Medical emergencies Flashcards
CPR in adults is given at what ratio?
30:2 chest compressions to breaths
What depth of CPR should be given?
5-6cm
What rate of CPR should be given?
100-120 rate
Continuous chest compressions should be given in which situation?
When definitive airway in place (e.g. Endotracheal tube)
What are the 2 types of shockable rhythm?
VF
Pulseless VT
What are the 2 types of non-shockable rhythm?
PEA
Asystole
After administering a shock, how long must chest compressions be carried out for before the next shock?
2 minutes
When should chest compressions stop?
When patient shows obvious signs of life
How often does the cardiac rhythm need to be checked when shocking/CPR?
Every 2 minutes
After the 3rd shock, what drugs must be administered?
IV adrenaline 1mg
IV amiodarone 300mg
Repeat doses of adrenaline every 3-5 mins (every other cycle of CPR)
Do not interrupt chest compressions to administer drugs
How often does adrenaline need to be administered when treating a shockable rhythm?
Repeat doses of adrenaline every 3-5 mins (every other cycle of CPR)
When IV access is not available to administer adrenaline/amiodarone, what can be done?
Administer drugs via intraosseous access (need trained members of team)
If initial rhythm is PEA or asystole, what is the first step?
2 minutes CPR before further rhythm check
1mg IV adrenaline (then 3-5 mins after)
DO NOT USE ATROPINE
What are the 4 Hs of the reversible causes of cardiac arrest?
Hypoxia
Hypovolemia
Hypo/hyperkalaemia
Hypothermia
Whare the the 4 Ts of the reversible causes of cardiac arrest?
Tamponade (cardiac)
Thromboembolism
Toxins
Tension pneumothorax
How do you treat hypoxia-induced cardiac arrest?
Airway adjunct (e.g. Guedel) or definitive airway (ET tube)
High flow O2
Ventilating patient
How is hypovolemia treated?
Fluid replacement
Give blood transfusion if large volume blood loss
Can Hb levels be used to reassure that a blood transfusion has worked?
No - always examine the patient thoroughly (Hb levels can be falsely raised)
How is hyperkalaemia treated?
Insulin and glucose
IV calcium gluconate to stabilise myocardium
Why can’t you give calcium and sodium bicarbonate with the same access line?
Insoluble precipitate forms –> blocks access line
What drug can be given for persistent VF/VT where hypomagnesaemia is suspected?
Magnesium sulfate
How can hypothermia be conservatively managed?
Dry patients
Warm blankets/ambient environment
Cover extremities
Infuse warm fluids
Monitor core temperature
If core body temp <30, what do the guidelines say about giving shocks/IV drugs
Limit shocks to 3
Withhold IV drugs (inc adrenaline, amiodarone) until body temp >30
If core body temp is between 30-35, how does this affect how you administer resuscitation drugs?
Double the intervals between drug doses
What is the treatment of tension pneumothorax?
Immediate decompression with large bore cannula
–> chest drain after ROSC
What is the main thromboembolic cause of cardiac arrest?
Massive PE
Can thrombolysis be used to treat massive PE causing cardiac arrest?
Yes but resuscitation may need to continue up to 90 minutes post thrombolysis
What drugs can cause cardiac arrest?
Opiods
TCAs
Benzodiazepines
How is opioid overdose treated?
Naloxone + close monitoring
How is TCA overdose treated?
Sodium bicarbonate
How is benzodiazepine overdose treated?
Flumazenil
don’t use if Pt dependent on benzos as causes seizures
How is anaphylaxis reaction to drug treated?
IM adrenaline 500mcg
+ antihistamine
+ corticosteroid
(do all this pre-arrest)
If cardiac arrest occurs, give 1mg IV adrenaline instead!
How is cardiac tamponade investigated and treated?
Ix: Echocardiogram
Tx: Pericardiocentesis
When managing a cardiac arrest in a woman in the later stages of pregnancy, what manouevre must be done?
Manually displace the uterus to the left
add left lateral tilt if only feasible
When should you consider emergency C-section if the woman has a cardiac arrest?
If initial resus attempts fail and within 5 mins of cardiac arrest
In cardiac arrest following cardiac catherisation, how many DC shocks may be administered to achieve ROSC?
3 stacked DC shocks
Which 2 vital signs are the most important when considering the management of Post-cardiac arrest syndrome?
Oxygen sats (94-98) + CO2 levels
Temperature (<36)
What is the difference between HHS and DKA?
Ketones and acidosis not present in HHS
Severe hypoglycaemia can be treated via parenteral treatment with which 2 drugs?
IM glucagon
or
IV glucose
What is the most common cause of hypoglycaemia in hospital patients?
Prescribing errors
What is the 1st principle of HHS treatment?
Give fluids to restore circulating volume
only initiate insulin when blood glucose is no longer falling with IV fluids alone
What is the difference between mild and severe hypoglycaemia?
Mild - blood glucose levels drop and person self-treats
Severe - 3rd-party required to treat the person
For hospital inpatients, what is the defining value of hypoglycaemia in mmol/litre?
Blood glucose <4.0 mmol/litre
What are adrenergic/autonomic symptoms (early) of hypoglycaemia?
Sweating Tachycardia Palpitations Pallor Hunger Restlessness
What are neuroglycopenic symptoms (late) of hypoglycaemia?
Confusion Slurred speech Drowsiness Numbness of nose/lips/fingers Anxiety Blurred vision
Frequent episodes of hypoglycaemia can lead to _______ awareness of hypoglycaemic symptoms
Reduced
What drug can mask adrenergic symptoms of hypoglycaemia?
Non-cardioselective beta blockers e.g. propanolol
What are lifestyle risk factors for hypoglycaemia?
Diet inc. fasting periods Age(older) Exercise History of severe hypos Hypo unawareness
What are medical risk factors for hypoglycaemia?
Insulin or glucose lowering drugs
Problems with BM monitoring
Comorbidity
Concomitant meds (e.g. stopping long-term steroids)
Renal issues (aki/dialysis)
Learning difficulties
When treating severe hypoglycaemia what is important to check first before starting treatment?
Pt’s level of conciousness
Gag reflex?
Able to tolerate oral meds
If blood glucose is still low despite repeated attempts at providing quick-acting carbs, what drug treatment can be given?
IM glucagon 1mg (also give larger carb snack together)
or
10% glucose infusion 150-200ml over 15 mins
If patient is conscious and able to swallow but confused, unable to cooperate or aggressive - how can hypoglycaemia be treated?
1.5-2 tubes of glucogel squeezed into mouth between teeth and gums
or
IM glucagon 1mg 1x and monitor after 15 mins
How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS AVAILABLE?
75-100ml 20% glucose over 15 mins via standard giving set
OR
150-200mlm 10% glucose over infusion pump/giving set
Rpt BM at 10 mins, if still <4.0 then repeat administration
How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS NOT AVAILABLE?
IM glucagon 1mg
Remember to give large carb snack 40g afterwards
Severe spontaneous hypoglycaemia is when blood glucose is below?
<2.2 mmol/litre
If no good reason for hypoglycaemic episode, which 2 things can be done?
Take bloods (insulin, C-peptide, IGF-1 and 3-beta-hydroxybutyrate)
Give glucose orally or IV (20% glucose solution) to restore blood glucose to normal
