Know This Shit (& algorithms) Flashcards

1
Q

Signs of rising intracranial pressure (Cushing’s Reflex)

A

(1) Bradycardia (slowing heart rate)
(2) Systolic hypertension (rising systolic BP / widening pulse pressure)
(3) Erratic respirations

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2
Q

Signs of pericardial tamponade (Beck’s triad)

A

(1) Narrowed pulse pressure (narrowing difference between systolic and diastolic
(2) Muffled heart tones
(3) JVD

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3
Q

Pediatric assessment triangle

A

(1) Appearance (tone, interactiveness, consolability, gaze, speech)
(2)Work of breathing (sounds, position, retractions, flaring, gasping)
(3)
Circulation to skin
(pallor, mottling, cyanosis)

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4
Q

Reversible causes of cardiac arrest
(Hs and Ts)

A

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hyper/hypokalemia
Hypothermia
Tension pneumo
Tamponade
Thrombosis
Toxins

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5
Q

Chest Pain / STEMI algorithm

A
  • 12 lead and transmit to receiving facility
  • O2 if less than 94%
  • 324 mg ASPIRIN
  • NITRO 0.4 mg for chest pain if SBP>100 (may repeat every 3-5 minutes as pain continues and BP allows)
  • for STEMI chest pain unresponsive to nitro: FENTANYL 0.5 mcg/kg IN/IV/IO
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6
Q

Bradycardia algorithm (adults)

A

< 60 and symptomatic

  • 12 lead
  • unstable & conscious: pacing & PUSH DOSE EPI (10-20 mcg every 2 min)
  • unstable & unconscious: work as a code (?)
  • stable & symptomatic: PUSH DOSE EPI or ATROPINE (1mg every 3-5 min)
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7
Q

Bradycardia algorithm (peds)

A

ages < or equal to 6 months and heart rate <60 (oxygenate and ventilate) and initiate chest compressions

otherwise:
CODE EPI (1:10,000): 0.01mg/kg every 3-5 min
ATROPINE: 0.02 mg/kg max initial dose 0.5mg

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8
Q

Supraventricular Tachycardia (adult) algorithm

A

unstable: sync cardiovert 70J/120J/150J/200J
(with FENTANYL if possible: 1mcg/kg)

stable & symptomatic (need medical direction if known WPW):
(1) vagal maneuvers
(2) ADENOSINE: 6mg fast bolus
ADENOSINE 2nd dose:12mg fast bolus
(3) CARDIZEM: 0.125 mg/kg max 12.5 slow push (max 10 mg if over 65 years old)
CARDIZEM 2nd dose: after 10 minutes as needed (same dose)

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9
Q

A-fib / A-flutter / multifocal atrial tachycardia algorithm

A

unstable: sync cardiovert
70J/120J/150J/200J
(with FENTANYL if possible: 1mcg/kg)

stable & symptomatic:
(1) CARDIZEM: 0.125 mg/kg max 12.5 mg slow push (max 10 mg if over 65 years old)
CARDIZEM 2nd dose: after 10 minutes as needed (same dose)

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10
Q

V-Tach with a pulse algorithm
(regular, wide)

A

unstable: sync cardiovert
70J/120J/150J/200J
(with FENTANYL if possible: 1mcg/kg)

stable:
(1) AMIODARONE: 150 mg over 10 minutes; repeat once as needed if VT recurs

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11
Q

Torsades algorithm

A

unstable: Defib
120J/150J/200J/200J

stable:
(1) MAGNESIUM SULFATE: 50mg/kg over 5-10 minutes, max 2g

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12
Q

Seizure algorithm

A
  • ongoing when we arrive or lasting >5 minutes; or more than 2 in one hour
  • pregnancy / postpartum: manage with mag
  • check blood sugar
  • manage airway (suction / ventilate as needed)
  • administer benzos:
    VERSED 0.2mg/kg IM/IN (max 5mg if <40kg; max 10mg if >40kg)
    ATIVAN or VERSED 0.1mg/kg IV/IO (slow push; max single dose 4mg)
  • monitor ETCO2

no ketamine for postictal patients

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13
Q

Syncope / Presyncope algorithm

A
  • includes both LOC and presyncope or “nearly blacking out”
  • check blood sugar
  • 12 lead
  • 500 mL fluid bolus if symptoms of poor perfusion; repeat as necessary
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14
Q

Sepsis algorithm

A
  • check blood sugar
  • ETCO2 and SPO2
  • 12 lead
  • 30 ml/kg fluid bolus
  • treat per “shock” algorithm as indicated
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15
Q

Indicators for sepsis

A
  1. SUSPECTED INFECTION OR IMMUNOSUPPRESSION(open wounds / UTI / pneumonia / meningitis / indwelling medical device / vomiting or diarrhea / recent surgery or procedure / chronic steroid use)
    => high risk: chemotherapy / sickle cell / bone marrow or organ transplant / severe intellectual disability

AND

  1. 2 OR MORE MARKERS OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME –Temp > 100 or < 97
    - HR > 90
    - RR > 20
    - glucose > 140 in non-diabetic
    - altered

(3. findings of shock)

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16
Q

Hypoglycemia algorithm

A
  • less than 60 mg/dL
  • ORAL GLUCOSE 15g PO; may repeat x1 as needed
  • DEXTROSE (D10) IV; 1ml/kg max 250mL (25g); titrate to effect
    or
    -GLUCAGON 1mg IM/IN (may repeat)
  • reassess blood sugar

** patients with insulin pump: if altered: stop insulin pump or disconnect at insertion site; if GCS 15 leave connected with pump running