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FACEM-Resus > Resus > Flashcards

Resus Flashcards

1
Q

What is CVP waveform

A

CVP is the measured pressure in Right Atrium- represent right sided filling.
a=atrial contraction
c=closure tricuspid valve
X=atrial relaxation
V=passive filling atrium
y= open tricuspid valve
Normal =5-12cm <5 hypovol >12 RVF
Analysis
Dominant a wave- TS/PS or pulm HTN
Dominant V wave- TR
Absent x descent- cardiac tamponade
Increased CVP- RvF - PE/ tamponade/ TV incompetence.

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2
Q

What is atrial waveform

A

1- systolic upstroke ventricular ejection - increased slope =increased contractility
2- systolic decline - rapid decline atrial pressure when ventricle stop contracting
3- diacritic notch- closure aortic valve pressure- measured at aorta
4- diastolic delay- pressure decrease as ventricle stops contracting

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3
Q

What is targeted temp management

A

Target <37.5
Principle- thought to improve outcomes AlS to protect against cerebral oedema
Avoid hypothermia
Duration 24 hrs
Prevent fever
No good evidence to actively cool
Not pre hospital

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4
Q

Causes PEA arrest

A

B-road complex QRS- us- LV hypokinesis- if hyper K- ca gluconate 10%60ml cacl-10%30ml
Na channel blocker- sodibic 100ml 8.4%
Or
Narrow complex QRS- RV collapse or tampon are or PTx pneumothorax
RV full- PE

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5
Q

Indications stopping CPR

A

Injuries not compatible with life-100% TBSA burn
NFR order
k>12 ph <6.5
No sign life Temp >32 degrees or 2hrs CPR <15 degrees
20-30 mins CPR- no ROSC (if rosc restart timer)
Underlying Rhythm- PEA or Asystole
Traumatic arrest- give blood
Or newborn- no HR after 10min CPR

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6
Q

HYPOTHERMIA - CPR

A

Reward pt- passive- remove wet clothes/dry/blanket
Active-external 28-32 degrees bair hugger
-internal- severe + CPR- thoracic/abdo lavage. Haemofiltratiin
<20 deg- intermittent CPR 5 min on 10 min off
<28 deg intermittent CPR 5 min on 5 min off
<30 no drugs trial 3 stacked shocks (defib not good till > 30 deg)
30-34 deg- double normal AlS drug intervals
Prolonged CPR till at least 30 degrees
Greater survival if rapid onset hypothermia
Child accidental etoh or drugs

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7
Q

CPR with toxins

A

CO- supplemental O2
Lignocaine Tox- intralipid- 20% 1-5mg/kg bolus
Cyanide- hydroxycobalamin 5mg IV
Digoxin- digibind in CPR 20 amps
TCA- sodibic 2mmol/kg 2-3 min post rosc
Opioids- Bali one 100mcg pre arrest IV 30-60 sec

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8
Q

CPR in pregnancy

A

Get help- OBGYN peads
L- lateral position
IV mgSO4- 4g Eclampsia
Causes- Cardiac/ PE/ haemorrhage-txt MTP
Sepsis/ ivabx/ IVF/ inotropes
HTN- eclampsia HELLP
Toxins
Amniotic fluid embolism
Prepare perimortem ceaser

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9
Q

CPR- in Trauma

A

Compression not routine
1-stop bleed
2-airway ETT
3- decompress chest- 2 finger thoracotomy
4- open chest decompresspercarditis
5- plug ventricular lacs
6- compress aorta
7- twist hi Lyn
8- MTP
9- crush injury manage hyper K

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10
Q

CPR and pulmonary Embolism

A

If lysis- ateplase <60kh 10mg bolus and 1.5mg/kg 2-4 hrs
Ateplase- >60mg 10mg IV bolus 90mg 2 hours
Heparin infusion
Prolonged CPR- 2 hrs post thrombopysis

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11
Q

CPR and asthma

A

Disconnect - BVM cpr forced exp
Seek and treat PTX
Prolong CPR and IVF
Severe bronchospasm/ mucus plug- CPR can dislodge and early tube suction and take over ventilation
Bronchodilators if ROSC

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12
Q

Anaphylaxis - CPR

A

Adrenaline- IM 500mcg IV- push 1mg +++
Prolonged CPR
Urgent intubation - vent
Fluid 20ml/kg
Adrenaline adrenaline Aim Map>65

