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NSER 7210 - Theory > Module 1 - Shock, Geriatrics, RSI > Flashcards

Module 1 - Shock, Geriatrics, RSI Flashcards

1
Q

Describe the role of universal screening of ED patients for IPV and other social issues.

A
  • opportunity to access resources
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2
Q

What is included in a comprehensive subjective history?

A
  • ETOH
  • Smoking
  • Illicit druge use
  • Interpersonal violence
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3
Q

What are the 7 P’s of rapid sequence intubation?

A
  1. Prepare
  2. Protection and position
  3. Preoxygenate
  4. Pretreat
  5. Paralysis and Induction (induction first!)
  6. Proof of placement
  7. Post-intubation care
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4
Q

What is involved in post-intubation care?

A
  • Re-check ABCs and full vitals
  • Secure ETT + document
  • Tubes (OG, foley, CVCs, ART lines)
  • Sedation & analgesia
  • Mechanical ventilation (BVM vs. ventilator)
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5
Q

What are common presentations of ecotopic pregnancy?

A
  • first trimester bleeding
  • abdominal pain
  • missed menstrual period
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6
Q

What are the clinical features of a ruptured ectopic pregnancy?

A
  • hypotension
  • tachycardia
  • moderate to severe abdominal pain
  • peritoneal signs (rebound tenderness)
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7
Q

What are the two treatments for ectopic pregnancies?

A
  1. Surgical management (for unstable patients)
  2. Medical management (stable patients)
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8
Q

What is the name of the medication used in the medical management of an ectopic pregnancy?

A

Methotrexate (MTX) - inhibits DNA synthesis and cell replication

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9
Q

What are the three stages of shock?

A
  1. Compensated
  2. Uncompensated
  3. Irreversivle
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10
Q

What are some signs and symptoms of shock?

A
  • tachycardia
  • hypotension
  • tachypnea
  • cool and clammy extremities
  • oliguria
  • dysglycemia
  • delirium
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11
Q

What are the 4 types of shock?

A
  1. Hypovolemic
  2. Cardiogenic
  3. Distributive (sepsis, neurogenic, anaphylactic)
  4. Obstructive
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12
Q

True or False:
Vital signs may be normal in compensated shock

A

True
- Body is able to maintain cardiac output
- Cellular damage is STILL happening

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13
Q

What is the key to treating all types of shock?

A

Early recognition and intervention

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14
Q

What is the first line drug of choice in anaphlaxsis?

A

Epinephrine

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15
Q

What is the first line druge of choice in vasodilatory and septic shock?

A

Norepinephrine

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16
Q

When is dopamine used?

A

Vasodilatory shock associated with BRADYCARDIA

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17
Q

What does dobutamine do?

A
  • Increases contractility of the heart
  • Vasodilation (decreases SVR)
    Can help improve CO by decreasing afterload, making it easier for the heart to eject blood with each contraction
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18
Q

What do colloid fluids contain?

A

Contain undissolved particles (protein, sugar, starch) that are too BIG to pass through capillary

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19
Q

What effect do colloids have? (Isotonic, Hypotonic, or Hypertonic)?

A

Hypertonic
- pull fluid from tissues into vasculature

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20
Q

What does fresh frozen plasma contain?

A

Albumin, Globulins, Antibodies, Plasma clotting factors

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21
Q

What are the components of the “Geriatric Giant”?

A
  • Delirium
  • Depression
  • Dementia
  • Drugs
  • De-conditioning
  • Falls
  • Pain
  • Incontinence
  • Malnutrition / Dehydration
  • Sleep disturbance
  • Elder abuse
22
Q

What are some cardiac changes that happen in older adults?

A
  • cardiac muscles thicken
  • arteries stiffen
  • valves stiffen
  • conductivity altered
23
Q

What are some respiratory changes that happen in older adults?

A
  • rigidity of chest wall
  • enlargement of chest wall
  • lung tissues diminish
24
Q

What are some renal changes that happen in older adults?

