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ICP Prep > ICP Guidelines > Flashcards

ICP Guidelines Flashcards

1
Q

Adenosine Pharmacology

A

AV Node anti arrhythmic (produces transient atrioventricular nodal block)
Binds to a1 receptors in AV node, forces potassium out of the cell + prevents calcium from coming in which hyper polarises the cell

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2
Q

Indications Adenosine

A

Regular SVT (Narror complex tachycardia)
Regular SVT with aberrancy of conduction (SVT-A)

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3
Q

Contraindications adenosine

A

Hx of second or third degree heart block or sick sinus syndrome (except for pt with functioning pacemaker)
Sinus node disease
Chronic obstructive lung disease (eg asthma)
Known Hypersensitivity

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4
Q

Precautions Adenosine

A

Current dipyramole therapy (Asantin, Persantin)
Pts on carbamazepine

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5
Q

Amiodorone Pharmacology

A

A class 3 anti arrhythmic agent
Potassium channel blocker (also sodium and calcium channel blocker and beta adrenocepter blocker). Prolonged the effective refractory period interrupts the reentry circuit

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6
Q

Amiodorone indications

A

VF/ VT refractory to cardioversion
Sustained or recurrent VT

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7
Q

Amiodorone contraindications

A

VT with inadequate perfusion or in pregnancy
Known hypersensitivity to Amiodorone or Iodine
TCA overdose

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8
Q

Precautions Amiodorone

A

Nil of significance

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9
Q

Side effects Amiodorone

A

Hypotension and Bradycardia

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10
Q

Atropine Pharmacology

A

Anticholinergic agent. Inhibits actions of acytocholyne on post gangleonic cholinergic nerves
Vagal blocker - allows sympathetic effect to increase SA node firing rate and increase conduction velocity through the AV node

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11
Q

Atropine Indications

A

Bradycardia with less than adequate perfusion
Organophosphate poisoning with excessive cholinergic effects
Nerve agent poisoning

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12
Q

Contraindications atropine

A

Nil

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13
Q

Precautions atropine

A

Atrial flutter
Atrial fib
Do not increase hr over 100 (except in kids under 6)
Glaucoma

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14
Q

Side effects atropine

A

Tachycardia

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15
Q

Absolute contraindications to thrombolisis

A

Active bleeding or bleeding disorders
Severe uncontrolled BP > 180/110
Surgery or major trauma in past 6 week
GI/GU Bleeding in past 2-4 weeks
TIA/CVA in past 12 months
Prior intercranial haemorrhage
Suspected aortic dissection
Known malignant intracranial neoplasm

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16
Q

Relative Contraindications to Thrombolysis

A

Current anti coags
Traumatic or prolonged CPR >10 mins
Hx of chronic severe or uncontrolled hypertension
Advanced liver disease
Advanced metastatic cancer
Non compressible vascular puncture (eg fistula or central venous access)
Pregnancy or 1 week post partum

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17
Q

Magnesium Pharmacology

A

Magnesium acts as a smooth muscle relaxant by blocking calcium channel mediated contraction and decreasing acytocholine release.

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18
Q

Magnesium Indications

A

Torsardes de pointe
Eclampsia
Severe Preeclampsia
Pts with severe asthma unresponsive to salbutamol/ ipratroprium

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19
Q

Contraindications Magnesium

A

Known heart blocks
Known hypersensitivity
Impaired renal / hepatic function
Addison’s disease

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20
Q

Side effects magesium

A

Hypotension
Circulatory collapse
CNS and resp depression
Cardiac arrhythmias
Loss of deep tendon reflexes

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21
Q

Clopidogrel Pharmacology

A

Clopidogrel is an antiplatelet medication that inhibits platelet aggregation by irreversibly binding to the adenosine diphosphate receptor (P2Y12) on platelets, thereby preventing activation of the ADP mediated glycoprotein GP IIb/IIIa complex, which is necessary for platelet aggregation.

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22
Q

Enoxaparan Pharmacology

A

Enoxaparin is an anticoagulant medication that binds to anti-thrombin III, causing inhibition of factor Xa and factor IIa.

