Emergency Flashcards
Dose adrenaline
1 mg iv every 3-5 minutes
Dose phenylephrine for hypotension following spinal?
50 micrograms bolus
(General dose 1 mcg/kg)!!
Dose adrenaline for hypotension and bradycardia following spinal?
10-20 micrograms
1 mg ampoule adrenaline to 10ml = 100 micrograms/ml
1 ml of this solution to 10ml = 10 micrograms/ml
Or 1mg ampoule to 200ml;this dilution contains 1000micrograms in 200ml = 5 micrograms/ml
Dose phenylephrine for CV collapse following induction?
1 microgram/kg (1 to 2ml of the dilution in an adult)
Prepare dilution: 10mg in 200ml saline (50 micrograms per ml)
Dose adrenaline following cardiovascular collapse after induction with both hypotension and bradycardia?
200 ng (nano gram) (0,2 mcg) /kg (1 to 2ml of the dilution)
Dilution prepared: 1mg in 200 ml saline (5 microgram/ml)
Dose ephedrine following cardiovascular collapse after induction with both hypotension and bradycardia?
0.1 mg/kg (1 to 2 ml of dilution)
Dilution prepared: 50 mg in 10 ml water (5mg/ml)
Increases HR and contractility of heart
Which emergency drug and dose is used for severe hypotension following induction with normal HR?
Phenylephrine 1 microgram/kg
Alpha 1 agonist vasotrope
Which emergency drug is used for severe hypotension following induction with decreased HR?
Adrenaline 200 ng/kg (direct alpha and beta agonist)
Or ephedrine 0.1 mg/kg or etilephrine (indirect alpha and beta agonists)
Dose adrenaline for cardiac arrest?
10-100 microgram boluses
Dose ephedrine for hypotension and bradycardia following spinal?
0,1 mg/ kg
Usually 5-10mg bolus
Max 50mg, after this ineffective
Preparation: dilute 50mg to 10ml; this contains 5mg/ml
Ample mnemonic for history taking in trauma?
Allergies
Medications or drug abuse
Pertinent medical history
Last meal or intake
Events leading up to injury
Name 5 contraindications to urinary catheter placement
• Blood at meatus
• perineal ecchymosis
• high riding prostate
• pelvic fracture
• blood in scrotum
Describe haemostatic resuscitation for trauma induced coagulopathy (7)
• Red cells
• if fibrinogen < 1 g/ L, correct with cryoprecipitate
• platelets
• correct clotting factors with FFP
• maintain normothermia
• calcium supplement: co-factor in clotting cascade
• Tranexamic acid (antifibrinolytic)
Cerebral perfusion pressure formula and normal value?
Cpp= map-icp
Aim for 60-70 mm Hg in head trauma patient ( 60-80 normal)
How can cerebral perfusion pressure be improved? (9)
• Increase mean arterial pressure by give into-tropes, isotonic iv fluids
• decrease venous pressure
•decrease carbon dioxide to cause vasoconstriction and therefore decreased blood flow, which decreases ICP
• decrease brain volume by treat/prevent oedema
• decrease CSF (ventricular drain)
• decrease oxygen consumption of brain ( also prevent seizure activity)
• maintain oxygen delivery (ventilation, hb)
• maintain homeostasis (temperature, glucose, electrolytes, prevent infection etc)
• surgical control of lesions (bleed etc)
Moa/class ephedrine?
• Adrenergic alpha and beta receptor agonist (sympathomimetic amine)
• dopaminergic agonist
Indication ephedrine?
Hypotension and bradycardia induced by anaesthesia (increase hr and contractility)
Class/moa phenylephrine? NB
Alpha 1 agonist
Indications phenylephrine?
Hypotension only! (Must have normal to high hr)
(Also shock, paroxysmal atrial tachycardia)
Alternative name for adrenaline?
Epinephrine
Difference between adrenaline and noradrenaline?
Adrenaline stimulate alpha and beta receptors. Noradrenaline more specific for alpha receptors
Indication epinephrine during anaesthesia?
Bradycardia and! Hypotension
Dose atropine for bradycardia?
0,04 mg/kg iv every 5 mins, Max 3 mg
Lignocaine moa?
Sodium channel blocker.
Moa amiodarone?
Potassium channel blocker
Name 3 indications amiodarone
• Refractory V fib after defib and adrenaline
• V tach
• supraventricular tachycardia
Dose amiodarone?
Iv 5 mg / kg infusion over 20 min - 2h dilated in 250 ml 5% dextrose
Repeat infusion up to 15 mg/kg in up to 500ml dilution per 24h
Describe your anaesthetic plan regarding agents for a patient with porphyria. ( 7)
Pre-op
• midazolam premedication (stress-trigger)
•5% dextrose infusion with electrolytes (hypoglycaemia and dehydration = trigger)
Intra-op
• opioid: sufentanyl (fentanyl, morphine, meperidine also fine)
• induction: propofol (avoid thiopentone, etomidate and ketamine controversial )
• muscle relaxant: rocuronium (sux and pancuronium also fine)
• volatile: sevo (any is fine)
• local: procaine.
Name a contraindication for nasal tubes
Base of skull #
Cerebral perfusion pressure aim in head injury?
60-70 mm Hg
Name 8 ways Cerebral perfusion pressure can be improved
• increase mean arterial pressure: inotropes, isotonic iv fluids
• decrease venous pressure
• increase co2 (vasodilatation-increase icp ), decrease co2 (vasoconstriction- decrease blood flow)
• decrease brain volume by treat edema
• decrease CSF: ventricular drain
• decrease oxygen consumption brain, prevent seizures
• maintain oxygen delivery: ventilation, Hb
• maintain homeostasis: temperature, glucose, electrolytes, prevent infection etc
Name 10 anaesthetic problems associated with burns
• Airway deformity: scar tissue or contracture of mouth. Difficult intubation
• difficult Iv access.
• impaired thermoregulation
• immunosuppression
• risk hypoxia-carbon monoxide poisoning
• haemodynamic instability, shock
• fluid creep
• blood loss and anemia
• electrolyte abnormalities: fatal hyperkalaemia
• over growth functional receptors at neuromuscular junction
• hypermetabolic state: may need reduced drug doses
Anaesthetic of choice for burns patients?
Propofol best for induction, then ketamine 2nd choice. Lower doses than normal
Volatile sevoflurane or isoflurane best: no sensitization of myocardium to arrhythmia
Avoid sux. Nondepolariser will require high dose