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13
Q

ALS drugs dose and indication

A

Sodibic- 1mmol/kg 2-3 mins indicated hyper K TCA OD or metabolic acidosis
Calcium- cacl- 10% 5-10ml 3x more Ca or ca gluconate- 15-30ml 10%- indicated ca channel OD/ high K and low Ca
Mag- 5-10months bolus 20ml 4 hr infusion or mg torsades- hypo K low mg and dig toxicity
Potassium- 10-40 mail k<2.5

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14
Q

ALS drug- lignocaine dose/ indication

A

Anti arrhythmic- class 1b
Dose- 1-1.5 mg/kg after 10 mins 0.5 mg/kg
Indicated- refractory VF or pulseless VT or VT storm
Adverse effect- hypotension/ bradycardia and heart block/ asystole or CNS toxicity

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15
Q

Resus drugs- ALS - Amiodarone dose/MOA or induction

A

Dose- arrest 300mg bolus with further 150mg IV if req
Indication- refactory or pulseless VF/VT - 3rd loop/ shock
Class 3 anti arrhythmic
Adverse effects- hypotension/ bradycardia/ heart block/ prolonged QT

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16
Q

ALS drugs- Adrenaline- dose/routes/ MOA

A

ALS- 1mg every 2nd Loop -VT/VF 2nd shock
- PEA/asystole- after 1st rhythm check
Stridor- nebulised 1mg in 10ml
IV/IO- cpr 10mcg/kg or pressor 10mcg
ACEM- 5mcg/min titrate up or down
Adverse effect- tachycardia/ severe HTN with ROSC
Tissue necrosis if extravate
MOA- alpha/ beta receptors - inotrope/ chronotrope raised SVR. Increased cerebral and coronary blood flow
Decreased splanchnic and peripheral
Tachycardia

17
Q

What are the steps post ROCS

A

A- ETT/ LMA secure airway- NGT/ CXr
B- aim SaO2 >94% max rib # or PTx and lung protective vent
C- target- SBO>100 MAp>80 12 lead ECG - cath lab if ischarmia
Inotrop- adrenaline 6mg in 100ml5-20 ml/hr amiodarone 0.6mg/kg/ hr
D- cerebral protection- head 30 degrees map>80 normo- glycaemia/ thermia/ normal Na. My seizure
Sedate P and F or M and M
Update Fsmily
ICU- organ donation?
Document and debrief

18
Q

4Hs and 4Ts management

A

Hypoxia- Fio2-100%
Hypovolemia- ivf 20ml\kg blood TEG
Hypo K- kcl 20min l peripheral 40 mmol CVC
Hyper K- cagluconate 10% 30ml. Insulin/ dextrose 10 units 50ml 50% dextrose and sodibic- 100ml 8.4%
Hypo/ hyperthermia- <35 >40 rewarm or cool.
Tension PTx- finger thoractomy ICC mid axillary line 4 ICS
Toxins- antidote/ charcoal/ dialysis
Tamponade- percardiocentesis/clam shell
Thrombosis/ thrombus- cardiac PCI or PE- thrombolysis

19
Q

What are causes of polymorphic VT

A

Torsades long QT
AMI
Short QT syndrome
Bi directional VT- dig toxcicity
Catecholamnergic polymorphic VT

20
Q

Cardiac arrest- when can you use 3 stacked shocks

A

In witnessed monitored arrest where defib attached

21
Q

What is coached algorithm

A

C- compression continued
O- oxygen away if BVM
All others clear
Charging
Hands off
Evaluate rhythm
Defib or disarm

22
Q

Cardiac arrest - when can u use precordial thump

A

Witnessed VT-VF arrest with no pulse and no defibrillator on sight

23
Q

Cardiac arrest- what is the chain of survival

A

Early recognition of CA
Early continuous CPR
Early defib
Minimise interruptions to cx compressiins
Aim nor other is
Avoid hyper or hypo O2

24
Q

Peadiatric intubation differences

A

Straight blade- anatomy large tongue/ loose teeth short upper airway/ floppy glottis/ soft collapsible and big head
ETT= age/4 + 4 depth ETTx3
Pre oxygenate rapid desat has low FRC
ROC/ fent and Midas
Ketamine 2-4mg/kg
Roc 1.2mg/kg
Ensure IV access or IO
Adrenaline 10mcg/ kg
Famil- consideration and communication

