resuscitation Flashcards
Q: What is the initial dose of adrenaline in adult cardiac arrest?
A: 1 mg IV/IO every 3-5 minutes.
Q: Name the 5 H’s in reversible causes of cardiac arrest.
Hypovolemia
Hypoxia
Hydrogen ion (acidosis), Hyper-/hypokalemia
Hypothermia.
Q: Name the 5 T’s in reversible causes of cardiac arrest.
Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)
Q: What is the target temperature for post-arrest targeted temperature management?
32-36°C for at least 24 hours.
Q: When should you consider terminating resuscitation efforts in asystole?
After 20-30 minutes of ACLS with no reversible cause identified and no ROSC.
Q: What rhythm requires immediate defibrillation?
A: Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)
Q: What is the initial biphasic defibrillation energy for VF?
A: 200 J (or manufacturer’s recommendation).
Q: What drug is used for torsades de pointes in cardiac arrest?
Magnesium sulfate 1-2 g IV.
Q: What is the compression rate in adult CPR?
A: 100-120 per minute.
Q: What is the compression depth in adult CPR?
A: 5-6 cm (about 2 inches).
Q: What is the role of capnography in cardiac arrest?
A: Confirms ETT placement and monitors CPR quality (target ETCO2 >10 mmHg).
Q: What is the recommended ventilation rate during CPR with an advanced airway?
A: 10 breaths per minute (1 every 6 seconds).
Q: What is a common cause of PEA in trauma?
A: Hypovolemia from hemorrhage.
Q: What is the post-ROSC blood pressure target?
A: MAP ≥65 mmHg.
Q: When is amiodarone indicated in cardiac arrest?
A: For refractory VF/pulseless VT after 3 shocks (300 mg IV bolus).
Q: What is the role of sodium bicarbonate in cardiac arrest?
A: Reserved for hyperkalemia or TCA overdose 1 mEq/kg IV.
Q: What ECG finding suggests hyperkalemia as a cause of arrest?
A: Peaked T waves or sine wave pattern.
Q: What is the compression-to-ventilation ratio in 2-rescuer infant CPR?
A: 15:2.
Q: What is the priority after ROSC?
optimise oxygenation and ventilation
Q: What are the 4 types of shock?
hypovolemic, cardiogenic, distributive, obstructive
Q: What is the hallmark of distributive shock?
low systemic vascular resistence (SVR)
Q: What is a common cause of obstructive shock?
pulmonary emoblism or tension pneumothorax
Q: What is the initial fluid bolus for hypovolemic shock?
20ml/kg crystalloid (normal saline)
Q: What vasopressor is first-line for septic shock?
noradrenaline (norepinephrine)
Q: What is the target MAP in septic shock?
≥65 mmHg
Q: What bedside test differentiates cardiogenic from distributive shock?
Echocardiography (poor LV function in cardiogenic).
Q: What is the treatment for anaphylactic shock?
IM adrenaline 0.3-0.5mg 1:1000
Q: What is a sign of inadequate perfusion in shock?
Prolonged capillary refill (>2 seconds).
Q: What is the role of lactate in shock?
Marker of tissue hypoperfusion; >2 mmol/L suggests severity.
Q: What fluid is preferred in hemorrhagic shock?
blood, packed red cells, plasma, platelets
Q: What is the dose of adrenaline in anaphylaxis?
0.01mg/kg IM (max 0.5mg) of 1:1000 solution
Q: What ECG finding suggests cardiogenic shock?
ST elevation: acute MI
Q: What is the treatment for tension pneumothorax causing shock?
urgent needle decompression (2nd ICS, midclavicular line)
Q: What inotrope is used in cardiogenic shock?
dobutamine or milrinone
Q: What is the formula for MAP?
MAP = DBP + 1/3 (SBP-DBP)
Q: What is a sign of neurogenic shock?
bradycardia with hypotension (spinal cord injury)
Q: What is the initial management of hemorrhagic shock?
control bleeding, transfuse blood products
Q: What is the role of vasopressin in shock?
A: Adjunct in refractory septic shock (0.03 units/min).
Q: What is the mortality risk of untreated septic shock?
Increases by 7-10% per hour without antibiotics.
What are the steps of rapid sequence intubation (RSI)?
Preparation, Preoxygenation, Pretreatment, Paralysis, Positioning, Placement, Post-intubation care
What is the dose of suxamethonium for RSI?
1-2 mg/kg IV
What is the dose of rocuronium for RSI?
1-1.2 mg/kg IV
What is the LEMON mnemonic for difficult airway?
Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility
What is the rescue airway device in a failed intubation?
Laryngeal mask airway (LMA)
What is the indication for a surgical airway?
Can’t intubate, can’t ventilate (CICV) scenario
Where is a cricothyroidotomy performed?
Cricothyroid membrane (below thyroid cartilage, above cricoid)
What is the preoxygenation goal in RSI?
SpO2 ≥95% for 3-5 minutes
What induction agent is used in hypotensive patients?
