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BPs Decks > RESUS AND EMERGENCY PROTOCOLS (27) > Flashcards

RESUS AND EMERGENCY PROTOCOLS (27) Flashcards

This deck is a copy of a Quizlet deck

1
Q

ALL AGES BLS. (2016)

A

Upon finding a collapsed casualty, commence resuscitation via the DRSABCD protocol:

  • D : DANGER: check for
  • R : RESPONSE : check for
    • talk n touch
    • squeeze n shout, if none:
  • S : SEND for help
  • A : AIRWAY : check open
  • B : BREATHING : if not breathing normally, go to C and start compressions
  • C : CIRCULATION : give 30* compressions at 2/sec, then 2 breaths, then repeat
  • D : DEFIBRILLATION : attach SAED ASAP & follow prompts

* NOTE, BLS uses a 30:2 ratio for ALL ages, although ALS introduces the 15:2 ratio for infants and children (?? in recognition of the importance of hypoxia as an aetiology)

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2
Q

ALL AGES ALS (2016) (except newborns)

A

Commence BLS at 30:2 (kids 15:2) and determine rhythm ASAP

  1. if SHOCKABLE (VT/VF): Shock immediately at 200J (kids 4J/kg) & commence 2m CPR even if reverts
  2. if NON SHOCKABLE (PEA/ASYSTOLE) : - commence 2m CPR & give ADRENALINE 1mg IV/IO asap (kids 10mcg/kg*)

During CPR:

  • get O2 in and CO2 out
  • get IV or IO access
  • consider ETT/LMA
  • consider the 4Hs & 4Ts
  • Every 2m: do a “CHARGE AND CHECK” and decide:
    • another Shock, or
    • more CPR, or
    • post ROSC care
  • Every 4m: give ADREN 1mg IV/IO (10 mcg/kg)
  • After the 3rd shock: give AMIODARONE 300 mg (kids 5mg/kg)

* 1ml of 1:10,000 per 10kg

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3
Q

‘CHARGE AND CHECK’ PROCEDURE DURING RESUSCITATION

A

When first applying pads, and every 2m thereafter, conduct a ‘CHARGE AND CHECK’ procedure.

  1. State “Compressions continue, oxygen and others away**”then CHARGE the defib.
  2. When CHARGED, state ‘_Stand Clear_” and CHECK rhythm:
  • If SHOCKABLE, confirm all clear, deliver shock, restart 2m CPR
  • If NONSHOCKABLE: dump charge and either:
    • Restart 2m CPR (if Asystole)
    • Start post ROSC care
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4
Q

WHAT TO DO IF AN ICD FAILS TO TREAT VF

A
  • Defibrillate externally as normal, but keep >10cm from the device*

*same same for pacemakers

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5
Q

DEFIBRILLATOR PADS AND DRUG PATCHES

A
  • Pads should not be placed over drug patches, remove or avoid
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6
Q

PAD POSITION FOR EXTERNAL PACING & CARDIOVERSION

A
  • Place the pads AP over the Left central chest
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7
Q

DRUGS GIVEN PERIPHERALLY DURING ARRESTS NEED:

A

they need a ‘flush and a fly’, ie

  • a 20ml flush

and

  • a 20 second limb elevation
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8
Q

WHAT IS THE ROLE OF INTUBATION DURING CPR?

A
  • Intubation, per se, does not improve survival, but allows continuous compressions which does, so an advanced airway (ETT or LMA) should be considered early in ALS
  • Ventilate at 10 breaths per minute after securing the airway
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9
Q

OXYGEN THERAPY DURING DEFIBRILLATION?

A
  • If using an open circuit (eg facemask), you should remove the O2 immediately before defibrillation
  • If its a closed circuit (LMA/ETT), you can leave it on.
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10
Q

FiO2 USED DURING CPR?

A
  • commence with FiO2 of 1.0 until ROSC, then
  • titrate to
    • 94-98% if N lungs
    • 88-92% if COAD
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11
Q

Effective FiO2 during EAR?

