ICP SKILLS INDICATIONS AND CONTRAINDICATIONS Flashcards
WHAT ARE THE INDICATIONS FOR CPAP?
- STABLE, W/ BASAL CRACKLES AND NIL RESPONSE TO O2, GTN AND FRUSEMIDE.
- INC. WORK OF BREATHING AND/OR MIDZONE TO FULL FIELD CRACKLES - CONCURRENTLY WITH PHARMACOLOGY
WHAT ARE THE CONTRAINDICATIONS FOR CPAP?
HELPS Fuck All
HYPOVENTILATION
EPISTAXIS
LOC = P OR U
PNEUMOTHORAX
SYS BP <90MMHG
FACIAL TRAUMA
ACTIVE VOMITING
WHAT ARE THE ADVERSE EFFECTS / COMPLICATIONS OF CPAP?
CH BAG
CORNEAL DRYING
HYPOTENSION
BAROTRAUMA
ASPIRATION
GASTRIC DISTENTION
ANXIETY
WHAT ARE THE INDICATIONS FOR PEEP?
CAN BE CONSIDERED WHENEVER USING A BVM.
PRIMARY USE FOR:
APO
DROWNING
ASPIRATION
ANY SITUATION WHERE SURFACTANT MAY HAVE BEEN COMPROMISED IN THE LUNGS CAUSING ATELECTASIS (ALVEOLAR COLLAPSE)
WHAT ARE THE CONTRAINDICATIONS FOR PEEP?
PNEUMOTHORAX.
WHAT ARE THE ADVERSE EFFECTS / COMPLICATIONS OF PEEP?
PH BBAG
PNEUMOTHORAX
HYPOTENSION
BAROTRAUMA
BREATH STACKING / OVER INFLATION
ASPIRATION
GASTRIC DISTENSION
WHAT ARE THE INDICATIONS OF NEEDLE DECOMPRESSION?
- SINGLE TENSION PNEUMOTHORAX WITH RESP/CARDIAC/HAEMODYNAMIC COMPROMISE.
- CHEST INJURIES IN MAJOR TRAUMA PERI ARREST.
- TRAUMATIC CARDIAC ARREST WITH ACTUAL OR SUSPECTED CHEST INJURY
WHAT ARE SOME CONSIDERATIONS FOR NEEDLE DECOMPRESSION?
- DO NOT REMOVE.
- BE CAUTIOUS IN PTS <50KG / THIN CHEST WALLS NOT TO ADVANCE TO FAR.
- FREQUENTLY REASSESS FOR EFFECTIVENESS.
WHAT ARE THE COMPLICATIONS OF LARYNGOSCOPY?
Laryngoscopy Should Help This Pt
LARYNGOSPASM
STIMULATION OF GAG REFLEX
HYPOXIA IF PROLONGED ATTEMPTS
TRAUMA IN AIRWAY RESULTING IN BLEEDING
PHYSIOLOGICAL PARAMETERS ALTERED EG. VAGAL STIM.
WHAT ARE THE INDICATIONS FOR LARYNGOSCOPY?
VISUALISATION OF GLOTTIS FOR:
- REMOVAL OF FOREIGN BODY AIRWAY OBSTRUCTION
- INSERTION OF ETT
- INSERTION OF INTRAGASTRIC TUBE
WHAT ARE THE INDICATIONS FOR AN ETT?
TO FACILITATE ARTIFICIAL VENTILATION AND PROTECT AIRWAY IN AN UNCONSCIOUS PT WITH:
- ABSENT COUGH / GAG REFLEX
- HYPOVENTILATION WITH HYPOXIA
WHAT ARE THE ADVERSE EFFECTS / CONSIDERATIONS FOR INSERTION OF AN ETT?
Don’t Over Think Intubation DOTI
- DISLODGMENT / MALPOSITION
- OBSTRUCTION
- TRAUMA TO AIRWAY
- INTERFERENCE OF PHYSIOLOGICAL FUNCTIONS EG FLITERING, WARMING AND HUMIDIFICATION OF INSPIRED AIR.
WHAT IS THE INDICATION FOR TRACHEAL SUCTION AND WHAT ARE THE CONTRAINDICATIONS?
INDICATION: TO REMOVE EXCESS SECRETIONS FROM THE TRACHEA.
CONTRAINDICATIONS: DO NOT SUCTION PINK FROTHY SPUTUM CAUSED BY APO
WHAT ARE THE ADVERSE EFFECTS OF TRACHEAL SUCTION?
- HYPOXIA LEADING TO ARRHYTHMIA AND FITTING.
- TRACHEAL MUCOSA TRAUMA.
- BRADYCARDIA FROM VAGUS NERVE STIMULATION FROM CONTACT WITH CORYNA.
