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
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 /2 + 4
How can you rapidly raise sodium
100ml 3 % raised by 2-3 mmol/l
Eg if seizing