It is similar in structure and action to heparin. However, enoxaparin generally provides a greater safety profile and more predictable response when compared to heparin due to an increase in the ratio between anti factor Xa and anti-factor IIa.

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23
Q

Heparin Pharmacology

A

Heparin is an anticoagulant medication that inhibits the mechanisms that induce the clotting of blood and the formation of stable fibrin clots at various sites in the normal coagulation system.

When heparin combines with antithrombin III (heparin co-factor), thrombosis is blocked through inactivation of activated factor X and inhibition of prothrombin’s conversion to thrombin. This also prevents fibrin formation from fibrinogen during active thrombosis. Heparin can prevent the formation of a stable fibrin clot by inhibiting the activation of the fibrin stabilising factor.

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24
Q

Tenectaplase Pharmacology

A

Tenecteplase is a tissue plasminogen activator that works by binding to the fibrin matrix of a thrombus and converting plasminogen to plasmin. This degrades the fibrin matrix of the thrombus and helps to restore perfusion to the affected vessel.

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25
Q

Thrombolysis Treatment <75 No Renal Failure

A

Clopidogrel 300mg OR
Enoxaparan 30mg IV
Tenectaplase weight based IV
15 mins later
Enxoparan 0.1mg/kg SC (max dose 100mg)

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26
Q

Thrombolysis Treatment >75 No Renal Failure

A

Clopidogrel 300mg OR
Enoxaparan .75mg/kg SC (Max dose 75mg)
Tenecteplase half of weight based dose IV

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27
Q

Thrombolysis Treatment any age Renal Failure

A

Clopidogrel 300mg OR
Heparin 5000IU OR
Tenectaplase weight based dosage IV (half dose for >75)
15 mins later
Heparin 1000IU infusion per hour

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28
Q

How to prepare heparin infusion

A

5000 IU (1mL) into 50mL saline to make 100 IU per mL

Commence at 10 mL per hour to achieve 1000 IU per hour

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29
Q

Bradycardia less than adequate perfusion treatment

A

Atropine IV 600mcg repeat 600mcg @ 3-5 mins if required
Adrenaline infusion 5mcg per min, increase by 5mcg/min at 2 min intervals to max of 20 per min (draw up 3mg of adrenaline into 47 ml D5W)
Bolus adrenaline 5mcg intervals as required
Transcutaneous Pacing

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30
Q

SVT Treatment

A

Modified valsalva x 2
Adenosine 6mg, repeat 12 mg at 2 mins, repeat 12mg at 2 mins if required.
Sedate and cardioversion
Sedate 2mg Midaz IV, repeat 1mg IV at 2 min intervals to max of 5mg
Sync cardiovert 100j, repeat 200j

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31
Q

Adenosine Special considerations

A

Caffeine, aminophylline and theophylline block the adenosine receptors and the full incremental dosage may be required.

Carbamazepine (‘Tegretol’) can increase the level of atrioventricular block. Reduced dosage by half should be considered.

Dipyramole (a platelet aggregation inhibitor) increases the plasma levels and cardiovascular effects of Adenosine. Reducing dose by half should be considered.

Heart Transplant recipients should receive half doses.

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32
Q

Torsardes Treatment

A

Magnesium Infusion 2G over 10 mins
Repeat once at 10 mins if nil or no response

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33
Q

Stable VT Treatment

A

Amiodorone infusion
5mg/kg IV (Max 300mg) over 20 mins once only (diluted with D5W to make 50ml)

34
Q

Unstable VT treatment

A

If sedation required 2mg Midazolam IV, repeat 1mg at 2 min intervals max 5mg.
Sync cardiovert 100j then repeat 200j if required
If reversion amidorone infusion as stable VT

35
Q

Hypothermic arrest alterations

A

Hypothermic Cardiac Arrest <30°C
If VF/VT is present, then Defibrillate 200j.
If after 3 defibrillation attempts VF/VT persist, then delay further defibrillation attempts until the patient’s temperature is >30°C.
Withhold adrenaline and amiodarone until the patient’s temperature is >30°C.
Hypothermic Cardiac Arrest >30°C
If VF/VT is present, then Defibrillate 200j every 2 minutes.
Administer Adrenaline and Amiodarone as indicated. The standard interval between drug administration should be doubled.