A
  • 17%
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12
Q

8 REVERSIBLE CAUSES OF CARDIAC ARREST

A

= the 4H’s and 4T’s

  • Hypoxia
  • Hypovolaemia
  • Hypo/Hyper thermia
  • Hypo/Hyper Kalemia, Natremia, Calceamia etc
  • Tension
  • Toxins
  • Tamponade
  • Thrombus
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13
Q

IN HYPOKALEMIC ARRESTS, GIVE:

A
  • 5mls of KCL (= 5mmol)
  • 5mls of MgSO4 (= 10 mmol)
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14
Q

MINIMUM DELAY BEFORE ASSESSING OUTCOME POST ROSC

A
  • Generally at least 72h, and in a specialist unit
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15
Q

IMMEDIATE POST ROSC CARE

A

Following a successful resuscitation

  1. Optimise the ABCs
  2. Ascertain the cause (elecs, 12 Lead etc)
  3. Consider ‘Targetted Temperature Management’ (32-36C)
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16
Q

SA NEONATAL* RESUSCITATION PROTOCOL. (2011)

Should really be termed ‘newborn’, as neonates are defined as 2h-28d

A

If vigorous, give to mum, if flat, resuscitate using a modified DRABCD but mask ventilation alone suffices for most

  • D = DRY OFF (neonates lose heat easily) and R = RUB: (some apnoeic neonates will breathe if stimulated) : spend 30s doing this then R/V, if still flat go to
  • A = AIRWAY : check open, insert guedell
  • B = BREATHING : give 15 mask breaths over 30s: (hold button to start/35cm on Neopuff) then check HR and responsiveness : if still apnoiec or HR<60, go to
  • C = CIRCULATION : compress* over lower 1/2 of sternum to 1/3 depth, give 3 compressions then 1 breath every 2s, consider #1 LMA or ETT 3.0 at 10cm
  • D = DRUGS : use IO or the single umby vein for access then give
    • Adren 10mcg/kg (= 0.1ml of 1/10000 per kg, ie typically 0.3mls)
    • NS 10ml/kg (typically 30 mls)

* only use ‘2 handed encircle’ if 2 rescuers, or changeover to resp takes too long

17
Q

ATLS OVERVIEW

A
  • PRIMARY SURVEY
  • RESUS AND ADJUNCTS
  • SECONDARY SURVEY
  • DEFINITIVE CARE
18
Q

ATLS PRIMARY SURVEY

A

= C-ABCDE:

  • Control CATASTROPHIC HAEMORRHAGE
  • AIRWAY with CSpine control
    • whilst protecting the C spine, ensure open via manipulation, suction, OPA, NPA, LMA, ETT or crike as reqd
  • BREATHING
    • Oxygen on
    • assess Resp function via RR, WOB, skin colour & oximeter
    • quick chest palp for gross # or air
    • auscultate 2nd & 5th interspaces
  • CIRCULATION
    • control lesser bleeding, splint #, consider pelvic binder
    • perform FAST and roll to check the back if not already done* for penetrating trauma
    • assess Circulation via Consc state, HR, pulse volume & perfusion
  • DEFICIT
    • GCS & pupils
    • rapid limb assessment for gross sensory/motor loss
  • EXPOSURE
    • undress fully to examine but keep warm

* may be done at initial transfer onto resus bed

19
Q

ATLS PRIMARY SURVEY ADJUNCTS

A

By the end of the PRIMARY SURVEY, and the RESUS AND ADJUNCTS phase that follows it, you should complete:

  • IVT x 2 and full set of bloods
  • consider NGT and IDC
  • Imaging: neck, chest, abdomen (FAST) & pelvis
  • full monitoring including temperature
20
Q

ATLS SECONDARY SURVEY

A

= AMPLE Hx: Allergies/Meds/Past Hx/Last Meal/Events leading to the trauma and ‘Head to toe’ exam:

  • HEAD: scalp, ears, eye ROM & acuity, face, mouth, cranials
  • NECK: clear if able, ausc carotids/vertebrals
  • CHEST: inspect, palpate clavs/ribs/sternum, percuss, auscultate
  • ABDO : inspect, palpate, percuss, auscultate
  • PELVIS: pull in then out (unless # known)
  • BACK: 4 person roll if not already done check back, PR, consider PV if injury suspected
  • ARMS & LEGS : bones, joints, pulses, sensation, power, reflexes

* eg pelvic # or penetrating injury

21
Q

FMC MASSIVE TRANSFUSION PROTOCOL 2012

A

If massive transfusion anticipated: notify lab and commence MTP immediately:

  1. Control bleeding with direct pressure, permissive hypotension & DCS
  2. Start PACK ONE
    • RBC x 5U O Neg (O pos OK)
    • FFP x 4U AB Pos (A Pos or AB Neg OK)
    • Plates x 1 ‘Four pack’ (unmatched)
  3. Consider TRANEXAMIC ACID 1g IV over 10/60 then 8/24
  4. Use PACK 2,3 etc
  5. Aim for
    • Temp > 35C
    • Platelets > 50,000
    • INR < 1.5 and APTT< 60*, or give more FFP
    • Ca++ > 1.1
    • Fibrinogen > 1.0g/L**, or give 4U Cryo
    • pH > 7.2, Lactate < 4mmol/L and BE < -6)
  6. rF7a remains unproven, but may consider 90mcg/kg IV in consultation with Lab
  • * obviously TEG now*
  • ** N is >2g/L*
22
Q