25
Q

Airway- what changes need to be thought about for intubation obese pt

A

Buy time- NIV/ delayed SI
Indications- do in DEM or OT
Get help- ent/ anos
Ramp- tragus to eternal notch
Aponeic O2- 15L/Min
Minimal drugs- ketamine or ROC
Pre O2- PEEP/ BVM/ NIV
Plan for difficulty
Post- intubated care

26
Q

What changes need to be thought about in septic pt intubation

A

Optimise the pt- pressors or IVF
Drug choice- ketamine 0.5mg/kg
ROC 1.6mg/kg
Reduce induction drug dose
Increased muscle relaxant dose
Maintain resp comp increased RR

27
Q

Complications when intubating asthmatic patient

A

Pneumothorax
Dynamic hyperinflation
Hypotension- decreased venous return and increased auto prep
Think-
D- dislodged tube
O- obstructed tube
P- pneumothorax
E- quipment failure
S- stacking

28
Q

What considerations need to be made in intubating asthmatic

A

Become hypotensive- give IVF prior
DelayedSI- NIV/ BVM/ PEEP
Drugs- ketamine 1-2 mg/kg - b agonist and bronchodilator
ROC- 1.2 mg/kg IV
Larger ETT size to reduce breath stacking
++ bronchodilators prior or post- IV salbutamol or IV adrenaline

29
Q

What are ideal ventilator settings in asthma

A

Vent- VC and SIMV
TV 6ml/kg
RR 6-8
Prolonged I:E ratio 1:4 reduce breath stacking

30
Q

What is different when intubate pregnant person

A

Similar concept difficulties for obese pt
Similar size ETT size
Intubate- in L lateral posturing wedge right hip
Laringoscope short handle Kessel blade

31
Q

Muscle relaxant reversal agents- non depolarising

A

Neostigmine adult 2.5mg + atropine 1.2mg
Child 0.08mg/kg
Suggamedex- normal 16mg/kg

32
Q

Muscle relaxants vecuronium dose and duration

A

Vec- non depolarising
10mg powder dilute 10mg in 10ml saline-1mg/ml
Dose 0.1mg/kg adult 10mg
Induction- 0.3mg/kg RSI
Duration 30 mins

33
Q

Muscle relaxant- Rocuronium dose/ onset/ metabolised/ adverse event

A

Non depolarising
ROC- 50mg in 5ml dilute 10mg/ml
Induction 1-1.2 mg/kg adult 100mg
Maintence 0.6mg/kg
Onset duration 45-60 secs
Duration 20-35 mins
Metabolised liver
Adverse effects- hypersensitivity/ tachycardia/ pain on injection/ if anticonvulsant- increased dose ROSC

34
Q

Suxamethonium- cI and side effects

A

Depolarising
CI- congenital myopathy
Neurology condition in last 6 months
Burns to 20% TBSA
Infection
Hyper K and Hypo k
Adverse K- hyper K in burn pt
Muscle fasiculations
Bradycardia esp in child
Decreased LOS tone- GORD/asp
Malignant hypothermia
Aponea
Increased intraoccular pressure

35
Q

Suxamethonium- dose/ phases/ duration/ onset

A

Presentation 100mg in 2ml as 50mg/ml
Dose- 1.5mg-2mg/kg adult 1-2.5 ml adult 100-150mg
Duration- 10mins
Rapid onset- fasicukations 30secs relax 45-60sec
2 phases
1- depolarising fasiculations flaccid paralysis
2- de- sensitising membrane desensitised early depolarised again

36
Q

Head injury- what do need to consider intubating pt

A

Minimise changed in BP- reduced induction dose- ketamine 1mgkg fentanyl 2-3mcg/kg
ROC 1.2mg/kg
Anticipate difficult if collar- inline stabilisation or BURP
Neuroprotective- head 30 degrees/ neck clear/ saO2 >90 PCO2 35-45
MAP>80 normothermia/ normoglycaemia Na 135-145

37
Q

Suxamethonium order of sensitivity of neuromuscular blockade

A

Large limbs—> diaphragm —> small trunk —> Larangeal—> eye muscles

38
Q

Surgical airway approach

A

Steps
1- stabilise thyroid cartridge
2- palpate cricoid membrane
3- 4cm vertical incision into CTM
4- wide horizontal incision CTM
5- dilate finger- confirm location
6- bougie—> size 6 ETT
7- connect and confirm

FACEM-Resus (3 decks)

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