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PSA > Medical emergencies > Flashcards

Medical emergencies Flashcards

1
Q

CPR in adults is given at what ratio?

A

30:2 chest compressions to breaths

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2
Q

What depth of CPR should be given?

A

5-6cm

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3
Q

What rate of CPR should be given?

A

100-120 rate

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4
Q

Continuous chest compressions should be given in which situation?

A

When definitive airway in place (e.g. Endotracheal tube)

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5
Q

What are the 2 types of shockable rhythm?

A

VF

Pulseless VT

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6
Q

What are the 2 types of non-shockable rhythm?

A

PEA

Asystole

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7
Q

After administering a shock, how long must chest compressions be carried out for before the next shock?

A

2 minutes

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8
Q

When should chest compressions stop?

A

When patient shows obvious signs of life

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9
Q

How often does the cardiac rhythm need to be checked when shocking/CPR?

A

Every 2 minutes

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10
Q

After the 3rd shock, what drugs must be administered?

A

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

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11
Q

How often does adrenaline need to be administered when treating a shockable rhythm?

A

Repeat doses of adrenaline every 3-5 mins (every other cycle of CPR)

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12
Q

When IV access is not available to administer adrenaline/amiodarone, what can be done?

A

Administer drugs via intraosseous access (need trained members of team)

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13
Q

If initial rhythm is PEA or asystole, what is the first step?

A

2 minutes CPR before further rhythm check

1mg IV adrenaline (then 3-5 mins after)

DO NOT USE ATROPINE

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14
Q

What are the 4 Hs of the reversible causes of cardiac arrest?

A

Hypoxia
Hypovolemia
Hypo/hyperkalaemia
Hypothermia

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15
Q

Whare the the 4 Ts of the reversible causes of cardiac arrest?

A

Tamponade (cardiac)
Thromboembolism
Toxins
Tension pneumothorax

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16
Q

How do you treat hypoxia-induced cardiac arrest?

A 
Airway adjunct (e.g. Guedel)
or definitive airway (ET tube)

High flow O2

Ventilating patient

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17
Q

How is hypovolemia treated?

A

Fluid replacement

Give blood transfusion if large volume blood loss

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18
Q

Can Hb levels be used to reassure that a blood transfusion has worked?

A

No - always examine the patient thoroughly (Hb levels can be falsely raised)

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19
Q

How is hyperkalaemia treated?

A

Insulin and glucose

IV calcium gluconate to stabilise myocardium

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20
Q

Why can’t you give calcium and sodium bicarbonate with the same access line?

A

Insoluble precipitate forms –> blocks access line

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21
Q

What drug can be given for persistent VF/VT where hypomagnesaemia is suspected?

A

Magnesium sulfate

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22
Q

How can hypothermia be conservatively managed?

A

Dry patients

Warm blankets/ambient environment

Cover extremities

Infuse warm fluids

Monitor core temperature

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23
Q

If core body temp <30, what do the guidelines say about giving shocks/IV drugs

A

Limit shocks to 3

Withhold IV drugs (inc adrenaline, amiodarone) until body temp >30

24
Q

If core body temp is between 30-35, how does this affect how you administer resuscitation drugs?

A

Double the intervals between drug doses

25
Q

What is the treatment of tension pneumothorax?

A

Immediate decompression with large bore cannula

–> chest drain after ROSC

26
Q

What is the main thromboembolic cause of cardiac arrest?

A

Massive PE

27
Q

Can thrombolysis be used to treat massive PE causing cardiac arrest?

A

Yes but resuscitation may need to continue up to 90 minutes post thrombolysis

28
Q

What drugs can cause cardiac arrest?

A

Opiods

TCAs

Benzodiazepines

29
Q

How is opioid overdose treated?

A

Naloxone + close monitoring

30
Q

How is TCA overdose treated?

A

Sodium bicarbonate

31
Q

How is benzodiazepine overdose treated?

A

Flumazenil

don’t use if Pt dependent on benzos as causes seizures

32
Q

How is anaphylaxis reaction to drug treated?