CRISIS COVER

A
  • C: call for help, Colour, Carotids, Conscious state
  • O: Check Oximeter, O2 to 100%
  • V: Ventilator off, Vaporiser off
  • E: check ETT, Exterminate the machine
  • R: remember PT, remember Anaphylaxis
23
Q

ANAPHYLAXIS IMMEDIATE MANAGEMENT

A
  1. DIAGNOSE IT
    • likely: if rash + hypotension + bronchospasm, possible if any 1
  2. DECLARE IT
    • “this could be anaphylaxis”, get help, get box, read card…
  3. DISCONTINUE TRIGGERS
    • relaxants, antibiotics, colloids, chlorhex, latex
  4. START IMMEDIATE MANAGEMENT (ABCs & Adrenaline)
    • Airway: support as required
    • Breathing:- 100% O2, if IPPV: use SMALL, SLOW breaths
    • Circulation:
      • if absent give Adrenaline 1mg IV (kids 10mcg/kg), fluids 20ml/kg and commence ALS
      • otherwise give Adren 100 mcg* IV prn (severe) or 10 mcg (mild), consider infusion
      • if no IV/IO access, give neat ADREN IMI into lateral thigh, 500mcg Adults, 300mcg large children, 150 mcg small children

* kids = 5mcg/kg

24
Q

ANAPHYLAXIS, REFRACTORY MANAGEMENT

A

If poor response:

  1. CONFIRM TRIGGERS STOPPED
  2. QUESTION THE DX:
    • get more information: TOE, elecs, gas, ecg, CXR etc
    • Is this high airways resistance from asthma, aspiration, tube kinked or blocked
    • is this low CO2 from oesophageal intubn, gas embolus or cardiac arrest
    • is this hypotension from hypovolaemia, MI, high spinal
    • is this swelling from Angioedema
    • still dont know: 4H & 4T
  3. ESCALATE RX
    • For resistant Hypotension:
      • NORAD
      • VASOPRESSIN: 20u in 40mls, 1ml stat then 4-1 mls/h
      • GLUCAGON (reverses BBlockers) : 1-5 mg slow IV
    • For resistant Bronchospasm:
      • consider AutoPeep : test disconnect
      • SALBUTAMOL IV: 3mg in 50mls: LD 4mls slow IV (240mcg) then 1-20 mls/h
      • STEROIDS & ANTIHISTAMINES : have now been deleted from acute management algorithms as they have no proven benefit !!
25
Q

TREATMENT OF LA TOXICITY

A
  1. Recognise the signs and symptoms, which can be delayed 30m
    • agitation, tremors, seizures
    • circumoral numbness and metallic taste
    • Diplopia and tinnitus
    • tachy then bradyarrhythmias and asystole
  2. address the ABCs via ALS
  3. LIPID RESCUE with 100mls of 20% INTRALIPID IV, repeat x several (not Propofol : insufficient lipid)
26
Q

MALIGNANT HYPERTHERMIA MECHANISM & RX

A
  • MH is a syndrome characterised by runaway oxidative metabolism in skeletal muscle triggered by SCOLINE or VOLATILES, and producing muscle rigidity and breakdown, hyperthermia, hyperkalemia, hypercarbia and acidosis
  • it occurs in humans, pigs, dogs, and horses and the cause is a hereditary defect in the RYANODINE RECEPTOR (a protein controlling Ca metabolism in skeletal muscle)

MH TREATMENT

  • stop trigger: vapour off, hyperventilate pt with high flow O2 but dont bother removing circuit/vaporiser etc
  • address the ABCs
  • start TIVA
  • DANTROLENE 2.5 mg/kg IV stat, repeat x several
  • cool with 4C RINSE and surface ice
  • ICU Monitoring of elecs etc
27
Q

TURP SYNDROME MECHANISM & TREATMENT

A

Excessive absorption of the GLYCINE irrigant into the vascular space during TURP can cause HYPERVOLAEMIA & HYPONATREMIA (<120), producing

  • SOB
  • visual changes
  • agitation and confusion
  • seizures

Rx

  • stop surgery
  • address the ABCs
  • correct the hyponatremia slowly*
    • change IVT to NS
    • consider Hypertonic saline
    • consider diuretics

*don’t correct HYPONATREMIA too rapidly or CENTRAL PONTINE MYELINOSIS

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