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Advanced Anesthesia II > Peds Crisis > Flashcards

Peds Crisis Flashcards

1
Q

Air Embolism s/s

A

drop in ETCO2
hypoxia
hypotension
mill-wheel murmur

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2
Q

Air Embolism treatment

A 
LLD + Tburg
100% FiO2
Flood field, stop all insufflation, N2O etc
Central Line + Aspirate
CPR 100 - 120/m

crani case - compress jugular veins
epi 1 - 10mcg/kg; epi 0.02-1 mcg/kg/m

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3
Q

Anaphylaxis s/s

A

hypotension
tachycardia
rash, bronchospasm

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4
Q

Anaphylaxis tx

A
  1. 100% FiO2
  2. treat hypotension w/fluids - 10 - 30 mL/kg
  3. pressors - epi 1-10 mcg/kg, vasopressin 10 mu/kg
  4. diphenhydramine 1 mg/kg or pepcid 0.25 mg/kg
  5. methylprednisone 2 mg/kg
  6. albuterol 4 - 6 puffs
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5
Q

Anterior mediastinal mass airway collapse

A

oxygen 100%
CPAP/PEEP
lateral/prone
rigid bronch

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6
Q

anterior mediastinal mass CV collapse

A 
Increase O2 to 100%
 Give fluid bolus
 Reposition to lateral or prone
 Ask surgeon for sternotomy and
elevation of mass
 Consider ECMO
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7
Q

bradycardia definition

A

< 30 days = < 100
<1 yr = <80
> 1 yr < 60

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8
Q

bradycardia + hypotension

A

chest compressions

epi 10 mcg/kg

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9
Q

bradycardia (no hypotension)

A

100% oxygen
fix ventilation
vagal - atropine 0.01 mg/kg

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10
Q

CCB overdose

A

cacl 10 - 20 mg/kg IV

ca gluconate 50 mg/kg IV

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11
Q

BB overdose

A

glucagon 50 mcg/kg

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12
Q

bronchospasm s/s

A

drop in ETCO2
drop in O2
airway pressure increases
shark fin

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13
Q

bronchospasm tx (intubated pt)

A

Increase FiO2 to 100%
1. Auscultate the chest:
• Equal breath sounds?
• Endobronchial ETT?
• Wheezing?
2. Check ETT:
• Kinked?
• Secretions/blood in ETT? Needs suctioning?
3. albuterol 2-10 puffs
4. deepen anesthetic
5. ketamine 1-2 mg/kg IV
6. EPI 1-2 MICROgrams/kg IV (MAX 1 mg)
7. steroids: methylprednisolone 2 mg/kg IV(MAX 60 mg) or dexamethasone 0.15-0.25 mg/kg(MAX 16 mg)
8. Consider chest radiograph
9. For refractory bronchospasm, consider magnesium
sulfate 50-75 mg/kg (MAX 2 grams) bolused over 20
minutes, (CAUTION, may cause hypotension)

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14
Q

bronchospasm tx (non-intubated)

A
  1. Administer supplemental oxygen
  2. Auscultate the chest, differentiate from
    stridor/extrathoracic airway obstruction
  3. albuterol (with spacer) 2.5-5 mg. If severe, 5-20 mg/hr inhaled
  4. chest radiograph
  5. Consider IV steroids:
    methylprednisolone 1 mg/kg IV
    or dexamethasone 0.15-0.25 mg/kg
  6. EPINEPHrine
    1-2 MICROgrams/kg IV (MAX 1 mg) or
    10 MICROgrams/kg
    subcutaneous/intramuscular (MAX 0.5 mg)
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15
Q

Cardiac Arrest

A

Increase O2 to 100%. Turn off anesthetics. Start timer
1. If ETT, 100-120 chest compressions/min + 10 breaths/min. Avoid hyperventilation
2. If no ETT, 15:2 compression
3. For chest compressions, maximize EtCO2 > 10 mmHg
• Use sudden increase in EtCO2 for ROSC, Do NOT stop compressions for pulse check
4. Obtain defibrillator. Attach pads. If VF/VT, shock 2 joules/kg. Continue chest compressions for 2
minutes