Ketamine (1-2 mg/kg IV)
What is the reversal agent for rocuronium?
Sugammadex (2-16 mg/kg IV)
What is the BURP maneuver?
Backward, Upward, Rightward Pressure on the larynx to aid visualization
What is the maximum attempts at intubation before switching to a rescue device?
3 attempts
What is the dose of propofol for RSI?
1-2 mg/kg IV
What is a sign of successful ETT placement?
Bilateral chest rise and ETCO2 waveform
What is the pediatric ETT size formula?
(Age/4) + 4 (uncuffed)
What is the complication of prolonged suxamethonium use?
Hyperkalemia
What is the first-line sedative for post-intubation care?
Propofol or midazolam
What is the role of apneic oxygenation?
Maintains oxygenation during intubation (nasal cannula at 15 L/min)
What is the treatment for laryngospasm?
Positive pressure ventilation, deepen sedation
What is the depth of ETT insertion at the teeth in adults?
21-23 cm (women), 23-25 cm (men)
What is the qSOFA score?
RR ≥22, SBP ≤100 mmHg, altered mental status (2+ suggests sepsis)
What is the initial fluid bolus in septic shock?
30 mL/kg crystalloid within 3 hours
What is the first-line antibiotic for suspected sepsis?
Broad-spectrum (e.g., piperacillin-tazobactam)
What is the time goal for antibiotic administration in sepsis?
Within 1 hour of recognition
What is the lactate clearance goal in sepsis?
≥10% reduction in 2-4 hours
What is the vasopressor of choice if fluids fail in septic shock?
Noradrenaline
What is the definition of septic shock?
Sepsis + hypotension requiring vasopressors + lactate >2 mmol/L
What is the role of corticosteroids in septic shock?
Hydrocortisone (200 mg/day) if refractory to vasopressors
What is a common source of sepsis in the elderly?
Urinary tract infection
What is the target ScvO2 in sepsis?
≥70% (central venous oxygen saturation)
What is the SIRS criteria?
2+ of: Temp >38°C or <36°C, HR >90, RR >20 or PaCO2 <32, WBC >12 or <4
What is the treatment for neutropenic sepsis?
Broad-spectrum antibiotics (e.g., meropenem) within 1 hour
What is the complication of delayed sepsis treatment?
Multi-organ dysfunction syndrome (MODS)
What is the role of source control in sepsis management?
Identify and eliminate the source of infection
What is the role of source control in sepsis?
Drain abscesses, remove infected devices ASAP
What is the pediatric fluid bolus in sepsis?
20 mL/kg crystalloid
What is the sign of end-organ dysfunction in sepsis?
Oliguria, elevated creatinine, or confusion
What is the dose of noradrenaline in septic shock?
0.01-3 mcg/kg/min IV
What is the role of albumin in sepsis?
Considered in severe hypoalbuminemia (<20 g/L)
What is the mortality rate of septic shock?
20-40% with optimal care
What is the diagnostic test for sepsis source?
Blood cultures (2 sets) before antibiotics
What are the components of the ATLS primary survey?
Airway, Breathing, Circulation, Disability, Exposure
What is the massive transfusion protocol ratio?
1:1:1 (PRBC:FFP:platelets)
What is the dose of tranexamic acid in trauma?
1 g IV over 10 min, then 1 g over 8 hours
What is the target SBP in permissive hypotension?
80-90 mmHg until bleeding controlled
What is the eFAST exam sequence?
RUQ, LUQ, pelvis, subxiphoid, lungs
What is the treatment for cardiac tamponade in trauma?
Pericardiocentesis or thoracotomy
What is the lethal triad in trauma?
Hypothermia, Acidosis, Coagulopathy
What is the indication for emergency thoracotomy?
Penetrating chest trauma with arrest <15 min
What is the fluid of choice in trauma resuscitation?
Blood products (avoid excessive crystalloid)
What is the GCS score for coma?
≤8
What is the treatment for tension pneumothorax in trauma?
Needle decompression followed by chest tube
What is the role of pelvic binding?
Stabilizes pelvic fractures to reduce bleeding
What is the target temperature in trauma resuscitation?
> 36°C (prevent hypothermia)
What is the sign of aortic injury on CXR?
Widened mediastinum
What is the management of flail chest?
Analgesia, oxygen, consider PPV if hypoxic
What is the dose of IV fluids in pediatric trauma?
20 mL/kg bolus of isotonic crystalloid
What is the dose of IV fluids in pediatric trauma?
20 mL/kg bolus
What is the purpose of damage control surgery?
Control bleeding and contamination, delay definitive repair
What is the sign of hypovolemic shock in trauma?
Tachycardia, hypotension, cool skin
What is the treatment for traumatic brain injury with herniation?
Hyperventilation, mannitol (0.5-1 g/kg IV)
What is the role of CT in trauma?
Identifies occult injuries (e.g., head, chest, abdomen)
