Fleischer & Ludwig's Flashcards
Medikamente im Fluid refraktärem Shock
F&L
Cold:
dopamine 5-10ug/kg/min
+ adre 0.05-1ug/kg/min
Warm:
Dopa+ noradrenalin (Same dosages)
After 40ml/kg volumen über 1h
F&l table 5.4
Kurzanamnese SAMPLE
Flch1
Signs Allergies Medication Past history Last meal Events leading up to
Is there evidence for albumin or colloids in Reanimation?
Flch1
No
How many percents of motor vehicle failures are pediatric patients?
What age group has the most pedestrian victims?
Flch2
49%
5-9 y
GCS points distribution
Flch2
Eye 4
Verbal 5
Motor 6
What min. BP equals peripheral vs central perfusion.
Flch 2
Peripheral pulse (radial) = sbp > 80 mmHg Central pulse = sbp > 50 mmHg
Hemorrhage classes
Flch2
Class 1 < 15% (20ml/kg)
2: 15-30% (20-40ml/kg)
3: 30-40% -> shock, sbp sinkt
4: >= 40% -> shock, narrow pulse -> immediate transfusion
Dilated neck veins + deceleration injury
Flch2
Cardiac tamponade
How much cristalloid for 100ml of lost blood.
Flch2
300ml
When to give FFP?
Flch2
FFP Not evaluated in children,
Adults 1:1 FFP & PRBC
How to evaluate normovolemia post reanimation?
Flch2
Urine output best measure.
>1y: 1ml/kg/h
<1y: 2ml/kg/h
How many patients with bowel perf have free air on abdominal CT?
Flch2
Only 25% have signs on CT
What’s correct ET-tube cuff pressure?
Flch3
20-30mmH2O
Rule of thumb for cuffed tube size/uncuffed
Flch3
Uncuffed: 4+age/4 (cuffed: -0,5)
What is the narrowest point of the airway at a child.
Flch3
Cricoid cartilage
RSI medication sedation
Flch3
Etomidate 0,3mg/kg not for septic shock due to adrenal suppression
Propofol 1-4mg/kg; hypotension!
Ketamine 1-3mg/kg; nicht für SHT, erhöht SVR und BP, Bronchidilatation
RSI medication paralyzing
Flch3
Succinylcholine 1-2mg/kg 30-60s inset, 3-8’ duration
CAVE myopathie da depolarisoiend (K+ release)
Alternative roccuronoium 0,6-1,2 mg/kg
Role of atropine in intubation
Flch3
Reduziert vagusstimulus und Sekretionen
Nur bei <1y systematisch
Percentage of primary cardiac arrests adult vs led
Flch4
13% in ped compared to 72% in adults
Measure for oropharyngeal airway (güdel)
Flch4
Corner of mouth to madibule
Measure for nasopharyngeal airway (Wendel)
Flch4
Nares to Targus
% of O2 delivered via different devices
Flch4
Nasal cannula 30-40%
Simple mask 35-60%
Partially rebreathing mask 50-60%
Non-rebreathing mask 95%
Defibrillation voltage
Flch4
2j/kg subsequent 4j/kg
When to deliver synchronous shocks (cardoversion)? And voltage
Stable perfusing ventricular or Supra ventricular tachycardia
Cardio version on R
0,5-1J/kg max 2j/kg. CAVE: conscious patient! Sedation and analgesia!
Approach to bradycardia
- Airway (o2 mangel)
- Erhöhter vagus tonus? => atropin
Heart block? => pacing? - Sonst: Adrenalin
Refractory VT/VF ohne Puls
Lfch4
Amiodarone: 5mg/kg max 3x IV rapid push
Torsade de pointe approach:
Flch4
Magnesium iv to be considered, 25-50mg/kg iv push if pulseless, over 10-20min if with pulse
Reversible causes of ACR
Flch4
Hypovolemia Hypoxia Hydrogen ion excess (acidosis) Hypoglycemia Hypokalemia Hyperkalemia Hypothermia Tension pneumothorax Tamponade – Cardiac Toxins Thrombosis (pulmonary embolus) Thrombosis (myocardial infarction)
SVT Approach
Flch4
Unstable: adenosine 0,1mg/kg rapid push followed by 0,2mg/kg rapid push if ineffective or synchronized cardioversion
Stable: vagal stimulus
