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HL1: Emergencies and Resuscitation Flashcards

1
Q

Normal UO (infants, young children)

A

1.5-2 mL/kg/hr

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2
Q

Normal UO (older children)

A

1 mL/kg/hr

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3
Q

Hypotension (<1mo)

A

SBP<60

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4
Q

Hypotension (1mo-1yr)

A

SBP<70

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5
Q

Hypotension (>1yr)

A

SBP< 70 + (2 x age)

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6
Q

Target end tidal CO2 during CPR

A

> 20mmHg

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7
Q

Shockable arrest rhythms (2)

A

Vfib and pulseless Vtach

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8
Q

Defibrillation doses

A

Initial shock: 2 J/kg
Second shock: 4 J/kg

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9
Q

Indication for emergent cardioversion

A

Hemodynamically unstable patients with tachyarrythmias and palpable pulses

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10
Q

Cardioversion doses

A

Initial shock: 0.5-1 J/kg
Second shock: 2 J/kg

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11
Q

Emergency meds you can administer via ETT

A

NAVEL: naloxone, atropine, vasopressin, epinephrine, lidocaine

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12
Q

Target RR during resuscitation

A

20-30 bpm (1 breath every 2-3 sec)

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13
Q

Sellick maneuver

A

The use of cricoid pressure to minimize gastric reflux and aspiration

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14
Q

How long should preoxygenate prior to endotracheal intubation?

A

At least 3 minutes

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15
Q

What should set suction devide to during ET intubation?

A

-80 to -120 mmHg

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16
Q

ETT size equation

A

ETT size = (age/4) + 4

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17
Q

ETT depth equation

A

ETT depth (cm) = ETT size x 3

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18
Q

4 common cuases for ET inbubation failure

A

DOPE: Displacement, Obstruction, Pneumothorax, Equipment failure

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19
Q

Adenosine indication & mechanism (in resuscitation)

A

SVT 2/2 AV node reentry or accesory pathways
Blocks AV node conduction

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20
Q

Adenosine dosing (in resuscitation)

A

Initial: 0.1 mg/kg (IV), max 6mg wait 2min between doses
2nd: 0.2 mg/kg (IV), max 12mg
3rd: 0.3 mg/kg (IV), max 12 mg

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21
Q

Adenosine side effects (in resuscitation)

A

Sense of doom, brief period of asystole

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22
Q

Amiodarone indication and mechanism (in resuscitation)

A

Shock-refractory VF, VT or SVT
K channel blocker, prolongs QT and QRS

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23
Q

Amiodarone dosing (in resuscitation)

A

5 mg/kg (IV/IO), max 300mg

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24
Q

Amiodarone side effects (in resuscitation)

A

Polymorphic VT, hypotension, decreased cardiac contractility

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25
Q

Atropine indication and mechanism (in resuscitation)

A

Bradycardia (esp in rapid sequence intubation where also decreases oral secretions), cholinergic drug toxicity, 2nd/3rd degree AV block
Anticholinergic increases AV node conduction

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26
Q

Atropine dose (in resuscitation)

A

0.2 mg/kg (IV/IM/IO), min 0.1 mg/dose, max 0.5 mg/dose. repeat once every 5min Max total 1mg (child) or 3mg (adolescent).

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27
Q

Atropine dose (rapid sequence intubation)

A

0.4-0.6 mg/kg

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28
Q

Atropine side effects

A

Tachycardia, myocardial ischemia, paradoxical bradycardia with too low dosing

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29
Q

Calcium chloride indication

A

Hypocalcemia, hyperkalemia, CCB overdose

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30
Q

Calcium chloride dose

A

20 mg/kg (IV/IO), max 1g

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31
Q

Calcium chloride side effects

A

Risk of myocardial necrosis, peripheral infoltration leading to tissue injury

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32
Q

Dextrose (in resuscitation) dose

A

0.5-1 g/kg (IV/IO).
Newborn: 5-10 mL/kg D10W
Infant/child: 2-4 mL/kg D25W
Adolescents: 1-2 mL/kg D50W

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33
Q

Epinephrine indication and mechanism (in resuscitation)

