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EPALS > General > Flashcards

General Flashcards

1
Q

DOPES
(Sudden deterioration post CA)

A

Displacement of the tracheal tube
Obstruction of the artificial airway
Pneumothorax
Equipment failures
Stomach distension

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2
Q

pH
PaCO2
HC03
Pa02

A

pH 7.35-7.45
PaCO2 4.5-6
HC03 22-26
Pa02 10-13

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3
Q

<C> Ac, B, C, D, E
</C>

A

Catastrophic haemorrhage
Airway with c-spine stabilisation
Breathing
Circulation
Disability
Exposure

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4
Q

High pH
High HCO3

A

Metabolic alkalosis

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5
Q

Low pH
Low HCO3

A

Metabolic acidosis

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6
Q

High pH
Low CO2

A

Respiratory alkalosis

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7
Q

Low pH
High CO2

A

Respiratory acidosis

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8
Q

Tranexamic acid

A

15mg/kg loading dose over 10 minutes
Infusion of 2mg/kg for at least 8 hours
Started within 3-4 hours of bleed

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9
Q

Epidermal burns

A

Injury to epidermal later only
Skin remains intact
Heals within seven days

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10
Q

Superficial partial thickness burns

A

Superficial layers; epidermis and superficial dermis
Blistered and pale pink, blood supply is maintained
Heals within 2-3 weeks

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11
Q

Full thickness burns

A

Involves epidermis, full thickness dermis and may involve subcutaneous tissue and deeper structure
White/charred, absent capillary refil
Surgical debridement and grafting

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12
Q

Deep partial thickness burns

A

Epidermis and dermis
Reduced CRT and poor blood supply
3+ weeks to heal, may require surgical intervention

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13
Q

Tension pneumothorax

A

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.

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14
Q

Needle decompression

A

The insertion of a cannula into the second intercostal space in the mid clavicles line on the side of the tension pneumothorax

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15
Q

Massive haemothorax

A

Due to blood accumulating in the pleural cavity

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16
Q

Flail chest

A

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.

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17
Q

Cardiac tamponade

A

The heart is pierced and blood fills the pericardial sack, which limits the space for cardiac contraction.

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18
Q

Chest drain insertion

A

Inserted in the 4th or 5th intercostal space between the anterior axillary line and mid-auxiliary line.

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19
Q

Traumatic diaphragmatic hernia

A

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.

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20
Q

Trachobronchial tree injures

A

Associated with a pneumothorax or haemothorax with subcutaneous emphysema

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21
Q

Pneumothorax

A

Air in the pleural space between the lung and the internal thoracic wall, which compresses the lung and impedes ventilation

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22
Q

IO insertion sites

A

Proximal tibia, distal tibia or distal femur

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23
Q

IV access

A

Antecubital fossa or saphenous vein

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24
Q

Contraindications of IO access

A

Brittle bones
Fractures
Infected skin/wounds
Unable to reinsert at site for 48 hours

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25
Q

Complications of IO

A

Tissuing or swelling of surrounding tissue
Embolism of bone or fat
Infection
Compartment syndrome
Skin necrosis
Fracture
Damage to growth plates

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26
Q

Sites of central venous access

A

Right and left internal jugular veins (R sided)
Right and left subclavian veins
Right and left femoral veins

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27
Q

Signs of circulatory failure

A

Decreased skin perfusion, prolonged capillary refill time and hypotension

28
Q

Cautions of fluid administration

A

Suspected cardiogenic shock as heart is unable to deal with volume load
Diabetic ketoacidosis as large fluid shifts are undesirable

29
Q

How many mls of fluids before ongoing losses to be suspected?

A

40-60ml/kg

30
Q

Signs of fluid overload

A

Moist sounds and crackles at lung bases
Jugular venous distension in children
Liver distension in infants

31
Q

Issues with 0.9% sodium chloride

A

Can cause hyperchloraemic acidosis due to high chloride content, which can promote inflammation and kidney injury

32
Q

Glucose dose

A

2ml/kg 10% glucose
2.5ml/kg in neonates

33
Q

When should the massive protocol be activated?

