Resus Flashcards
Factors to consider in termination of paediatric resuscitation
Total arrest time Response to therapy Premorbid state Potential reversible factors Parents wishes
30 min of ACLS including 2 doses of adrenaline without response
Factors associated with prolonged resuscitation
- recurring or refractory VT or VF
- toxic exposure
- Significant hypothermia with ice immersion
Dose of adenosine for paediatric SVT
0.1 mg/kg then 0.2mg/kg (6/12/12)
Dose of amiodarone in cardiac arrest
5mg/kg to 300 mg
Paediatric differences in airway management
Airway - large tongue - wide floppy epiglottis - anterior and cephalad vocal cords (C2/3) - narrowest at cricoid < 8 yrs Breathing - low FRC, high compliance - rapid hypoxia - rapid O2 metabolism Cardiovascular - bradycardia from Vagal stimulation
Dose of adrenaline in anaphylaxis
10 mcg / kg - to 500 mcg
0.01 mls/kg of 1:1000 - max 0.5 mls
Dose of lipid emulsion in local anaesthetic toxicity
1.5 mls/kg IV bolus then infusion of 0.25 mls/kg/min for 30-60 min.
What is the chain of survival
Recognition of emergency and activation of EMS Early CPR Earliest use of Defib Effective ALS Integrated post-resuscitation care
Outline post-resuscitation care
Target temperature management (32-36 deg)
Optimise airway
Maintain normal CO2 and sat 94-98
Circulatory support, maintain tissue perfusion
Control seizures
Control BSL, avoid hypoglycaemia
Treat underlying cause
Outline reasons to cease resuscitation in an adult
Resuscitation > 30 min without ROSC at any stage
- unless hypothermia, some drugs, PE suspected and given thrombolysis
Advanced care directive
Family indicates patient would not want invasive therapy
Describe airway assessment
Look externally - trauma, large tongue, large incisors Evaluate 3:3:2 Modified mallampati score Obstruction Neck mobility
Describe assessment of post-intubation hypoxia
DOPES
- Displacement of ETT
- Obstruction of ETT
- Patient —> pneumothorax, PE, pulmonary oedema, CVS collapse
- Equipment: ventilator
- Stacked breaths
Expected A-a gradient
Age / 4 + 4
Oxygen flux equation
= 1.39 x Hb x o2 sat / 100 + 0.03 x PaO2 x CO
Describe the RUSH ultrasound protocol for haemodynamic assessment
Pump, tank and pipes - HIMAPS Heart: PLAX and Apical (effusion, LV size & function, RV function & size) IVC: volume, PE Morrisons pouch (RUQ): Free fluid Aorta & deep veins (AAA, DVT) Pneumothorax - Lung
Causes of hypoxia on ABG
Diffusion defect VQ mismatch (PE) Hypoventilation Shunt (fails to improve with 100% O2) - intra or extrapulmonary) Or low FiO2
Components of Alvarado score
Migration to RLQ Anorexia Nausea Tender RLQ Rebound pain Elevated temp Leucocytosis Shift left 1 point each, except RLQ tenderness & leucocytosis (2) 4-6 imaging + surg consult
Viral causes of gastroenteritis
Rotavirus CMV Enteric adenovirus Coronavirus Norovirus
Bacterial causes of gastroenteritis
Campylobacter jejunum Salmonella enteriditis E. Coli spp Bacillus ceres Shigella Clostridium difficile
Drug therapy management of oesophageal varicella bleeding
Octreotide or somatostatin
Terlipressin
Describe risk quantification for stroke in AF
CHADS 2 VASC
CHF, HTN, Age > 75, Diabetes, Stroke (2), vascular disease, age 65-74, Sex (F)
Anticoagulate if > 1 other than sex (NICE)
Risk of stroke with 2 RF = 3% per year.
DDx stroke
Intracranial SOL, subdural, brain tumour, abscess Post-ictal (Todd’s paresis) Head injury Encephalitis Encephalopathy (metabolic, drug induced) Electrolyte (hyponatraemia) Metabolic (hypoglycaemia) Migraine Functional Toxic / acute drug effect
Summary of ACEM position statement on thrombolysis
IV TPA, particularly within 3 hrs, increases the odds of better functional outcome (“good”) (NNB 7 @ 3 hrs to 4.5 hrs 18).
Increases the risk of ICH (NNH 42) and death (NNH 120)
Most important: stroke severity, comorbidities: HTN, DM, AF.
Poorer outcome with thrombolysis most clearly associated with greater stroke severity.
Describe investigation for SAH
CT, with angiogram if SAH identified, on presentation
If CT negative, reported by neuroradiologist, and within 6 hrs, then < 1% risk of SAH
If CT > 6 hrs is negative, then LP
If CTA no aneurysm, then if aneurysmal pattern, CT is repeated later.
High risk criteria in syncope
Chest pain History of CCF, ventricular arrhythmia or PPM Abnormal ECG Exertional symptoms Age > 60