36
Q

Inadequate perfusion treatment cardiogenic cause

A

If chest clear 250ml bolus up to 20ml/kg
Adrenaline infusion 3mg to make up 50ml D5W. Start at 5mcg / min, increased by 5mcg/min 2 minutely to max of 20mcg
Adrenaline bolus upto 100mcg as required

37
Q

Why give heparin and not enoxaparan in renal failure patients

A

Heparin is a large, negatively charged molecule that does not undergo renal elimination to a significant extent. Instead, it is mainly metabolized in the liver and reticuloendothelial system.
Since heparin is not primarily excreted by the kidneys, it does not accumulate in patients with renal failure, and its anticoagulant effect is not significantly altered in this population.
Enoxaparin is a low molecular weight heparin (LMWH) that is partially eliminated by the kidneys. It undergoes both renal and hepatic metabolism.
In patients with renal failure, the clearance of enoxaparin is reduced, leading to its accumulation in the body.

38
Q

Inadequate perfusion associated with hypovolaemia treatment

A

If BP <100 or HR >100 20 ml/kg normal saline
If BP still <100 or HR >100 20ml/kg normal saline
After 40ml/kg consult for further 20ml/kg if required

39
Q

Modifying factors for fluid administration

A

Pt with isolated neurogenic shock can be given up to 500ml Normal Saline bolus to correct hypotension. No further fluid should be given if SCI is the sole injury.

Penetrating Trunk Injury, suspected aortic aneurysm or uncontrolled haemorrhage - Accept palpable carotid pulse with adequate conscious state and transport immediately

40
Q

Treatment crush injury

A

Prior to removing force:
Supplemental oxygen
500ml bolus normal saline
If hyperkalemia suspected 50ml sodium bicarb IV

41
Q

Ventilation rates asthma for infant, small child and large child

A

Infant 15-20 ventilations / min
Small child 10-15 ventilations / min
Large child 8-12 ventilations / min

42
Q

Sedation to maintain intubation dosages peadiatrics

A

Infusion:
Morphine/Midaz: 0.1-0.2mg/kg/hour OR
Fentanyl/Midaz: 1-2mcg/kg/hr + 0.1-0.2mg/kg/hour
Bolus:
Morphine/midaz: 0.1mg/0.1mg/kg
Fent/Midaz: 0.1mg/1mcg/kg as required

43
Q

Bradycardia Treatment Paediatric

A

Correct Hypoxia
Chest compressions if <60 in infants or <40 in children
Adrenaline 10mcg/kg IV repeat 3 minutely as required
Normal saline 20ml/kg
Consult for pacing if required

44
Q

Treatment SVT Paediatrics

A

Valsalva
Adenosine 100mcg/kg IV
After 2 mins Adenosine 200mcg/kg IV
If unresponsive consider cardioversion
If sedation required 50mcg midazolam / kg IV repeat at 2 min intervals (Max 200mcg/kg)
Sync cardiovert at 1 j / kg

45
Q

Paediatric Pain Relief dosages

A

Paracetamol 15mg/kg
Ibuprofen 10mg/kg
Fentanyl IN Small child (10-24kg) 25mcg repeat 3 times
Fentanyl IN Large child (>25kg) 50mcg repeat 3 times
Methoxyflurane 3ml repeat once
Morphine IM 0.1mg/kg (max 5mg) consult for further dosages
Morphine IV 0.05mg/kg repeat 5 mins. Consult after 0.2mg/kg
Fentanyl IV 0.5mcg /kg repeat 5 mins. Consult after 2mcg/kg
Medical consult for ketamine 0.5mg/kg

