Resuscitation Flashcards
Initial fluid resuscitation in DKA
20ml/kg IV bolus over 20 mins if stable, over 5-10 mins if hypotensive
Ongoing IV fluids in DKA
5-9kg - 6.5ml/kg/hr
10-20kg - 6ml/kh/hr
20-40kg - 5ml/kg/hr
>40kg - 4ml/kg/hr (max 500ml/hr)
When is it ok to use NaHCO3 in DKA?
hyperkalemia with ECG changes
Risk factors for cerebral injury in DKA
lower pH
hypocapnia (pCO2 <18)
longer duration of symptoms
more severe dehydration (high HCT, BUN)
younger age (>5y)
new-onset diabetes
sick appearance
Frequency of initial bloodwork monitoring in DKA
glucose + fluid balance q1h
VBG, lytes, urea, creat q2h
How do you adjust fluid administration if evidence of cerebral edema in DKA?
lower to 75% of recommended rate
What are the 3 cardinal signs of neurogenic shock?
Hypotension
Bradycardia
Peripheral Vasodilation
*hypothermia
Above what level of injury is neurogenic shock most likely to happen
above T6
medications that can be given endotracheally
epinephrine
atropine
naloxone
lidocaine
diazepam
Steps in resuscitation of acute adrenal insufficiency
Hydrocortisone 50-100mg/m2 IV (or 1-2mg/kg)
Volume expansion 20-60ml/kg
Maintenance fluids with 10% dextrose and WITHOUT K+ until K+ in normal range
Consider therapy to decrease K+ IF ECG changes present
What is part of a critical sample?
glucose
insulin
ketones
free fatty acids
lactate
uric acid
ammonia
cortisol
growth hormone
TSH
IGF1
What should labs show in critical sample for hyperinsulinism?
hyperinsulinemia
hypofatty acidemia
hypoketonemia
inappropriate glycemic response to glucagon
Meds to treat Torsades de Pointe
sulfate de Mg 25-50mg/kg, max 2g IV
lidocaine 1mg/kg
Target temp after ROSC
normothermia (36° to 37.5°C) for 5 days
or hypothermia (32° to 34°C) for 2 days followed by 3 days of normothermia
Parkland Formula
4 mL/kg/% of BSA of crystalloid over the first 24 hours, half during the first 8 hours from the time of injury and half during the next 16 hours
What receptor(s) does epinephrine act on and what is its effect?
a1, b1, b2 stimulation
inotrope, chronotrope, vasoconstriction (higher dose)
What receptor(s) does norepinephrine act on and what is its effect?
a1, b1 stimulation
inotrope + vasopressor
What receptor(s) does dobutamine act on and what is its effect?
b1 stimulation, mixed alpha agonist/antagoist
inotrope + chronotrope
What receptor(s) does vasopressin act on and what is its effect?
vasoconstriction (independent of adrenergic receptors)
What receptor(s) does dopamine act on and what is its effect?
a1, b1, b2, D1 stimulation
inotrope, chronotrope, vasoconstrictor (higher doses)
Mechanism of epinephrine in treating anaphylaxis
α-adrenergic agonist - vasoconstriction, increased blood pressure, and decreased capillary leakage
β-adrenergic agonist - stimulates bronchial smooth muscle relaxation, increased cardiac output, and inhibits further mediator release
Dose of epi for cardiac arrest
0.01mg/kg (0.1ml/kg of the 0.1mg/ml concentration)
max dose 1mg
CPR ratio compression:breaths for 1 person rescue
30:2
CPR ratio compression:breaths for 2 person rescue
15:2
When to initiate CPR
no pulse
HR < 60 with poor perfusion
Up to what age do you use child AED pads?
8yrs
Endotracheal dose of epi for cardiac arrest
0.1mg/kg (0.1ml/kg of the 1mg/ml concentration)
Amiodarone dose for cardiac arrest
5mg/kg - repeat up to 3 total doses
Lidocaine dose for cardiac arrest
1mg/kg bolus loading dose
Defibrillation doses for cardiac arrest
- 2J/kg
- 4J/kg
max 10J/kg or adult dose
When is atropine used in resuscitation
bradycardia caused by increased vagal tone or primary AV block
Dose of atropine for bradycardia
0.02mg/kg
may repeat once
min dose 0.1mg - max dose 0.5mg
Adenosine dose for SVT
0.1mg/kg (max 6mg)
2nd dose 0.2mg/kg (max 12mg)
Synchronized cardioversion dose
0.5-1J/kg
increase to 2J/kg PRN
Rate of rescue breaths (with pulse or intubated patient)
1 breath q 2-3 seconds (20-30 breaths/min)
Pair the vasopressor with the type of shock:
epinephrine
norepinephrine
cold shock
warm shock
epinephrine - warm shock
norepinephrine - cold shock
Treatment of V Tach with pulse and good perfusion
Amiodarone 5mg/kg over 20-60 mins
or
Procainamide 15mg/kg over 30-60 mins
Dose of epinephrine for anaphylaxis
0.01mg/kg using 1mg/mL formulation