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16
Q

cardiac arrest part 2

A

If still in VF/VT, shock 4 joules/kg q2 min (up to 10 joules/kg on subsequent shocks)
-Resume chest compressions immediately regardless of rhythm
- EPINEPHrine 10 MICROgrams/kg IV q 3-5 min while in arrest (MAX 1 mg)
• If still no ROSC after second dose of EPINEPHrine, activate ECMO (if available)
- Check pulse & rhythm q 2 min during compressor change
-Lidocaine 1 mg/kg bolus (MAX 100 mg); may repeat (total: 2 doses) OR amiodarone 5 mg/kg
bolus; may repeat (total: 3 doses)

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17
Q

H&Ts

A 
hypoxia
hypotension
tension pneumothorax
hypovolemia
hypothermia
acidosis
hyperkalemia
cardiac tamponade
hypoglycemia
thrombosis
toxin
trauma
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18
Q

difficult airway unexpected

A 
100% fio2
call for help - surgical airway cart, rigid bronch
OPA/NPA/LMA attempts
OG decompression
reverse?

after 2 attempts change providers; consider alternative approaches

macroglossia (beckwith-wiedemann, Pierre robin, mediastinal mass - prone or lateral)

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19
Q

younger kids difficult airway

A

rigid bronch

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20
Q

older kids difficult airway

A

jet ventilation or cricothyrotomy or trach

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21
Q

hyperkalemia

A 
s/s
tall peaked T waves
heart block
sine wave
v fibb/asystole
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22
Q

hyperkalemia treatment

A
  1. CPR/PALs if unstable
  2. 100% fio2
  3. ca gluconate 60 - 100 mg/kg OR cacl 20 mg/kg
  4. switch to NS
  5. dextrose 1 g/kg and insuline 0.1 units/kg
  6. albuterol
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23
Q

Hyperkalemia other treatments

A

bicarb 1 mEq/kg
lasix 1 mg/kg
terbutaline 10 mcg/kg

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24
Q

dopamine

A

2 - 20 mcg/kg/m

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25
Q

epinephrine

A

1 - 10 mcg/kg

0.02 - 1mcg/kg/m

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26
Q

cacl

A

10 - 30 mg/kg or caglu 50 mg/kg

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27
Q

phenylephrine bolus

A

1 mcg/kg

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28
Q

phenylephrine gtt

A

0.1 - 2 mcg/kg/m

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29
Q

ICP increased

A
  1. Secure airway
  2. Sedation prior to transport
  3. PaCO2 30 - 35 and PaO2 > 80
  4. HOB @ 30
  5. hypertonic saline 3% 1-5 mL/kg over 20 m
  6. mannitol 1 g/kg
  7. lasix 1 mg/kg
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30
Q

transfusion reactions

A
  1. epi 1 mcg/kg
  2. diphenhydramine 1 mg/kg
  3. methylprednisolone 2 mg/kg
31
Q

tension pneumothorax

A

14 - 16G for teens

18 - 20 G for infants

32
Q

tachycardia definition

A

> 220 for infant, > 180 for a child

33
Q

tachycardia treatment

A

100% fio2
vagal
adenosine for SVT 0.1 mg/kg
synchronized cardiovert 1 J/kg

34
Q

wide complex tachycardia

A

amiodarone 5 mg/kg

35
Q

torsades

A

magnesium 50 mg/kg (max 2 g)

lidocaine 1 mg/kg IV (max 100 mg)