A
  • Less renin production
  • Decrease in filtration
  • Decrease ability to concentrate urine
  • Decrease in renal blood flow
25
Q

What are signs of multiple organ dysfunction in septic shock? *

A
  • Altered mental status
  • tachypnea
  • poor cap refill
  • hypotension
  • tachycardia
  • thrombocytopenia (increase d-dimer)
  • metabolic acidosis (increase lactate)
  • urine output < 0.5 mL/kg/hr)
26
Q

What are the endothelia cell dysfunctions that leads to multiple organ dysfunction?*

A
  • capillary leak
  • microvascular thrombus
  • cell adhesion
  • tissue hypoxia
  • apoptosis
  • impaired vascular tone
  • free radical damage
27
Q

What can make for a difficult airway with RSI?

A
  • Obesity
  • Short or wide neck
  • Obvious signs of deformity
28
Q

What are the two paralytics that are commonly used in RSI?

A
  • Roccuronium (non-depolarizing)
  • Succinylcholine (depolarizing)
29
Q

Which is longer acting, Roc or Succ?

A

Roccuronium

30
Q

In what cases does Succinylcholine have to be used carefully?

A
  • Hyperkalemia (K+)
  • Renal Failure
  • Burns
  • Conditions that increase neuromuscular blockade (low Ca+, low K+, high Mg+, metabolic acidosis)
31
Q

What is the name of the reversal agent for rocuronium?

A

Sugammadex

31
Q

What are the drugs used for induction?

A
  • Propofol
  • Ketamine
  • Etomidate
  • Midazolam
32
Q

What are the hazards of using Propofol?

A
  • HYPOTENSION
  • decreased HR
  • allergy to eggs, soy, peanuts
  • no analgesic effect
33
Q

What is ketamine used for?

A

Induction for RSI

34
Q

What is a potential side effect of ketamine?

A

May enhance pressor response
- increase HR
- increase BP
- decrease RR

35
Q

What is fentanyl used for?

A

Analgesic

36
Q

What is a potential hazard of using Fentanyl?

A
  • Decrease RR
  • Decrease HR
37
Q

What is the antidote for too much fentanyl?

A

Naloxone

38
Q

What is Phenylephrine used for?

A

Treatment of vasodilation and hypotension during anesthesia
- treatment of +++ low BP

39
Q

What are some hazards of using phenylephrine?

A
  • PVCs
  • VT
  • Increased BP
  • Can’t use with sulfite allergy
  • Causes severe peripheral vasoconstriction and reduced blood flow to organs
40
Q

What is a side effect of Etomidate?

A

Can block the adrenal glands production of cortisol (stress hormone) that actually aids the body to deal with cardiovascular effects of sepsis, including hypotension
- can also decrease BP
- increase HR

41
Q

What is a side effect of Midazolam?

A

Hypotension
Respiratory depression

42
Q

What is considered in “Prepare & Plan” during RSI?

A
  • gather the team
  • vocalized plan and reason
  • backup plan(s)
  • prepare equipment and drugs (suction, oxygen, BVM, laryngoscope, ETT, OPA, bougie, RSI + pressers, EtCO2, SpO2, tele, NIBP)
43
Q

What is considered in “Protection & Position” during RSI?

A
  • consider c-spine
  • adjust patient prior to or after induction and paralytics given to ensure adequate ergonomics
44
Q

What is considered during “Pre-oxygenate” during RSI?

A
  • 100% FiO2 for 3-5 minutes
  • NRB, BVM, BiPap
  • consider apneic oxygenation with nasal prongs
  • advise physician when saturations reach a predetermined cutoff number to reduce potential harm (SpO2)
45
Q

What is considered during “Pre-treatment” during RSI?

A
  • Atropine - prevent bradycardia in children
  • Lidocaine - neuroprotection in head injury, decrease airway reactivity in asthma
  • Fentanyl - neuroprotection in head injury
  • Rocuronium - prevent fasciculations from Succinylcholine
    ***These are not routinely seen in practice
46
Q

What is the goal of the induction agent during RSI?

A

To provide rapid unconsciousness, unresponsiveness, amnesia, and analgesia

*Always give induction agent prior to paralytic

47
Q

What is the goal of the paralytic agent during RSI?

A

Muscle paralysis to create an optimal environment for intubation

48
Q

How is “Proof is Placement” verified during RSI?

A
  • Visualization of tube through vocal cords
  • Equal chest rise + fall
  • Auscultation - no epigastric gurgling
  • EtCO2 waveform capnography > 30
  • Colourmetric - purple to gold if CO2 present (Gold is Good!)
  • Portable chest xray
49
Q

What is the expected capnography with CPR?

A

10

NSER 7210 - Theory (6 decks)

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