A

IM adrenaline 500mcg

+ antihistamine

+ corticosteroid

(do all this pre-arrest)

If cardiac arrest occurs, give 1mg IV adrenaline instead!

33
Q

How is cardiac tamponade investigated and treated?

A

Ix: Echocardiogram

Tx: Pericardiocentesis

34
Q

When managing a cardiac arrest in a woman in the later stages of pregnancy, what manouevre must be done?

A

Manually displace the uterus to the left

add left lateral tilt if only feasible

35
Q

When should you consider emergency C-section if the woman has a cardiac arrest?

A

If initial resus attempts fail and within 5 mins of cardiac arrest

36
Q

In cardiac arrest following cardiac catherisation, how many DC shocks may be administered to achieve ROSC?

A

3 stacked DC shocks

37
Q

Which 2 vital signs are the most important when considering the management of Post-cardiac arrest syndrome?

A

Oxygen sats (94-98) + CO2 levels

Temperature (<36)

38
Q

What is the difference between HHS and DKA?

A

Ketones and acidosis not present in HHS

39
Q

Severe hypoglycaemia can be treated via parenteral treatment with which 2 drugs?

A

IM glucagon
or
IV glucose

40
Q

What is the most common cause of hypoglycaemia in hospital patients?

A

Prescribing errors

41
Q

What is the 1st principle of HHS treatment?

A

Give fluids to restore circulating volume

only initiate insulin when blood glucose is no longer falling with IV fluids alone

42
Q

What is the difference between mild and severe hypoglycaemia?

A

Mild - blood glucose levels drop and person self-treats

Severe - 3rd-party required to treat the person

43
Q

For hospital inpatients, what is the defining value of hypoglycaemia in mmol/litre?

A

Blood glucose <4.0 mmol/litre

44
Q

What are adrenergic/autonomic symptoms (early) of hypoglycaemia?

A 
Sweating
Tachycardia
Palpitations
Pallor
Hunger
Restlessness
45
Q

What are neuroglycopenic symptoms (late) of hypoglycaemia?

A 
Confusion
Slurred speech
Drowsiness
Numbness of nose/lips/fingers
Anxiety
Blurred vision
46
Q

Frequent episodes of hypoglycaemia can lead to _______ awareness of hypoglycaemic symptoms

A

Reduced

47
Q

What drug can mask adrenergic symptoms of hypoglycaemia?

A

Non-cardioselective beta blockers e.g. propanolol

48
Q

What are lifestyle risk factors for hypoglycaemia?

A 
Diet inc. fasting periods
Age(older)
Exercise
History of severe hypos
Hypo unawareness
49
Q

What are medical risk factors for hypoglycaemia?

A

Insulin or glucose lowering drugs

Problems with BM monitoring

Comorbidity

Concomitant meds (e.g. stopping long-term steroids)

Renal issues (aki/dialysis)

Learning difficulties

50
Q

When treating severe hypoglycaemia what is important to check first before starting treatment?

A

Pt’s level of conciousness

Gag reflex?

Able to tolerate oral meds

51
Q

If blood glucose is still low despite repeated attempts at providing quick-acting carbs, what drug treatment can be given?

A

IM glucagon 1mg (also give larger carb snack together)
or
10% glucose infusion 150-200ml over 15 mins

52
Q

If patient is conscious and able to swallow but confused, unable to cooperate or aggressive - how can hypoglycaemia be treated?

A

1.5-2 tubes of glucogel squeezed into mouth between teeth and gums
or
IM glucagon 1mg 1x and monitor after 15 mins

53
Q

How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS AVAILABLE?

A

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

54
Q

How do you manage a semi- or unconscious hypoglycaemic patient IF IV ACCESS IS NOT AVAILABLE?

A

IM glucagon 1mg

Remember to give large carb snack 40g afterwards

55
Q

Severe spontaneous hypoglycaemia is when blood glucose is below?

A

<2.2 mmol/litre

56
Q

If no good reason for hypoglycaemic episode, which 2 things can be done?

A

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

PSA (1 decks)

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