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CCFP-EM > Resuscitation > Flashcards

Resuscitation Flashcards

1
Q

Define Shock

A

A state where oxygen demand is greater than supply

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2
Q

Types of Shock

A

Hypovolemic
Obstructive
Cardiogenic
Distributive

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3
Q

Causes of cardiogenic shock

A

Ischemia
Arrhythmia
Valvular dysfunction
B-Blocker / CCB overdose

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4
Q

Causes of obstructive shock

A

Tamponade
Tension pneumo
PE

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5
Q

Causes of distributive shock

A

Sepsis
Anaphylaxis
Pancreatitis
Neurogenic / spinal
Addison’s / Adrenal insufficiency
Toxins

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6
Q

Predictors of difficult to BVM

A

Beard
Obese
Older (neck mobility)
Teeth (edentulous)
Sounds (snoring / obstruction)
- STOPBANG > 3
- Snores
- Tired
- Observed Apnea
- Pressure (BP)
- BMI > 35
- Age > 50
- Neck > 17”
- Gender (M)

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7
Q

Predictors of difficult to Intubate / airway assessment

A

Look
Evaluate 3-3-2
Mallampatti
Obstruction / obesity
Neck Mobility

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8
Q

Predictors of difficult to Supraglottic device

A

Restricted mouth opening
Obese/obstruction
Distorted anatomy
Stiff neck or lungs

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9
Q

Etomidate Risk

A

Adrenal suppression
Myoclonus
Regional cerebral excitation

Dose 0.3 mg/kg (20 mg in average size)

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10
Q

Propofol Risk

A

Decreased cardiac output
Peripheral vasodilation

Dose 1.5-3 mg/kg (150 mg in average size - less if old or sick)

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11
Q

Ketamine Risks

A

Theoretical ICP increase (no evdience)
Bronchorrhea
Laryngospasm
Cardiac depression in patients with adrenal supression / catecholamine exhausted

Dose 1-2 mg/kg (1oo mg in average size)

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12
Q

Succinylcholine Contraindications

A

known hypersensitivity
family hx of malignant hyperthermia
recent burn. trauma, crush injury, neuromuscular disease, denervation (stroke, spinal cord)

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13
Q

Initial NPPV setting

A

iPAP = 10 cm
ePAP = 5 cm

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14
Q

Initial vent setting for ARDS

A

SIMV @ 6 cc/kg, RR 12, FiO2 = 1, PEEP = 10, I:E = 1:2

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15
Q

Vent setting in Asthma intubation

A

Volume - A/C or SIMV +PS
- 6-8 ml/kg
- RR 8-10 BPM
- I:E = 1:3-4
- FiO2 = 100%
- PEEP = 2-5 cmH2O

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16
Q

Vent Settings in Neuro ICH

A

Have to avoid hypotension, hypercarbia and hypoxemia
- Prevent sympathetic response with large dose fentanyl and topicalization or IV lidocaine
- Fentanyl 2-3 mg/kg
- Esmolol 1.5 - 2 mg/kg
- Ketamine or Etomidate for induction

Vent settings: Aim for PCO2 ~ 35
- Low PEEP 5-10 cm H2O

17
Q

Vent and airway management in Metabolic Acidosis

A

Avoid intubation if possible - Minute ventilation needs HIGH
Settings: Assist Control 8ml/kg IBW
RR: 30 / min
(Require 120 ml/kg/min of minute ventilation, if attempting to reduce PCO2 may need 240 ,l/kg/min)
at 8 ml/kg - 30 BPM)

18
Q

Normal Electrolyte Lab Values

A

Osm - 287
Na - 135-145
Cl - 98-106
K - 3.5-5.0
Lactate < 2
pH 7.35-7.45

19
Q

IVC Measurements

A

1.3 - 2.5 cm normal.

20
Q

1st and 2nd line vasopressors in septic shock

A

norepinephrine
2nd - vasopressin or epi

21
Q

1st line vasopressors in neurogenic shoclk

A

Norepinephrine

22
Q

1st line pressors in Cardiogenic shock

A

Norepinephrine as 1st line
- Low dose Epi (0-5 mcg) may act as pure inotrope without effects on vasodilation
- Vasopressin helpful in patients with pulmonary HTN or tachycardia
1st line inotrope - Dobutamine

23
Q

Management of extravasation of pressors into peripheral tissues

A

Phentolamine injected into the site

24
Q

SIRS Definition

A

2+ of
T < 36 or >38
RR > 22 or pCO2 < 32
HR > 90
WBC < 4 or > 10 or> 10% bands

25
Q

Surviving sepsis guidelines in 2021 - First 3 hours

A

Measure a lactate
Draw Blood Cx
Give broad spectrum Abx
Fluid bolus of 30 ml/kg of Ringers/Plasmalyte if lactate > 4 or hypotensive
Early vasopressors if hypotensive despite fluid resuscitation.
Redraw lactate if initially elevated

26
Q

ACLS Cardiac Arrest

A

Activate Emergency Response System
Pulse check - if absent, immediate HQ CPR
- 120 BPM
- At least 5 cm with complete recoil
If Shockable:
- Shock as soon as advised
- Continue CPR
- Shock Q2 mins if remains shockable
- Obtain airway and IV/IO Access
- Epinephrine Q4 mins
- Consider advanced capnography
- If after 2 shocks still in VF or pulseless VT then Amiodarone (300 mg IV)

If not shockable:
- CPR
- Epi Q4 mins
- Think of reversible causes: Hypoxia, hypovolemia, hypothermia, acidosis, hypo/hyper K. Thrombosis (pulm or cardiac), tamponade, tension pneumo, toxins

27
Q

ACLS Brady with a pulse algorithm

A

HR < 50
1) Treat underlying cause. Give oxygen, cardiac monitor for rhythm, BP, IV/IO access, 12 lead ECG
2) Unstable: altered LOC, ischemic chest pain, acute heart failure, shock?
- Yes: Atropine (0.5 mg bolus up to 3 mg). If ineffective - transcutaneous pacing or epi infusion (2-10 mcg/min)
- No: monitor and observe
3) Expert consultation

28
Q

ACLS Tachy with a pulse Narrow Algorithm

A

HR > 150
Unstable: Acute HF, ischemic CP, hypotension, altered LOC
Yes: Synchronized cardioversion
No: ECG, IV access, Vagal maneuvers, Adenosine (6 mg IV push), B-blocker or CCB.

29
Q

ACLS Tachy with a pulse wide algorithm

A

HR > 150
Unstable: Acute HF, ischemic CP, hypotension, altered LOC
Yes: Synchronized cardioversion
No: ECG, IV access, Consider antiarrhythmic infusion:
- Procainamide 20-50 mg/min to 15 mg/kg. Stop if hypotension or QT increases by 50%
- Amiodarone: 150 mg over 10 mins, repeat if recurs.

30
Q

Vent Modes

A

Assist / Support - Patient triggered
Control - Set times / RR

31
Q

Volume Control Variables and significance

A

Safest in ED Setting
- Tidal Volume
- Resp Rate
(TV x RR = min vent)
- FiO2
- PEEP
(FiO2 PEEP, Oxygenation)
- I:E ratio or flow rate
(for Obstructive issues)

32
Q

Peak Flow Rate Standard Settings

A

60-100 L/min (100 is high end)
(For RR 12 - I:E 1:4)
1 sec inspiration ~ 1 L

33
Q

Winter’s Formula

A

HCO3 x 1.5 +8 +/- 2
- Optimized minute vent for metabolic acidosis.

CCFP-EM (20 decks)

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