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1. Fellowship Written - SAQ > Resus > Flashcards

Resus Flashcards

1
Q

fever and lymphoma (could be any long term disease)
What factors influence abx choice

A
  • allergies
  • recent sensitivities
  • likely source
  • local guidenlines
  • presence of indewelling lines
  • ?neutropenia
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2
Q

Steps in management with end points

A

end points are hr under 100, BP over 100 systolic, MAP over 65, UO 0.5ml/kg/min

  1. fluid bolus 500ml/1l normal saline
  2. insert central line if needing ionotropes and norad 5mcg/min
  3. broad spectruam abx eg taz 4.5g
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3
Q
A
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4
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5
Q

With choking what are the features of an effective cough?

A
  • crying/speech
  • loudness of cough
  • can take breathe before coughing
  • child alert
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6
Q

choking child algorithm

A
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7
Q

what are the featurs of chest compression in children

A
  • 100 per minute
  • 15:2
  • 1/3 chest diameter
  • uninterrupted
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8
Q

hyperkalaemia treatment

A
  • IV Ca gluconate 30mL 10% for cardiac protection
  • IV HCO3 50-100mmol – K reduction
  • IV insulin 10U / dextrose 50mL 50% - K reduction
  • Intubate – protect airway and control CO2
  • IV fluid N/S – titrate to UO 1ml/kg/hr to manage rhabdo and prevent further renal failure
  • Also accept – salbutamol for K reduction
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9
Q

what are the immediate steps in anaphylaxis management for a child?

What are the next steps?

A
  • Stop precipitating factor
  • oxygen via hudson mask aiming over 95% with 100% 02
  • 10mcg/kg IM adrenaline into upper outer thigh - repeat after 5 mins +/- adrenaline neb 5ml
  • IV hydrocortisone 5mg/kg
  • Fluid bolus 10mls/kg with aim for CRT under 2 secs

Next steps

Further IM adrenaline and fluid
Adrenaline infusion 0.1-1mcg/kg/min
Intubate

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10
Q

What is the treatment for hyperkalaemia in arrest?

A

All quicker than normal hyperkalaemia:

  1. Protect the heart: give 10 mL calcium chloride 10% IV by rapid bolus injection or 30ml of calcium gluconate
  2. Shift potassium into cells: Give glucose/insulin: 10 units short-acting insulin and 25 g glucose IV by rapid injection. Monitor blood glucose.
  3. Give sodium bicarbonate: 50 mmol IV by rapid injection (if severe acidosis or renal
    failure).
  4. Consider dialysis
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11
Q

What are the specific modifications to ALS for the following?

A
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12
Q
A
  • Commence CPR 15:2 – 2 rescuers, 100/min
  • Apply 100% O2 via BVM / intubate OK
  • IV access and fluid bolus O.9% saline 20ml/kg (or similar) (200ml)
  • IV adrenaline 10mcg/kg (12 month old approx. 10kg – accept 100mcg)
  • Seek and treat hypoglycaemia with IV 5ml/kg 10% dextrose (ie 50ml 10%)
  • IV antibiotics OK – ceftriaxone / cefotaxime – 50-100/kg
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13
Q

what are the benefits of parental presence during resus?

Disadvantages?

A

Benefits

  • allows parents to see all treatment being provided
  • allows initiation of grieving process if unsuccessful**

Disadvantages

  • can worsen staff grief and be highly emtive
  • potential for interference
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14
Q

what are the causes of post cardiac arrest hypotension?

A
  • Cardiogenic
  • Hypovolemic
  • Obstructive - tampandae, pneumpthorax
  • Maldistributive - SIRS
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15
Q

What are the priorities of post cardiac arrest care

A

ABCDE
normoglycaemia
normothermia
ECG
Treat cause
sats 94-98

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16
Q

main features and interpretation

A

Sinus rhythm, rate ~70,
left axis deviation, LBBB with positive modified sgarbossa criteria
* STEMI-equivalent and may benefit from PCI

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17
Q

What did the Airways-2 trial show

A
  • RCT
  • showing supraglottic higher success at ventilation than ETT
  • similar rate neurological outcomes
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18
Q

what is the initial management and assessment of a new born?

A
  1. clamp umbilicus
  2. prevent heat loss - keep warm with towel
  3. gentle stimulation eg rubbing back
  4. APGAR
  5. open aiway

Check
* Tone
* HR
* Breating

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19
Q

what is the initial rate of face mask ventilations for newborn?

