Must Know Flashcards

1
Q

Hypoxemia - What Do You Do?

A
  1. Increase 100% O2
  2. Check vitals (BP, EKG, EtCO2, PIP)
  3. Hand ventilate - check compliance, rule out circuit leak/machine factors
  4. Listen breath sounds
  5. Check ETT - correct position, suction to clear secretions/obstruction
  6. DDx
  7. Treat as indicated - recruitment breaths, bronchodilators, reposition ETT, adjust vent settings (PEEP), increase FRC (reverse T, desufflate abd), etc
  8. Additional tests: ABG, CXR
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2
Q

Hypoxemia: DDx

A
  1. Hypoventilation
  2. Low FiO2
  3. V/Q Mismatch or Shunt
  4. Diffusion Problem
  5. Increased Metabolic O2 Demand
  6. Artifact
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3
Q

Hypoventilation: Signs

A
Low TV or RR
High or low EtCO2
Poor chest rise
Decreased breath sounds
Patient bucking ventilator
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4
Q

Hypoventilation: Rule out or fix equipment and patient causes

A
Circuit leak
ETT: obstruction or kink
High PIP
Residural NMB
Asynchronous breathing with ventilator
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5
Q

PostOp Respiratory Failure: DDx

A
Residual Rx: NMB, Opioids, Anesthetic
Laryngospasm/Bronchospasm
Pulmonary edema
High spinal
Pain
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6
Q

V/Q Mismatch or Shunt: DDx

A
Mainstem intubation
Atelectasis
Aspiration
Bronchospasm/Anaphylaxis
Mucus plug
Pleural effusion
*PTX
*Hypotension
*Embolus - air, blood, fat, AFE
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7
Q

Increased Metabolic Demand: DDx

A
MH
Thyrotoxicosis
Sepsis
Hyperthermia
NMS
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8
Q

Bronchospasm - What Do You Do?

A
  1. Increase 100% O2
  2. Deepen anesthetic
  3. Inhaled agents: albuterol +/- ipratropium
  4. If persists = small dose of epinephrine (10 mcg)
    - Ketamine, hydrocortisone, nebulized racemic epi
    - Rule out anaphylaxis & problems with ETT
    - Change I:E ratio - allow of adequate exhalation
    - ABG
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9
Q

Bronchospasm: DDx

A
Mainstem intubation
Kinked ETT
Mucus plug
Anaphylaxis
Asthma
COPD
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10
Q

Delayed Emergence

A
  1. Monitors - check vitals (BP, oxygenation, ventilation)
    Hypoxemia, hypercarbia, hypothermia
  2. Meds
    Anesthetic agents OFF?
    Residual NM paralysis? and reverse prn
    Opioids (naloxone 40 mcg q2 min, max 400 mcg)
    Benzos (flumazenil 0.2 mg q1 min, max 1 mg)
    Scopolamine (physostigmine 1 mg)
    Medication swap or dosing error?
  3. Neuro exam for focal deficits
    Pupils, asymmetrical movement, gag reflex
    Stat head CT?
  4. Labs
    Glucose, ABG, electrolytes
  5. Treatment as indicated
  6. Residual abnormalities - neuro ICU with serial exams. Repeat CT or MRI as indicated.
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11
Q

PEA: What Do You Do?

A
  1. Verify and initiate CPR
  2. Secure airway, ventilate 10 BPM
  3. Ensure adequate IV access
  4. Epinephrine 1 mg q 3-5 mins
  5. Continue to monitor for shockable rhythm
  6. Find and treat causes - H&Ts
  7. Consider TTE/TEE or ECMO
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12
Q

PEA: DDx

A
Hemorrhage
Shock
PE
PTX
Auto PEEP
Anaphylaxis
Anesthesia OD
Medication error
High spinal
LAST
Vagal stimulus
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13
Q

H’s & T’s

A
Hypovolemia
Hypoxemia
Tension PTX
Thrombosis - Coronary, Pulmonary
Toxins
Tamponade - Cardiac
Hypo/Hyperthermia
Hypo/Hyperkalemia
Hypoglycemia
H+ (acidosis)
Hypocalcemia
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14
Q

ROSC

A

Presence of pulse and BP
Abrupt sustained increase PetCO2 (>40)
Appearance spontaneous arterial pressure waves

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15
Q

Therapeutic Hypothermia: Indications

A

Comatose post-cardiac arrest/ROSC

Inpatient: all cardiac arrest
Outpatient: V fib or PEA

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16
Q

Therapeutic Hypothermia: Initiate

A

Cooling blankets, ice packs, rapid infusion ice-cold IVF

Achieve temp of 32-34 Celcius x 12-24 hours

2 sources core temp mgmt: esophageal, bladder, or PAC