Emergencies

Question 1

Dec BP and etCO2 sitting position

Answer 1

VAE

• listen for murmur
• flood with saline
• aspirate from CVC or pic line
• TEE
• 100% O2
• left lateral
• support with fluids, vasoconstrictors
• PEEP could impair venous return, reverse normal transatrial gradient of left to right and risk paradoxical embolism

Question 2

No IV access with hemorrhage

Answer 2

Central line
I/O
Surgeon for cutdown
IV guided PIV later
Set up blood salvage

Question 3

Hypoxia, dec breath sounds

Answer 3

Verify ETT placement
100% O2, hand ventilate
Hypoxia, arrthymia
PTX
- spontaneous respirations, PPV could make this a tension PTX
- needle decompression 2nd IC mid clavicular line

Question 4

Tx MH

Answer 4

Hyperventilate on 100% O2
Dantrolene 2.5 mg/kg then 1mg/kg every 6 hours for 24-48 hours
Active cooling
Tx hyperK
Tx rhabdo (mannitol)
Tx dysrythmias
Monitor coags for DIC, electrolytes, blood gases (acidosis), urine output

Question 5

How would you manage post extubation rapid labored breathing with rales?

Answer 5

Evaluate patient
Assess adequacy of O2, ventilation, work of breathing, signs of obstruction - SpO2, ABG
Assess mental status
Give O2 - mask, CPAP
Identify and treat underlying cause

Re-intubate at any point where delay for further evaluation would place patient at unacceptable risk

Question 6

Time remaining in O2 cylinder?

Answer 6

hours = psi/200xflow rate

Question 7

How would you intubate pregnant, minimally responsive patient with swollen tongue?

Answer 7

Given altered mental status, I would be concerned that further deterioration could place me in a position of managing her airway emergently.

ETT placement with goals of maintaining spontaneous ventilation, avoiding aspiration. Slow controlled induction with ketamine, prepared fro emergency tracheostomy.

Question 8

What are some reversible causes of cardiac arrest? (H&Ts)

Answer 8

Hypovolemia
Hypoxia 
H+
Hypo/hyperK
Hypothermia

Tension PTX
Tamponade
Toxins
Thrombosis - coronary or PE

Question 9

Joules for synchronized cardioversion - narrow regular complex

Answer 9

50-100J

Question 10

Joules for synchronized cardioversion - narrow irregular complex

Answer 10

120-200J

Question 11

Joules for synchronized cardioversion - wide regular complex

Answer 11

100J

Question 12

Dose of amiodarone for VF/VT

Answer 12

300mg bolus –> 150mg second dose

Question 13

Joules for defibrillation

Answer 13

120-200J

Question 14

Joules for pediatric defibrillation

Answer 14

2J/kg –> 4J/kg –> max 10J/kg or adult dose

Question 15

Joules for pediatric synchronized cardioversion

Answer 15

0.5-1J/kg –> 2J/kg

Question 16

Tx for unstable tachycardia with a pulse

Answer 16

synchronized cardioversion
50-100J if narrow
120-200J if irregular

Adenosine if regular and narrow

Question 17

Tx stable wide complex tachycardia with a pulse

Answer 17

Amiodarone 150mg over 10min

Expert consultation

Question 18

What would you expect the etCO2 to be with a PTX?

Answer 18

If tension PTX –> low etCO2 from low CO

Could be initially inc in etCO2 from hypoventilation, then decrease as grows larger in size and develops into tension PTX

If cause is pneumoperitoneum –> inc etCO2