A

Asytole, PEA, VF, VT (give within 5 minutes). Diastolic hypotension, bradycardia.
Alpha agonism

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34
Q

Epinephrine dosing (in resuscitation)

A

0.01 mg/kg (IV/IO), max 1mg
Or, 0.1 mg/kg (ET), max 2.5 mg
repeat every 3-5 min

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35
Q

Epinephrine side effects

A

Tachycardia, ectopy, tachyarrythmias, hypotension

36
Q

Lidocaine indication and mechanism (in resuscitation)

A

Shock-refractory VF, VT (second line after amiodarone). Used in ET intubation to prevent increase in ICP. Can use on status asthmaticus.
Na-channel blocker

37
Q

Lidocaine dosing (in resuscitation)

A

1 mg/kg (IV/IO), max 100mg
Or, 2-3 mg/kg (ET)
repeat every 5 minutes Max 3 mg/kg in the first hour

38
Q

Lidocaine side effects (in resuscitation)

A

Myocardial depression, AMS, seizures, muscle twitching

39
Q

Mag sulfate indication and mechanism (in resuscitation)

A

Torsades, hypomagnesemia
Calcium antagonist decreases abnormal depolarizations

40
Q

Mag sulfate dose (in resuscitation)

A

50 mg/kg (IV/IO), max 2g

41
Q

Mag sulfate side effect

A

Hypotension, bradycardia

42
Q

Naloxone dose (in resuscitation)

A

0.1 mg/kg (IV/IO/subQ/IM), max 2g
Or, 0.2-1 mg/kg (ET)
Or, 2-8 mg (IN)
redose every 2 min prn

43
Q

Procainamide indication and mechanism (in resuscitation)

A

Refractory SVT, afib, aflutter, VT
Na-channel blocker

44
Q

Procainamide dose (in resuscitation)

A

Load 15-20 mg/kg (IV/IO) and infuse over 30-60 minutes

45
Q

Procainamide side effects

A

Proarrythmic, polymorphic VT, hypotension

46
Q

Glycopyrrolate indication

A

Prevents hypersalivation and bradycardia in ET intubation, and preserves pupillary exam iso trauma (compared with atropine)

47
Q

Glycopyrrolate dose (in ET intubation)

A

0.004-0.01 mg/kg (IV/IO/IM), max 0.1 mg

48
Q

Etomidate (induction agent sedative) pros and cons

A

Pros: minimal CV side effects, can minimally decrease ICP
Cons: supresses adrenal corticosteroid synthesis, lowers seizure threshold, avoid in septic shock

49
Q

Fentanyl (induction agent analgesic sedative) pros and cons

A

Pro: minimal CV effects, good in shock
Con: chest wall rigidity, bradycardia, respiratory depression

50
Q

Ketamine (induction agent analgesic sedative) pros and cons

A

Pros: bronchodilation, abates bradycardia, increases HR and SVR, dissociative amnesia
Cons: hallucinations, hypersalivation, vomiting, laryngospasm

51
Q

Midozolam (induction agent amnestic anxiolytic sedative) pros and cons

A

Pro: miniman CV effects
Cons: resp depression, hypotension

52
Q

Propofol (induction agent sedative) Pros and cons

A

Pro: ultra short acting
Cons: myocardial depression, metabolic acidosis, paradoximal hypertension in children, avoid in shock

53
Q

Succinylcholine (induction agent, depolarizing neuromuscular blockade) proc and cons

A

Pros: rapid onset, short acting, reversible with acetylcholinesterase inhibitor
Cons: hyperkalemia, increased ICP, intraocular and intragastric pressure, bradycardia, malignant hyperthemia

54
Q

Succinylcholine (induction agent, depolarizing neuromuscular blockade) contraindications

A

NM disease, myopathies, spinal cord injuries, crush injury, burns, renal insufficiency

55
Q

Rocuronium (induction agent, nondepolarizing neuromuscular blockade) pros and cons

A

Pros: minimal CV effects, reversible with sugammadex
Cons: decreased clearence in hepatic insufficiency, caution in patients with difficult airway

56
Q

How is vecuronium different from rocuronium?

