Resus Flashcards
fever and lymphoma (could be any long term disease)
What factors influence abx choice
- allergies
- recent sensitivities
- likely source
- local guidenlines
- presence of indewelling lines
- ?neutropenia
Sepsis
Steps in management with end points
end points are hr under 100, BP over 100 systolic, MAP over 65, UO 0.5ml/kg/hr
- fluid bolus 500ml/1l normal saline
- insert central line if needing ionotropes and norad 5mcg/min
- broad spectruam abx eg taz 4.5g
Paeds life support algorithm
What do you do ‘during CPR’
What are the drugs?
During CPR:
Airway adjuncts/o2/waveform capnography
IO or IV access
Plan actions before interrupting CPR
Drugs
Shockable - adrenaline 10mcg/kg every second shock and amioderone 5mg/kg after third
Non shockable - adrenaline 10mcg/kg immediately then every second
With choking what are the features of an effective cough?
- crying/speech
- loudness of cough
- can take breathe before coughing
- child alert
choking child algorithm
NB - BLS is 15:2 with 2 rescue breaths
what are the featurs of chest compression in children that make it different to adult
(Four)
- 100 per minute
- 15:2 in BLS
- 1/3 chest diameter
- uninterrupted where possible in ALS
hyperkalaemia treatment
Protect heart
* IV Ca gluconate 10ml/10%/10 mins
Lower K
* IV HCO3 50-100mmol – K reduction
* IV insulin 10U / dextrose 50mL 50% - K reduction
– salbutamol
Increase excretion
diuretics
Anaphylaxis algorithm
What is the treatment for hyperkalaemia in arrest?
All quicker than normal hyperkalaemia:
- Protect the heart: give 10 mL calcium chloride 10% IV by rapid bolus injection or 30ml of calcium gluconate
- Shift potassium into cells: Give glucose/insulin: 10 units short-acting insulin and 25 g glucose IV by rapid injection. Monitor blood glucose.
- Give sodium bicarbonate: 50 mmol IV by rapid injection (if severe acidosis or renal
failure). - Consider dialysis
What are the specific modifications to ALS for the following?
- 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
what are the benefits of parental presence during resus?
Disadvantages?
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
what are the causes of post cardiac arrest hypotension?
- Cardiogenic
- Hypovolemic
- Obstructive - tampandae, pneumpthorax
- Maldistributive - SIRS
What are the priorities of post cardiac arrest care
ABCDE
normoglycaemia
normothermia
ECG
Treat cause
sats 94-98
main features and interpretation
Sinus rhythm, rate ~70,
left axis deviation, LBBB with positive modified sgarbossa criteria
* STEMI-equivalent and may benefit from PCI
What did the Airways-2 trial show
- RCT
- showing supraglottic higher success at ventilation than ETT
- similar rate neurological outcomes
what is the initial management and assessment of a new born?
- clamp umbilicus
- prevent heat loss - keep warm with towel
- gentle stimulation eg rubbing back
- APGAR
- open aiway
Check
* Tone
* HR
* Breating
what is the initial rate of face mask ventilations for newborn?
40-60 a minute
what are the two most important indications for starting CPR on newborn?
- absent pulse
- HR under 60 despite 30 seconds of assisted ventilation
what are the methods for determining HR of a newborn?
- listen to the heart
- feel for pulsations at base of umbilicus
what is the ratio of chest compressions to ventilations in newborn?
3:1
how do you differentiate umbilical vein from artery
vein is larger and thin walled
neonate
What are the Termination of resus rules for stopping OOHCA
- No ROSC
- No Shock administered
- OHCA not witnesed by ambos
- OHCA not witnessed by bystanders
- no bystander CPR performed
what are the pros and cons of mechanical CPR devices
Pros
- Useful for prolonged CPR
- minimises 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
what is the best ecmo for respiratory or cardiac failure
cardiac - VA
resp - VV
what are the contraindications to ECMO
- poor baseline
- terminal illness
- not enough resources
- futile
what features are predictive of survival in OOHCA
- VF/VT on ambo arrival
- bystander CPR
- ROSC in field
- mild therapeutic hypothermia
- PCI if stemi
what are the uses for waveform capnography in cardiac arrest
- identifies ROSC
- asseses qualityof chest compressions
- confirms rate of compressions
- adjunct for prognostication
- confirms tracheal position placement
what groups would benefit from ECMO
- treatment resistant in respiratory arrest eg life threatening asthma
- treatment resistant cardiac failure eg severe myocarditis
- life threatenin poisoning eg calcium channel blockers
- environmental eg hypothermia
inclusion critera for paeds ECMO
- failure of treatment methods for support or cardio or respiratory failure
- reversible condition
- temporising measure to facilitate definitive treatment eg surgery
what are the prognosticating factors post hanging
- down time and time to first BLS/first aid
- cardiac arrest at scene
- co-morbidities
- other injuries
- estimated height of hanging
- 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
why is the chest compressions to ventilation ratio different across ages
younger people tend to have A/B issues over C
what is a hypertensive emergency?
over 180/120 with signs of end organ damage or over 200
abnormalities
splinter haemorrhages
cotton wool spots
papilloedema
abnormalities
second degree HB
LVH - DEEP S WAVES
Borderline wide QRS
LAD
Q waves inferiorly
adaptations to ALS for hypothermia
● 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
What are the four stages of hypothermia
What can cause an elevated CVP
fluid overload
pregnancy
PE
vasopressors
RVF
tampanade
PEEP
interpret and diagnosis
Emphysematous pyelonephritis
- Enlarged left kidney
- Air in kidney
- Surrounding fat stranding
What are the Infusion rates for
Adrenaline
NORAD
Adrenaline 1-20mcg/min
NORAD 2-30mcg/min (2-30ml/hr)
paeds bradycardia algorithm
status algorithm
Paeds SVT algorithm
Paeds VT algorithm
newborn life support
adult ALS guideline
What do you do during cpr and what are the e drugs
During CPR:
Airway adjuncts/o2/waveform capnography
IO or IV access
Plan actions before interrupting CPR
Drugs
Shockable - adrenaline 1mg every second shock and amioderone 300mg after third shock
adult bradycardia algorithm
adult tachyarrthymia algorithm
what are the end points for sepsis treatment?
- hr under 100
- BP over 100 systolic
- MAP over 65
- UO 0.5ml/kg/hr
equation for baby weight
over 1 year = age + 4 X 2
under 1 year = age in months x0.5 + 4
How can you rapidly raise sodium
100ml 3 % raised by 2-3 mmol/l
Eg if seizing