A

40-60 a minute

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20
Q

what are the two most important indications for starting CPR on newborn?

A
  • absent pulse
  • HR under 60 despite 30 seconds of assisted ventilation
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21
Q

what are the methods for determining HR of a newborn?

A
  1. listen to the heart
  2. feel for pulsations at base of umbilicus
22
Q

what is the ratio of chest compressions to ventilations in newborn?

A

3:1
90/30 per minute

23
Q

how do you differentiate umbilical vein from artery

A

vein is larger and thin walled

24
Q

newborn

A

BVM – if not breathing after stimulation
CPR – if HR less than 60 despite initial BVM
Intubation – prolonged CPR
Adrenaline 10-30mcg/kg – ongoing HR <60 despite BVM and initial CPR
IV fluid – 10mL/kg – ongoing HR <60 despite BVM and CPR
(accept some form of IV/IO access)

25
Q

neonate

A
26
Q

What are the TOR rules for caesing OOHCA

A
  1. No ROSC
  2. No Shock administered
  3. OHCA not witnesed by ambos
  4. OHCA not witnessed by bystanders
  5. no bystander CPR performed
27
Q

what are the pros and cons of mechanical CPR devices

A

Pros

  • Useful for prolonged CPR
  • minimeses interruptions
  • useful in difficult setting eg car

Cons
* no rosc benefit
* no mortality benefit
* no outcome on neurology
* blunt force trauma
* device malfunction
* training to attach

28
Q

what is the best ecmo for respiratory or cardiac failure

A

cardiac - VA
resp - VV

29
Q

what are the contraindications to ECMO

A
  • poor baseline
  • terminal illness
  • not enough resources
  • futile
30
Q

what features are predictive of survival in OOHCA

A
  1. VF/VT on ambo arrival
  2. bystander CPR
  3. ROSC in field
  4. mild therapeutic hypothermia
  5. PCI if stemi
31
Q
A
32
Q

what are the uses for waveform capnography in cardiac arrest

A
  1. identifies ROSC
  2. asseses qualityof chest compressions
  3. confirms rate of compressions
  4. adjunct for prognostication
  5. confirms tracheal position placement
33
Q

what groups would benefit from ECMO

A
  1. treatment resistant in respiratory arrest eg life threatening asthma
  2. treatment resistant cardiac failure eg severe myocarditis
  3. life threatenin poisoning eg calcium channel blockers
  4. environmental eg hypothermia
34
Q

inclusion critera for paeds ECMO

A
  1. failure of treatment methods for support or cardio or respiratory failure
  2. reversible condition
  3. temporising measure to facilitate definitive treatment eg surgery
35
Q

what are the prognosticating factors post hanging

A
  1. down time and time to first BLS/first aid
  2. cardiac arrest at scene
  3. co-morbidities
  4. other injuries
  5. estimated height of hanging
36
Q
A
  • Needs urgent intubation – anticipate difficult airway
  • Determine neuro status prior to RSI
  • Manual C spine immobilization to be considered
  • Neuroprotective measures
    o Head up 30deg
    o Collar off
    o Oxygenation, avoid hypercarbia
    o Sedation/par
37
Q
A
38
Q
A
39
Q

why is the chest compressions to ventilation ratio different across ages

A

younger people tend to have A/B issues over C

40
Q

what is a hypertensive emergency?

A

over 180/120 with signs of end organ damage

over 200

41
Q

abnormalities

A

splinter haemorrhages
cotton wool spots
papilloedema

42
Q
A
43
Q

abnormalities

A

second degree HB
LVH
Borderline wide QRS
LAD
Q waves inferiorly

44
Q

adaptations to ALS for hypothermia

A

● Change in the adrenaline interval, may withhold until temperature >30, double duration
between drug if temp is 30-35 degrees
● Intubate sooner, rather than later
● Chest may be stiff -makes compressions harder, consider using LUCAS
● Prolonged CPR is indicated
● Early call for ECMO CPR

45
Q
A
46
Q

What are the four stages of hypothermia

A
47
Q
A
48
Q

how do you estimate weight of child

A

Weight = (Age + 4) x2 (1-10yrs)

49
Q

What can cause an elevated CVP

A

fluid overload
pregnancy
PE
vasopressors
RVF
tampanade
PEEP

50
Q
A
51
Q

interpret and diagnosis

A

Emphysematous pyelonephritis
- Enlarged left kidney
- Air in kidney
- Surrounding fat stranding

1. Fellowship Written - SAQ (27 decks)

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