A

Longer time to paralysis

57
Q

HFNC max flow

A

2 L/kg/min
(or ~12L/min for infants/toddlers, ~30L/min for children, and ~50L/min for adolescents)

58
Q

Goal tidal volume (Vt) in mechanical ventilation to avoid volutrauma

59
Q

Goal peak inspiratory pressure (PIP) in mechanical ventilation to avoid barotrauma

60
Q

Max FiO2 in mechanical ventilation to avoid oxygen toxicity

A

FiO2 < 60%

61
Q

Indications for SBT

A

FiO2<50%, PEEP=5, PIP<20, RR wnl, acid/base wnl

62
Q

What is the first and most sensitive VS change before shock?

A

Tachycardia

63
Q

What is something you should do in all etiologies of shock?

A

Administer 100% supplemental oxygen

64
Q

Dobutamine mechanism and use (in shock)

A

Selective B1 agonist
For normotensive, poorly perfused shock
(Beware arrythmias)

65
Q

Dopamine mechanism and use (in shock)

A

Stimulates NE release, direct alpha agonism at high doses. Ionotrope.
For shock with poor contractility

66
Q

Milrinone mechanism and use (in shock)

A

Type 3 PDEi, ionodilator, improve CO with minimal effect on HR
For normotensive shock with myocardial dysfunction

67
Q

Epinephrine mechanism and use (in shock)

A

B1/B2/A1 agonist
Hypotensive shock, cold septic shock

68
Q

Norepinephrine mechanism and use (in shock)

A

B1/A1 agonist
Warm shock, low SVR

69
Q

Phenylephrine mechanism and use (in shock)

A

Pure A1 agonist
General vasoconstrictor
(Beware reflex bradycardia)

70
Q

Vasopressin (ADH) use (in shock)

A

For cardiac arrest, refractory hypotension in septic shock, and GI hemorrhage

71
Q

Blood product dose in hemorrhagic shock

A

10 mL/kg boluses of PRBCs

72
Q

IM epi dose in anaphylaxis

A

0.01 mg/kg/dose, max 0.3mg/dose.
redose every 5-15 minutes

73
Q

Definition of pulmonary hypertension

A

resting mean pulmonary arterial pressure (PAP) >25 mmHg among children >3 months

74
Q

Hypertensive emergency definition

A

BP acutely >99%ile with signs of end organ damage (encephalopathy, vision disturbance, CHF, AKI)

75
Q

Hypertensive urgency definition

A

BP acutely >99%ile with NO signs of end organ damage

76
Q

What is a goal rate of correction of BP in hypertensive emergency/urgency?

A

reduce BP by 25% in the first 8 hours, then gradual normalization over the next 24-48 hours

77
Q

4 meds you can use in a tet spell

A

ketamine (increases SVR, sedating), morphine (sedating, suppresses hyperpnea), phenylephrine (increases SVR), propranolol (increases ventricular filling)

78
Q

Lethargy

A

depressed consciousness resembling sleep from which a patient may be briefly aroused by stimulation

79
Q

Stupor

A

depressed consciousness resembling sleep from which a patient may be briefly aroused only with profound stimulation

80
Q

GCS: what are the categories and how many points each?

A

EVM: Eye 4, Verbal 5, Movement 6

81
Q

Initial management of symptomatic hyponatremia

A

3-5 mL/kg bolus of 3% HTS over 15-30 minutes until seizure stops or serum sodium >125

82
Q

Complex febrile seizure definition

A

At least one of the following: duration >15 minutes, more than one within 24 hours, or focal onset

83
Q

What pressure is diagnostic of elevated ICP?

A

At least 20 mmHg

84
Q

When does the PDA close?

85
Q

PE ECG finding

A

Sinus tachy with S1Q3T3

86
Q

5 H’s (reversible causes of PEA arrest)

A

Hypoxia, hypothermia, hypoglycemia, hyper/hypokalemia, hypovolemia, H+ (acidosis)

87
Q

5 T’s (reversible causes of PEA arrest)

A

Tension pneumo, tamponade, thrombus (PE, MI), toxins, trauma

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