36
Q

pulmonary HTN

A

iNO 20 - 40 ppm

  1. deepen sedation
  2. paralyze
  3. if hypotensive, vasopressin 0.03 u/kg
37
Q

MI

A 
oxygen 100%
(anemia, hypotension?)
- drop demand on the heart
- nitro 5 mcg/kg/m
-heparin 10 u/kg
38
Q

massive hemorrhage

A

O - PRBCs and AB + plasma until cross matched

  • monitor for hyperkalemia
  • monitor calcium
  • warm PRBCs and FFP
39
Q

Hct < 21%

A

4 mL/kg PRBC increase Hct by 3%

40
Q

Plt < 50 k

A

10 mL/kg apheresed platelets increases plt by 30 - 50 k

41
Q

INR > 1.5

A

10 mL/kg plasma increases coags by 20%

42
Q

fibrinogen < 100 mg

A

10 mL/kg cryo increases it by 30 - 50

43
Q

MH

A
  1. attach charcoal filter
  2. oxygen 10 L/m
  3. hyperventilate
  4. dantrolene 2.5 mg/kg
44
Q

dantrolene

A

20 mg/vial
mix w/60 mL
max dose 10 mg/kg

45
Q

ryanodex

A

250 mg in 5 mL

46
Q

LA toxicity

A

100% oxygen

  • midaz 0.1 mg/kg
  • epi 1 mcg/kg
  • avoid prop/vasopressin/CCB/BB
47
Q

intralipid therapy

A

20% @ 1.5 mL/kg
gtt @ 0.25 mL/kg/m

repeat q3-5m
double if BP remains low
continue for 10m once BP stablizes

48
Q

max IL therapy

A

10 mL/kg over first 30m

49
Q

laryngospasm s/s

A

inspiratory stridor
accessory muscles
drop in oxygen, HR
loss of end tidal

50
Q

laryngospasm tx

A
  1. oxygen + remove stimulus
  2. positive pressure + jaw thrust
  3. propofol bolus
  4. succinylcholine 0.1 mg/kg IV or 4 mg/kg IM
  5. atropine 0.02 mg/kg IV or 0.04 mg/kg IM
  6. DVL and ETT
51
Q

what are the RF for cardiac arrest? (6)

A
  1. cardiac surgery
  2. < 1 mo old
  3. ASA >= 3
  4. prematurity
  5. CHD
  6. emergency
52
Q

heart disease r/t cardiac arrest

A

AS
CM
single ventricle

54% arrested in a general operating room

53
Q

name the drug etiologies of cardiac arrest during anesthesia

A
  • OD
  • Sux
  • Neo dysrhythmia
  • Med swap
  • drug rxn
  • LA
  • inadequate reversal of paralytic
  • opioid respiratory depression
54
Q

name the CV causes of cardiac arrest

A 
hypovolemia
hemorrhage
inadequate volume administration
hypeerK, hypoCa, hypoglucosee
vagal (abd. eye. neck. heart)
55
Q

ROSC

A

return of perfusing rhythm and BP for 20 mins post-arrest

56
Q

full recovery after OR cardiac arrest in kids =

A

48 - 61%

57
Q

asystole in the OR -

A

most likely an initial rhythm in response to vagal stimulation

58
Q

reversal of vagal stimulation

A

glyco 10 - 20 mcg/kg
atropine 10 - 20 mcg/kg
insufflation, carotid massage

59
Q

predictor of mortality

A

CPR > 15m

60
Q

when should ECMO be initiated

A

10 m after failed resuscitation

61
Q

hypotension for a neonate

A

<60 sbp

62
Q

infant hotn

A

< 70 sbp

63
Q

hotn child

A

SBP <70 + 2xage

64
Q

hotn for > 10y

A

SBP < 90

65
Q

where do you check pulse in a newborn

A

umbi

66
Q

where do you check pulse for infant

A

brachial

67
Q

child pulse check?

A

carotid or brachial

68
Q

what drugs can go down ett

A 
naloxone
atropine
vasopressin
epi
lido

2 - 5 x IV dose + 5mL flush

69
Q

defibb

A

vtach

vfibb

70
Q

cardiovert

A

afibb
afluttere
svt

71
Q

how much do you flish drugs during cardiac arrest

A

0.25 mL/kg
5 mL = infant
10 mL = child

72
Q

preferred site for an IO

A

anterior tibia, below growth plate

73
Q

afteer ROSC -

A

avoid hyperthermia, hyperglycemkia, seizures

Advanced Anesthesia II (9 decks)

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