emergencies Flashcards
why do we do needle decompression
in an emergency setting to buy you some time before inserting a chest drain
needle decompression
done in 2nd intercostal space mid clav
chets drain
done in 5th itercostal mid axiallary
so where is the first rib
you wont be able to feel it as its bascially under the clavicle so the first rib you feel is the 2nd rib
why is a atnesion penumothorax a emergency
as the mediastinal shift occurs it causes a sn obstructive shock compressing the vana cava and not alloweing blood to reach the heart
so what are the 3 signs that would alert you to a tension pneumor
- TACHY + HYPO (SIGNS OF SHCOK)
- ABSENT BREATH SOUNDS
- DYSPNEAC
JVP AND TRACHEAL SHIFT ARE MUCH LATER SIGNS
which do you treat with a 3 way dressing
OPEN
PRIMARY PNEUMO
HAPPNES WITHOUT ANY CHEST PROBLEMS UNDERLYING DISEASE
how to avoid hitting the nerves and vessels
when in the space always go over the bottom rib as the bundle is underneth the top rib!
e.g 2nd intecostal space is between 2nd and 3rd rib so lie the needle over the 3rd rib .
DESCRIBE RECOVERY POSTION
MNEUMOIC FOR ALTERNED MENTAL STATUS
A- ALCOHOL, ACIDOSIS, AMMONIA , ARRYTHMIAS
E- EPILESY
I- INFECTIONS
O - OVERODES, OXYGEN, OPIATES
UR-UREMIA
Non shockable tx
Cprand adrenaline (amiodorone later on)
Non shcoabkle rtyhme
Pea
Asytole
Shockable rhythms
Vtach (plus less)
V fib
Why is torsdades dangerous
Can lead to v fib
What do you use to shock in a cardiac arrest
De fib
Causes of carriac arrest
5 h
4 t
How do you recognise a cardiac arrest
Absent breathing or agonal
No central pulse
So don’t just rely on peripheral ? Ask ababa
What’s a Farida arrest call number
2222
How long do you do cpr for
2 mins then check for a rhythm
What is something imprortanf before you shock someone
Remove oxygen
Tell people to stand clear
What is the joules for cardiac arrest
Not specified in guideline
Range from 120~ 360
Algorithm for shockable Rythm
ABCDE
Secure airway
Give oxygen
Shock
Resume cpr for 2 mins
After 3 rounds of shocks 300mg amiodorone and 1mg adrenaline IV or IO
Then repeat adrenaline every 3~5 mins I.e every other cycle
After 5 shocks give 150 mg amiodorone
Algorith, for non shockable
ABCDE
Secure
Oxygen
Cpr
Adrenaline 1mg iv or io
T
Keep giving every 3-5 mins or every other cycle
Cannot shock or give Amod wrong unless rhythm changes to a shockable one
Every time you do a Rythm check what should you do
Always stop compressions and pause a little
Every time you do a Rythm check what should you do
Always stop compressions and pause a little
What’s the definition of septic shock
- Despite aggressive resuscitation cannot maintain a MAP above 65 so need vasopresssor
- Lactate more than 2 despite fluids
What kind of vasopressor do we give in septic shock
Noradrenaline first line
News parameters how many
6
What’s are the cut offs for news
- 5 or more
3 or more in 1 section
In terms of news of o2 says what to always remember
To add 2 to the score of a patient if they are receiving supplemental oxygen
What’s more important in terms of bp for a deteririoting patient
Hypo
Because hyper can be due to pain or distress
What is a news score we are very worried about
7 plus
Traffic light system news
Less than 5
5/6 moderate or a single 3
7+ severe
DKA
Triad
Hypergycelmia
Ketonemia more than3
Acidosis <7.2 or bicarbonate <15
Nb! Hyperglycaemia may not always be present in DKA (euglycemic dka)
What is DKA associated with
Type 1 but it can happen in type 2 very rare
Young kids
DKA happens commonly
In children
Signs of DKA
Fruity breath
Tacky
Hypo
Abdomen pain
Vomitting
Dehydrated
Kussmail breathing
Altered mental status
Protocol for DKA
- Start fluids
- Them start insulin infusion 0.1 units per kg per hour 1 hour after starting fluids
Theee is a a risk of hypokalemia so think about adding potassium
To what level would you consider adding glucose in DKA
Once the glucose falls below 14
malignant hypertension
whats the main thing we are worried about here
> 180/120
encephlopathy as leads to edema of brain
what are the signs of end organ failure in hypertension
- headache
- vision- retinal hemorrgage, papilledema
- kidney
- encephalopathy
seizure - heart
what are we aiming the drop for and why in malignant hypertension
1st line
around 160/100 otherise can cause a stroke ischemic
ca channel blocker
