Resus Flashcards
What is the management of PEA and asystole?
NON shockable
Continue CPR
Adrenaline 1mg IV in every other cycle if persists
What is the management of VF and VT?
Shock - **
Amiodarone 300mg IV (one off) and adrenaline (every other cycle) 1mg IV 1 in 10,000 given after the third shock
What are some causes of airway compromise?
Angioedema
Anaphylaxis
Burns
Wheeze
Surgical emphysema
Reduced conc
What are some simple airway manoeuvres?
Suction - visible vomit, blood, secretions or foreign body
Head tilt/chin lift
Jaw thrust - both hands, hook fingers under angle of pt jaw and lift mandible forwards
What are some airway adjuncts?
Oropharyngeal airway - insert upside down and rotate 180 degrees to keep the tongue away from airway, rigid, need to be unconc
Nasopharyngeal airway - through nostril, used in conc pt, CI in basal skull fracture
What is an iGel?
Supraglottic airway - flexible plastic tube w inflatable cuff - sits over the top of the larynx
What is a definitive airway?
Endotracheal tube, need to insert w laryngoscope
Only airway that protects against aspiration
What is the management of a conc choking pt?
- Cough !!
- 5 back blows between shoulder blades
- 5 abdo thrusts pulling up and in sharply
Cont until obstruction dislodged or pt loses conc
What is the management of an unconc choking pt?
- 2222
- Open the mouth and observe if obstruction is visible and remove - attempt this once
- Jaw thrust or head tilt/chin lift
- CPR if pt not breathing
What are the GCS scores for motor response?
6 - obeys commands (normal)
5 - localises to pain
4 - w draws to pain
3 - flexor response to pain
2 - extensor response to pain
1- no response to pain
Cause pain - squeeze trap
What are the GCS scores for verbal response?
5 - oriented
4 - confused conversation
3 - inappropriate speed
2 - incomprehensible
1 - none
What are the GCS scores for eye opening?
4 - spont
3 - open in response to speech
2 - opens to pain
1 - no eye opening
When would a GCS make you worried?
GCS <8 = pt unable to maintain their airway
What are the classifications of hypothermia?
Mild - 32-35
Mod - 28-32
Severe - <28
What are the features of hypothermia on an ECG?
Bradyarrhythmia - sinus brady, slow AF, heart block
J waves
Prolonged PR, QRS and QT intervals
Shivering artefact
V ectopics
Cardiac arrest
What is the management of hypothermia?
Warming the pt:
- Warm blanket
- Warm fluid
- Warm IV fluids
- Bair Hugger
- ECG monitoring - high risk of cardiac arrest
What are some causes of burns?
Thermal - hot liquids, steam, fire
Chemical - acid = coagulation necrosis, alkali = liquefaction necrosis
Electrical - electrical source passes through body, has an entry and exit wound and causes internal damage
What is inhalation injury?
Damage to the airway secondary to inhalation of hot air, normally when there is flame or smoke exposure in a closed space
Mortality in burns increased 20% when there is an associated inhalation injury
When would you suspect inhalation injury?
Stridor, hoarse voice, resp or airway compromise
Singed nasal hairs, facial burns, soot around nose
What is the initial management of a burns patient?
AtoE
IV morphine
Strict fluid balance chart
Wound dressing - varied guides but initially clingfilm
Risk of hypothermia due to heat loss from burns sites so warmed room, warmed fluids
What is the management of minor burns?
- Remove source of the burn
- Remove non adherent clothing
- Cool wound under running water for 20 mins
What is Wallace’s rule of nines?
Head = 4.5%
Torso = 18%
Arm = 4.5%
Gentials = 1%
Upper and low leg = 9%
These percentages only count for anterior, if ant and post affected double them
eg. front of L arm = 4.5%, all L arm front and back = 9%
What are the different classifications for burns thickness?
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Superficial burn:
- Deepest layer involved
- Appearance
- Pain
- Prognosis
Epidermis
Dry, pink no blisters, blanches
Painful
Heals w/o scarring in 5-10 days
Superficial partial thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis
Upper dermis
Blisters, wet, pink, blanches
Painful
Heals w/o scarring <3 weeks
Deep partial thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis
Lower dermis
Yellow or white, dry, non blanching
Decreased sensation
Heals in 3-8 weeks, scars if takes >3 weeks
Full thickness:
- Deepest layer involved
- Appearance
- Pain
- Prognosis
Subcut tissue
Leathery or waxy white, dry, non blanching
Painless
Heals by contracture and will scar
How do you calc fluid resus in burns?
Parkland formula
adults - 4ml (Hartmann’s) x weight (Kg) x %TBSA burned
50%given in first 8 hours post burn then remaining 50% in next 16 hours
children - 3ml
What is the ongoing care of a burns pt?
Burns unit - 10-39%, deep or full thickness, specialised areas, chemical electrical injury, pregnant, NAI
Burns centre - >40% or inhalation injury, concomitant major trauma, concomitant co morbidities
What are some physical cooling methods?
Remove clothes, water sprays, ice packs, cooling blanket
Water immersion
Cold IV fluids
IV cooling catheters
ECMO?
What are some pharmacological cooling methods?
Paracetamol aspirin NSAIDs (no benefit in heat stroke)
Stop serotonin meds
Dantrolene for malignant hyperthermia (not beneficial in heat stroke)