46
Q

Treatment Croup

A

5mg/5ml Nebulised Adrenaline
600mcg/kg IV/IM/Oral Dexamethasone

47
Q

Treatment Asthma Paediatric

A

Salbulatoml pDMI (Repeat 20 mins)
1-5 years 6 puffs
>6 years 12 puffs
Ipratropium PDMI (Repeat 20 mins max 3 times)
1-5 years 4 puffs
>6 years 8 puffs
Salbulatmol IB neb
1-5 years 2.5mg Salbutamol + 250mcg IB
>6 years 5mg Salbutamol + 500mcg
Adrenaline IM 10 mcg per kg max 500mcg repeat 5 mins
Normal Saline up to 20ml/kg
Dexamethasone 600mcg/kg (max 8mg) IM /IV /ORAL
Adrenaline infusion 0.1mcg/kg/min titrated to response or adverse effects
Magnesium 50mg/kg (max 2G) Infusion over 20 mins

48
Q

Treatment nausea and vomiting paediatrics

A

Ondansatron 0.1 mg/kg IV or IM (max 4mg) only in patients over 2

49
Q

Treatment hypoglycaemia paediatrics

A

Glucagon IM
<25kg 0.5 IU
>25kg 1 IU
Glucose IV
10% 500mg/kg or 5ml/kg with 10ml saline flush
Repeat same at 5 min intervals as required

50
Q

Treatment hyperglycaemia paediatrics

A

10ml kg normal saline IV

51
Q

Treatment continuous seizures paediatric

A

Midazolam 0.15mg/kg IV / IM (max 10mg)
Repeat IV at 5 mins OR IM at 10 mins
Consider intubation

52
Q

Anaphylaxis Treatment paediatric

A

10mcg / kg IM Adrenaline (max 500mg) repeat at 5 min intervals
(Salbutamol / IB / adrenaline Neb as per relevant guidelines)
Adrenaline infusion commencing at 0.1mcg/kg/min tirated to response max starting rate 10mcg per minutes
Saline 20ml/ kg, repeat same then consult

53
Q

Paediatric organophosphate treament

A

Atropine 20 mcg/kg IV
Repeat same at 5 mins

54
Q

Treatment for overdose paediatrics

A

Narcotics:
Naloxon 10mcg / kg IM/IV Repeat same IV at 5 mins
(Max 400mcg per bolus total max 2mg)
TCA overdose:
Hyperventilate to aims for CO2 of 25-30
Sodium Bicarbonate 2ml/kg IV over 2 minutes
Repeat after 10 mins if symptoms persist

55
Q

WHO Paediatric Shock Criteria for Emergency Triage Assessment and Treatment (ETAT)

A

Patients must meet ALL 4 criterion to satisfy the criteria.

Capillary Refill >3 seconds
Cold Extremities
Fast pulse
Weak Pulse: For children under one year old, assess the brachial pulse. For all other children assess the radial pulse.

56
Q

Sepsis treament paediatric

A

Normal Saline 10ml/kg IV Repeated once after 15 mins
Ceftriaxone 50mg / kg if over 1 hour from hospital on consult
Adrenaline infusion starting at 0.1mcg/min on consult

57
Q

Ketamine Pharmacology

A

Ketamine is an intravenous anesthetic agent (NMDA receptor antagonist)

At lower doses it is a significant analgesic whilst preserving airway reflexes and respiratory drive.

There is minimal haemodymanic compromise as Ketamine acts as a sympathomimetic which may lead to transient tachycardia and hypertension.

Ketamine produces a dissociative state that in a small number of patients may potentially cause them to have issues with perception resulting in disinhibition or emergence phenomenon.

