
C - 4 RBC, 4 FFP, 1 Platelets
D - 4 RBC, 4 FFP
A
MTP box 3 contains what?
A 2 RBC, 2 FFP
B 4 RBC, 4 FFP, 1 Platelets
C 4 RBC, 4 FFP, 3 Cryo
D 4 RBC, 4 FFP, 1 Cryo
B 4 RBC, 4 FFP, 1 Platelets
Which boxes are repeated in an MTP?
A - 1 & 2
B - 3 & 4
C - 1 & 4
D - 2 & 4
B
What does DRSABCD stand for?
Check for DANGER
Check for a RESPONSE
SEND for help
Check the AIRWAY
Check for BREATHING
Start CPR
DEFIBRILLATION
Continuous Positive Airway Pressure, Propofol and Suxamethonium is textbook treatment for what emergency?
A - Bronchospasm
B - Laryngospasm
C - Difficult intubation
D - Anaphylaxis
B
Bronchospasm may be treated with:
A -Salbutamol via ETT or IV
B - Adrenaline
C - Volatile anaesthetics (increased MAC)
D - All the above
D
Five common causes of anaphylaxis?
Latex
Colloid
Antibiotics
Muscle relaxant
Chlorhexidine
Patient blue
sugamadex -[likelihood appears to be dose-related]
What are 5 symptoms of anaphylaxis?
Difficult/noisy breathing
Wheeze/Persistent cough
Swelling of the face and tongue
Swelling/tightness in the throat
Difficulty talking
Persistent dizziness/ loss of consciousness
Abdominal pain and vomiting
Hives, welt and body redness/rash
Hypotension
What are the signs and symptoms of Local Anaesthetic Toxicity?
Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness
Convulsions and loss of consciousness
Hypotension, bradycardia, and respiratory arrest
What are the early signs and symaptoms of Malignant hyperthermia?
Prolonged muscle spasm after Suxamethonium
Tachycardia
Tachypnoea in a spontaneous breathing patient
Increased CO2
Cardiac arrhythmias
What are the Developing Signs and Symptoms of Malignant hyperthermia?
Rapid increase in temperature (0.5 degrees every 15 minutes)
Respiratory and metabolic acidosis
Hyperkalaemia
Profuse sweating
Decrease SpO2
Mottled skin
Cardiac instability
Muscular rigidity
What are the Late Signs and Symptoms of Malignant hyperthermia?
Cola coloured urine
Increase CK serum
Coagulopathy
Severe muscle ache
Cardiac Arrest
What does TACO stand for and what is it?
Transfusion Related Circulatory Overload
Pulmonary oedema primarily caused by volume excess
Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.
What does TRALI stand for and what is it?
Transfusion Related Acute Lung Injury
Repaid onset of excess fluid in the lungs.
Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest
What is Acute Haemolytic Transfusion Reaction
AHTR
A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)
What is ROSC?
Return of spontaneous circulation
Generally detected by arterial pulse palpation and end tidal CO2 monitoring
What is the flow rate of a 14g cannula?
Just gravity - 250ml/min
Pressurized – 380ml/min
What is the flow rate of a RIC line?
1000ml/min
What is the normal heart rate range for a child?
70-160 BPM
Discuss the immediate management of an airway fire;
Stop laser immediately
Turn O2 off
Call for help
Establish a hands-off team leader and delegate roles
Use saline swabs to put out fire
Get the fire extinguisher and fire blanket and attempt to extinguish the fire
Turn off medical gases and disconnect ventilator
Remove ETT and remove flammable material from airway
Pour saline into airway
After fire extinguished re-establish tube and reintubate and reestablish ventilation
Using AMBU bag with room air
Assess airway for injury
Emergency tracheostomy if intubation failed
Give 5 reasons why a women would require an emergency LSCS
Prolonged labour
Foetal distress
Cord prolapses
Exhaustion
Placenta problem
Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;
3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells
This can lead to problems such as oedema, reduced cardiac output and hypotension
3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids
Define vasovagal;
Over activity of the vagus nerve resulting to a temporary fall in blood pressure, heart rate, fainting
Discuss first degree burn;
Effect the outer layer of skin – superficial
Discuss second degree burn;
Involves the epidermis and part of the lower layer of skin - dermis
Discuss third degree burn;
Destroys the epidermis and dermis
This may go into the subcutaneous tissue
Discuss fourth degree burn;
Go through both layers of skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone
Explain the rule of nines and how it is used to estimate the extent of a burn’s injury;
Dividing the bodies surface area into percentages to calculate the extent of the burns injury
Front + back of head and neck = 9%
Front + back of each arm = 9%
Chest = 9%
Stomach = 9%
Upper back = 9%
Lowerback = 9%
Front and back of each leg and foot 9% each side
Genital area = 1%
Explain common complications associated with burns surgery;
Blood loss – debrided tissue bleeds freely
Hypothermia
Infection
Breathing problems
Fluid loss
Difficult placement of monitoring and IV
Define ACVPU;
Alert
Confusion [new onset or worsening] confusion
Voice
Pain
Unresponsive
Define GCS;
Glasgow coma scale
What are the 3 consciousness ratings of the Glasgow coma scale?
Severe - 3-8
Moderate - 9 - 12
Mild - 13-15
What are the 3 assessments for the Glasgow coma scale?
Eye opening
Spontaneous – 4
To sound – 3
To pressure – 2
None - 1
Verbal response
Orientated – 5
Confused – 4
Words – 3
Sounds – 2
None - 1
Motor response
Obey commands -6
Localising - 5
Normal flexion - 4
Abnormal flexion - 3
Extension - 2
None - 1
State normal range of an ICP measurement;
5-12mmHg
Normal CBP pressure range
8-12mmHg
State the relationship between CSF, CBF and ICP;
CSF, CBF, ICP are constant so an increase in one should cause a reciprocal decrease in one both remaining two
Vice versa
Briefly explain the relationship between CPP/MAP and ICP
Cerebral perfusion pressure is the effective pressure that results in blood flow to the brain
CPP = Mean Arterial Pressure – Intracranial Pressure
Define CPP;
Cerebral perfusion pressure
Explain Cushing’s triad;
Refers to a set of signs that are indicative of increased intracranial pressure
Consists of bradycardia
Irregular respirations
Widened pulse pressure
Increase between systolic and diastolic pressure
What is the normal range for CO2?
35-45 mmHg
Define AHTR
Acute haemolytic transfusion reaction
Is this arterial waveform normal, under or over damped?
Normal
Is this arterial waveform normal, under or over damped? And what can cause it?
Overdamped
Loose connections
Air bubbles
Kinks
Clots
Spasms
No volume or low pressure in pressure bag and tubing
Is this arterial waveform normal, under or over damped?
Underdamped
Increased vascular resistance
Hypothermia
tachycardia
Excessive movement of the catheter within the artery leading to false high systolic or a false low diastrolic pressure
What is this capnography trace?
Oesophagus intubation
Low level ETCO2 that quickly tapers off
What is this capnography trace?
CPR
What is this capnography trace?
ROSC
Return of spontaneous circulation
What is this capnography trace?
Airway obstruction or apnoea
Interrupted breaths
What is this ECG trace?
Sinus Arrhythmia
What is this ECG trace?
Normal sinus Rhythm
What is this ECG trace?
Sinus tachycardia
What is this ECG trace?
Sinus bradycardia
What is this ECG trace?
Paroxysmal supraventricular tachycardia PSVT
Rate changes abruptly and unexpectedly
What is this ECG trace?
Ventricular tachycardia
What is this ECG trace?
Ventricular Fibrillation
What is this ECG trace?
asystole
