General Flashcards
DOPES
(Sudden deterioration post CA)
Displacement of the tracheal tube
Obstruction of the artificial airway
Pneumothorax
Equipment failures
Stomach distension
pH
PaCO2
HC03
Pa02
pH 7.35-7.45
PaCO2 4.5-6
HC03 22-26
Pa02 10-13
<C> Ac, B, C, D, E
</C>
Catastrophic haemorrhage
Airway with c-spine stabilisation
Breathing
Circulation
Disability
Exposure
High pH
High HCO3
Metabolic alkalosis
Low pH
Low HCO3
Metabolic acidosis
High pH
Low CO2
Respiratory alkalosis
Low pH
High CO2
Respiratory acidosis
Tranexamic acid
15mg/kg loading dose over 10 minutes
Infusion of 2mg/kg for at least 8 hours
Started within 3-4 hours of bleed
Epidermal burns
Injury to epidermal later only
Skin remains intact
Heals within seven days
Superficial partial thickness burns
Superficial layers; epidermis and superficial dermis
Blistered and pale pink, blood supply is maintained
Heals within 2-3 weeks
Full thickness burns
Involves epidermis, full thickness dermis and may involve subcutaneous tissue and deeper structure
White/charred, absent capillary refil
Surgical debridement and grafting
Deep partial thickness burns
Epidermis and dermis
Reduced CRT and poor blood supply
3+ weeks to heal, may require surgical intervention
Tension pneumothorax
When air is forced into the pleural cavity without means of escape, it accumulates and comes under pressure.
This pressure can displace the mediastinum to the opposite side of the chest, causing compression of the great vessels.
Needle decompression
The insertion of a cannula into the second intercostal space in the mid clavicles line on the side of the tension pneumothorax
Massive haemothorax
Due to blood accumulating in the pleural cavity
Flail chest
Where two or more ribs are broken in two or more places so that they are not connected to the rest of the rib cage and do not move in conjunction with it on expiration and inspiration.
Cardiac tamponade
The heart is pierced and blood fills the pericardial sack, which limits the space for cardiac contraction.
Chest drain insertion
Inserted in the 4th or 5th intercostal space between the anterior axillary line and mid-auxiliary line.
Traumatic diaphragmatic hernia
Occurs more often following abdominal trauma. Diagnosis can be from hearing bowel sounds on chest auscultation and seeing bowel within the chest cavity on an x-ray. Treated by surgical repair.
Trachobronchial tree injures
Associated with a pneumothorax or haemothorax with subcutaneous emphysema
Pneumothorax
Air in the pleural space between the lung and the internal thoracic wall, which compresses the lung and impedes ventilation
IO insertion sites
Proximal tibia, distal tibia or distal femur
IV access
Antecubital fossa or saphenous vein
Contraindications of IO access
Brittle bones
Fractures
Infected skin/wounds
Unable to reinsert at site for 48 hours
Complications of IO
Tissuing or swelling of surrounding tissue
Embolism of bone or fat
Infection
Compartment syndrome
Skin necrosis
Fracture
Damage to growth plates
Sites of central venous access
Right and left internal jugular veins (R sided)
Right and left subclavian veins
Right and left femoral veins
Signs of circulatory failure
Decreased skin perfusion, prolonged capillary refill time and hypotension
Cautions of fluid administration
Suspected cardiogenic shock as heart is unable to deal with volume load
Diabetic ketoacidosis as large fluid shifts are undesirable
How many mls of fluids before ongoing losses to be suspected?
40-60ml/kg
Signs of fluid overload
Moist sounds and crackles at lung bases
Jugular venous distension in children
Liver distension in infants
Issues with 0.9% sodium chloride
Can cause hyperchloraemic acidosis due to high chloride content, which can promote inflammation and kidney injury
Glucose dose
2ml/kg 10% glucose
2.5ml/kg in neonates
When should the massive protocol be activated?
If above 40ml/kg of O rhesus negative has been given
Lorazepam
Benzodiazepines with anti-seizure and dedication properties
0.1mg/kg IV, can be repeated after 5-10 minutes
Levetiracetam
Inhibits the release of neurotransmitters for nerve end terminals. Second line for seizures
40mg/kg given over 5 minutes
Phenytoin
Inhibits the spread of seizure activity in the cortex. Second line therapy in seizures
20mg/kg IV given over 20 minutes
Ketamine
Sedative, analgesic and anaesthetic agent. Inhibits actions of NMDA receptors by glutamate.
