Resus Prox Pearls, part 1

Question 1

Universal sign for an airway obstruction

Answer 1

the individual grab his or her neck with both hands

Question 2

most effective modality for return of spontaneous criculation

Answer 2

Early defibrillation

Question 3

In cardiac resuscitation, magnesium is initial treatment for

Answer 3

Torsades de pointes and dysrhythmias secondary to hypomagnesemia, cardiac arrest from QT prolongation, or cardiac glycoside toxicity.

Question 4

A single-center case series of patients with diagnosed pulmonary embolism suffering PEA arrest found that rapid administration of ________ to be safe and effective.

Answer 4

Alteplase 50 mg IV

With 20 out of 23 patients demonstrating ROSC.

Question 5

Fluid resuscitation in pregnant women

Answer 5

To accommodate the increase in blood and plasma volume that develops during pregnancy, make sure that the volume of resuscitative fluids increases by 50% above that required by the nonpregnant patient.

Question 6

Remarks on decisions for continued care following successful resuscitation of a cardiac arrest patient

Answer 6

Clinical neurologic reflexes are NOT predictive of cardiac arrest outcomes.
Bedside neurologic examination should NOT influence decisions for continued care in the first 72 hours following successful resuscitation.

Question 7

Imaging after ROSC

Answer 7

1. In the ED, perform head CT in survivors as soon as feasible.
2. Head CT can identify SAH or epidural and subdural hematomas.
3. The degree of cerebral edema can also be assessed by head CT*
4. Brain MRI is generally neither practical nor useful during initial ED management

• Because cerebral edema often peaks severeal days after resuscitation , swelling that’s radiographically apparent on initial CT is worrisome sign

Question 8

the most common use of NIPPV is for ______

Answer 8

cardiogenic pulmonary edema

Question 9

In patients with COPD, NIPPV is helpful in those with

Answer 9

respiratory acidosis

Question 10

Remarks in confirming endotracheal tube location

Answer 10

1. Directly visualizing the tube between the vocal cords is the best method for confirming successful placement.
2. Confirm ET tube positioning with multiple methods (capnometry, auscultations, xray, ultrasound)

Question 11

Remarks on CXR in confirming ET tube placement

Answer 11

1. CXR is customarily obtained after intubaiton to verify correct vertical positioning of the ETT.
2. However, a CXR does NOT reliably distinguish ETT placement in the trachea from the esophagus

Question 12

Remarks on ketamine

Answer 12

Ketamine preserves the respiratory drive, an ideal feature for sedation during awake intubation.

Question 13

Do not use succinylcholine in patients with

Answer 13

suspected preexisting significant hyperkalemia (especially renal failure), myopathies, or myasthenia gravis 📌

Question 14

Treat malignant hyperthermia with

Answer 14

Dantrolene 2.5 mg/kg IV
Temperature control

Question 15

Suggamadex

Answer 15

Reversal agent that reverses blockade from rocuronium or vecuronium by encapsulating the molecules of the nondepolarizing agents circulating in plasma.
The dose is 2 to 4 mg/kg, depending on the intensity of neuromuscular paralysis.

Question 16

The mainstays of treatment of suspected acute respiratory distress syndrome (ARDS) are _________

Answer 16

Low tidal volume ventilation,
Adequate PEEP, and
Treatment of the underlying condition

Question 17

Tracheostomy is preferred in what age group

Answer 17

children under 12 y/o, particularly those under 8 y/o

Question 18

Tube size used for cricothyrotomy

Answer 18

Adult:
6-mm tracheosotmy tube, or
5- to 6-mm endotracheal tube
Do NOT use a largery (≥7 mm) tube or one smaller than 4 mm, the latter excepted in pediatric patients

Question 19

Remarks on cricothyroid membrane incision

Answer 19

1. The horizontal orientation is in anatomic alignment with the membranes to avoid vascular injury.
2. Once the membrane is perforated, do not leave it empty; slide foreps, dilator, or tracheal hook around the blade or place a bougie before removing the scalpel

Question 20

Remarks on needle cricothyrotomy

Answer 20

1. 12- to 16-gauge needle catheter inserted into the trachea
2. The catheter must be attached to a higher-pressure oxygen source (≥35 psi); it cannot simply be attached to a standard wall oxygen outlet and be turned up or to wide open
3. With proper jet ventilation, adequate oxygenation and ventilation occur

Question 21

In needle cricothyrotomy, once the catheter is fully inserted, _____

Answer 21

a stabilizing hand must always be present; do not ever let the proximal end be unsecured