A

If above 40ml/kg of O rhesus negative has been given

34
Q

Lorazepam

A

Benzodiazepines with anti-seizure and dedication properties
0.1mg/kg IV, can be repeated after 5-10 minutes

35
Q

Levetiracetam

A

Inhibits the release of neurotransmitters for nerve end terminals. Second line for seizures
40mg/kg given over 5 minutes

36
Q

Phenytoin

A

Inhibits the spread of seizure activity in the cortex. Second line therapy in seizures
20mg/kg IV given over 20 minutes

37
Q

Ketamine

A

Sedative, analgesic and anaesthetic agent. Inhibits actions of NMDA receptors by glutamate.
1-2mg/kg IV, can be given IM at 4mg/kg

38
Q

Naloxone

A

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

39
Q

Atropine

A

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

40
Q

Sodium bicarbonate

A

1mmol/kg or 1ml/kg of 8.4 solution
Under 3 months, weaker solution (4.2%) to be used

41
Q

Adenosine

A

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.

42
Q

Non shockable rhythms

A

Asystole and PEA

43
Q

Shockable rhythms

A

PVT, VF

44
Q

Asystole

A

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.

45
Q

Pulseless electrical activity

A

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

46
Q

Adrenaline dose in CA

A

0.1ml/kg, 10mcg/kg of 1:10,000

47
Q

Pulse checks

A

Infant: brachial or femoral
Above one year: carotid or femoral

48
Q

Pulseless ventricular tachycardia

A

Broad complex tachycardia

49
Q

Drugs in shockable rhythms

A

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

50
Q

Treatment of hypercalcaemia

A

Fluid resuscitation with 0.9% sodium chloride, infusion of twice the basic daily fluid requirement

51
Q

Treatment for hypocalcemia

A

IV or IO administration of calcium gluconate or oral supplements of calcium

52
Q

Treatment of hypokalaemia

A

Careful IV potassium infusion, with ECG monitoring and close attention to infusion site
0.5mmol/L/hr

53
Q

Treatment for hyperkalaemia

A

IV calcium gluconate or calcium chloride
IV sodium bicarbonate if acidotic or in renal failure

54
Q

Treatment for hyponatremia

A

If seizing, correct with 3ml/kg of 3% sodium chloride over 20 minutes
Other corrections at rate of 0.5mmols/L/hr

55
Q

Treatment for hypernatremia

A

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

56
Q

Anaphylaxis IM adrenaline doses

A

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

57
Q

Refractory anaphylaxis adrenaline infusion dose

A

1mg (1ml of 1mg/1ml 1:1000) in 100ml of 0.9% sodium chloride via a dedicated line

58
Q

Urine output

A

1ml/kg/hr

59
Q

Salbutamol

A

Beta-2 agonist used to relax the smooth muscle in the airway.
Treatment for asthma and hyperkalaemia.
Can cause tachycardia, hypertension, hypokalaemia and arrhythmias

60
Q

First line therapy for seizures

A

Midazolam buccal OR lorazepam IV/IO (0.1mg/kg)

61
Q

Second line therapy for seizures

A

Levetiracetam 30-60mg/kg over 5 minutes
Phenytoin 20mg/kg over 20 minutes
Phenobarbital 20mg/kg over 5 minutes

62
Q

Insulin infusion dose in DKA

A

0.05-0.1units/kg/hr
Start 1-2 hours after starting IVI

63
Q

DKA mild dehydration

A

5%
pH 7.2-7.29

64
Q

DKA moderate dehydration

A

7% pH 7.1-7.19

65
Q

DKA severe dehydration

A

10%
pH less than 7.1

66
Q

SCIWORA

A

Spinal chord injury without radiographic abnormality

EPALS (2 decks)

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