58
Q

Contraindications Ketamine

A

Known hypersensitivity
Age <1 year
Traumatic Head Injury
Hypertension BP > 180mm Hg sys, 100mm Hg Dia
Suspected Acute Coronary Syndrome
Suspected Heart Failure
Known Hydrocephalus or raised intraoccular pressure

59
Q

Precautions Ketamine

A

Age > 60yrs
Prior administration of midazolam or other CNS depressant drugs
Significant hypovolaemia
Globe injury
Complex facial injuries and factures
Impaired respiratory function
Symptoms of psychosis

60
Q

Side effects Ketamine

A

Dissociation and trance like state
Potential transient hypertonicity and nystagmus
Disinhibition – disturbed perception
Emergence
Hypertension, Tachycardia
CNS and rarely respiratory depression
Hypersalivation
Vomiting
Laryngospasm

61
Q

How to prepare GTN for infusion for APO

A

Draw up 1ml (5mg) of GTN with 49ml D5W (makes solution of 5mg in 50ml)

62
Q

GTN infusion dosage for APO

A

Start 10 mcg/min / 6ml/hour in conjunction with CPAP. Increase in 10 mcg intervals every 3-5 minutes. Consider decreasing if BP drops below 120systolic.

63
Q

Frusemide dosage APO

A

20 - 40mg IV (if evidence of fluid overload)

64
Q

Sodium bicarbonate pharmacology

A

A hypertonic crystalloid solution which contains sodium and bicarbonate ions in a solution of high pH
This raises Raises pH by increasing plasma bicarbonate levels, which are known to buffer excess hydrogen ion concentration

65
Q

Indications Sodium Bicarbonate

A

Symptomatic Tricyclic Antidepressant (TCA) overdose or hyperkalaemia
Crush Syndrome with evidence of hyperkalaemia
Cardiac arrest with suspected hyperkalaemia or TCA overdose

66
Q

Sodium Bicarbonate dosage for TCA overdose

A

100ml Sodium bic given over 3 minutes
Consider consult for further dosages

67
Q

Lignocaine preperation for concious IO Paed / Adult

A

Both 0.5mg / kg
Max dose paed 20mg
Max dose adult 40 mg

68
Q

Frusemide Pharmacology

A

Furosemide is a potent loop diuretic that acts on the kidneys to ultimately increase water loss from the body. Causes venous dilatation and reduces venous return

69
Q

Contraindications Frusemide

A

Nil of significance

70
Q

Precautions Frusemide

A

Hypotension

71
Q

Side effects frusemide

A

Hypotension
Dysrhythmia due to electrolyte imbalance

72
Q

Lignocaine Pharmacology

A

A local anaesthetic agent
Actions:
Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution)

73
Q

Lignocaine Contraindications

A

Known hypersensitivity
Bradycardia with inadequate perfusion
Evidence of 2° or 3° heart block

74
Q

Precautions Lignocaine

A

When using Lignocaine 1% as diluent for IM Ceftriaxone it is important to rule out inadvertent IV administration due to potential CNS complications

75
Q

CPAP Contras

A

Asthma
Pts <16
Pts with inadequate respiratory effort
Heart failure with hypotension
GCS <13
Pneumothorax
Facial injury or facial deformity
Epistaxis

76
Q

Post Partum Haemorrage Treatment

A

600ml blood loss first 24 hours or excessive haemorrage 1-6 weeks post partum
Ergometron 250mcg IV
Repeat 250mcg IV if inadequate response

77
Q

Ergometron Pharmacologuy

A

Causes contraction of the uteration and vascular smooth muscle
General Vasocontriction

78
Q

Ergometron Contraindications

A

Known allergy
Past history of pre-eclampsia
Hypertension

79
Q

For an adrenaline infusion (3mg in 1000ml) how many mcg per mil and what infusion rate does 1mcg/min equal

A

Adrenaline infusion
3mg of 1:1000 Adrenaline added to 47ml D5W = 60mcg/ml
Infusion rate 1mls/hr = 1mcg/min titrated up or down according to response

80
Q

How to prepare infusion of adrenaline where infusion pump unavailable in anaphylaxis

A

Adrenaline Infusion pump unavailable
Mix 500mcg (0.5ml) of 1:1000 Adrenaline with 500ml Normal Saline = 1mcg/1ml
Start Adrenaline infusion at 10ml/min (10mcg/min - 200 drops per minute) titrating up or down according to response.

ICP Prep (4 decks)

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