WHAT ARE THE INDICATIONS FOR AN INTRAGASTRIC (IG) TUBE?
WHAT IS THE CONTRAINDICATIONS FOR NASAL INSERTION?
INDICATIONS:
- VOMITING
- INTERFERENCE WITH IPPV
- ALL PAEDS. POST INTUBATION
- TX - NEONATE / PAED / SPINAL / ABDO
- OVERLOAD OF FLUID
- REGURGITATION
CONTRAINDICATIONS:
NASAL INSERTION IF SUSPECTED BASE OF SKULL FRACTURE. MUST BE INSERTED ORALLY.
WHAT ARE THE INDICATIONS FOR EXTUBATION?
IMPROVEMENT IN PT CONDITION OR PHYSICALLY TRYING TO REMOVE ETT.
SEDATION WOULD BE BETTER IN ALMOST ALL CIRCUMSTANCES.
WHAT ARE THE INDICATIONS FOR APPLICATION OF THE LUCAS DEVICE?
- HPCPR CARRIED OUT FOR MINIMUM 10MINS
- TO ASSIST IN FACILITATING TX FOR PT’S IN CARDIAC ARREST.
- > 9 AND <16 TO ASSIST IN FACILITATING TX.
WHAT ARE THE CONTRAINDICATIONS FOR APPLICATION OF THE LUCS DEVICE?
LUCAS GOT SLAP T
- SIGNIFICANT COMORBIDITIES INCLUDING VAD
- LESS THAN 9YO
- ANYONE TOO BIG OR TOO SMALL
- PT’S UNDER 16 UNTIL TX
- TRAUMATIC CARDIAC ARREST
WHAT ARE THE INDICATIONS FOR BVM AND WHAT ARE THE COMPLICATIONS FROM BVM?
INDICATIONS:
- HYPOVENTILATION
- SEVERE APO
COMPLICATIONS:
- GASTRIC DISTENTION
- BAROTRAUMA
- HYPOTENSION
WHAT ARE THE INDICATIONS FOR TRANSCUTANEOUS PACING?
HHOP
- HR <40BPM
- HAEMODYNAMICALLY COMPROMISED
- OVER 16YO
- PHARMACOLOGY - NIL RESPONSE
WHAT ARE THE CONTRAINDICATIONS FOR TRANSCUTANEOUS PACING?
“OUUCHH”
- OVERDRIVE PACING OF VENTRICULAR RHYTHMS.
- UNABLE TO PERFORM CONSCIOUS SEDATION CHECKLIST
- UNDER <16YO
- CARDIAC ARREST
- HR >40BPM
- HAEMODYNAMICALLY STABLE
WHAT ARE SOME OF THE REASONS FOR FAILURE OF TRANSCUTANEOUS PACING?
WHAT ARE SOME CONSIDERATIONS FOR TCP?
REASONS FOR FAILURE:
- FAILURE TO INCREASE CURRENT HIGH ENOUGH FOR ELECTRICAL CAPTURE.
- FAILURE TO CONFIRM MECHANICAL CAPTURE (INC. LOC, PALPABLE PULSE THAT MATCHES PACING RATE, SPO2 PLETH)
- FAILURE TO MONITOR FOR ONGOING MECHANICAL CAPTURE
CONSIDERATIONS:
- PHARMACOLOGY: MIDAZOLAM AND MORPHINE DRAWN UP SEPARATELY. MIDAZ =ANXIOLYSIS, MORPH = ANALGESIA.
NOT DRAWN UP IN M&M PREPARATION.
- PADS >8CM AWAY FROM AN IMPLANTED DEVICE (PACEMAKER).
WHAT ARE THE INDICATIONS FOR SYNCHRONISED CARDIOVERSION?
“LARHA”
- LOC = P OR U
- AGE >16, HR >160
- RHYTHM SVT OR VT
- HAEMODYNAMIC COMPROMISE
- AGE 1 - <16YO, HR >180
NOTE: TORSADES IS AN INDICATION FOR SYNC. CARDIOVERSION BUT LIGNOCAINE 2% IS ADMINISTERED INSTEAD OF AMIODARONE.
WHAT ARE THE JOULES INDICATED FOR ADULTS AND PAEDS FOR SYNCHRONISED CARDIOVERSION?
WHAT MEDICATION IS GIVEN AFTER 3 SHOCKS IF UNSUCCESSFUL OR IF CARDIOVERSION IS CONTRAINDICATED?
ADULT:
1ST - 100J
2ND - 150J
3RD - 200J
MEDICATION: AMIODARONE
NOTE: TORSADES IS AN INDICATION FOR SYNC. CARDIOVERSION BUT LIGNOCAINE 2% IS ADMINISTERED INSTEAD OF AMIODARONE.
PAED:
1ST - 1J / KG
2ND - 2J / KG
3RD - 4J / KG