1-2mg/kg IV, can be given IM at 4mg/kg
Naloxone
Fast acting opiate antagonist to be used for symptomatic opiate positioning
Under 5 years, 100mcg/kg
Above 5 years, 2mg
Can be repeated every 3 minutes, or continuous infusion 10-160mcg/kg/hr
Atropine
Used to treat bradycardia from vagal stimulation. Blocks the effects of the vagal nerve on the SA and AV nerve to increase sinus automatically, facilitate AV node conduction and increase heart rate
Under 11 years, 20mcg/kg
12-17 years 300-600mcg
Sodium bicarbonate
1mmol/kg or 1ml/kg of 8.4 solution
Under 3 months, weaker solution (4.2%) to be used
Adenosine
Causes atroventricular block. Impairs accessory bundle re-entry at the AV node, which is responsible for SVT
Neonate and 1-11 months: 150mcg/kg increased 50-100mcg every 1-2 mins. Neonate max dose 300mcg/kg, 1-11 months max dose 500mcg/kg.
1-11 years: 100mcg/kg increased 50-100mcg every 1-2 minutes. Max dose 500mcg/kg
12-17 years: 3mg, then 6mg after 1-2 mins, then 12mg after 1-2 mins.
Non shockable rhythms
Asystole and PEA
Shockable rhythms
PVT, VF
Asystole
Total absense of effective electrical and mechanical activity in the heart
No ventricular function but occasionally some arterial activity which may show as P waves.
Pulseless electrical activity
Organised cardiac electrical activity in the absense of palpable central pulse or signs of life
ECG rhythms is often slow, broad complex although could be any variation of QRS complex
Adrenaline dose in CA
0.1ml/kg, 10mcg/kg of 1:10,000
Pulse checks
Infant: brachial or femoral
Above one year: carotid or femoral
Pulseless ventricular tachycardia
Broad complex tachycardia
Drugs in shockable rhythms
Give drugs after three shocks
Adrenaline 0.1ml/kg (10mcg/kg) 1:10,000 every other cycle
Amiodarone 5mg/kg after third shock and once more after fifth shock
Treatment of hypercalcaemia
Fluid resuscitation with 0.9% sodium chloride, infusion of twice the basic daily fluid requirement
Treatment for hypocalcemia
IV or IO administration of calcium gluconate or oral supplements of calcium
Treatment of hypokalaemia
Careful IV potassium infusion, with ECG monitoring and close attention to infusion site
0.5mmol/L/hr
Treatment for hyperkalaemia
IV calcium gluconate or calcium chloride
IV sodium bicarbonate if acidotic or in renal failure
Treatment for hyponatremia
If seizing, correct with 3ml/kg of 3% sodium chloride over 20 minutes
Other corrections at rate of 0.5mmols/L/hr
Treatment for hypernatremia
Fluid resuscitation over 48 to 72 hours to avoid cerebral oedema
Correct at rate of decrease of 0.5mmol/L/hr
If levels above 170, rehydrate with 0.9% NaCl and add potassium once passing urine
Anaphylaxis IM adrenaline doses
Under 6 months: 100-150 micrograms
6 months to 6 years: 150 micrograms
6-12 years: 300 micrograms
Above 12 years: 500 micrograms
EVERY FIVE MINUTES
Refractory anaphylaxis adrenaline infusion dose
1mg (1ml of 1mg/1ml 1:1000) in 100ml of 0.9% sodium chloride via a dedicated line
Urine output
1ml/kg/hr
Salbutamol
Beta-2 agonist used to relax the smooth muscle in the airway.
Treatment for asthma and hyperkalaemia.
Can cause tachycardia, hypertension, hypokalaemia and arrhythmias
First line therapy for seizures
Midazolam buccal OR lorazepam IV/IO (0.1mg/kg)
Second line therapy for seizures
Levetiracetam 30-60mg/kg over 5 minutes
Phenytoin 20mg/kg over 20 minutes
Phenobarbital 20mg/kg over 5 minutes
Insulin infusion dose in DKA
0.05-0.1units/kg/hr
Start 1-2 hours after starting IVI
DKA mild dehydration
5%
pH 7.2-7.29
DKA moderate dehydration
7% pH 7.1-7.19
DKA severe dehydration
10%
pH less than 7.1
SCIWORA
Spinal chord injury without radiographic abnormality
