Resuscitation and Pharmacology Flashcards by maya hs

Pediatric differences in anatomy/ physiology and how they relate to trauma (5)?

Inc BSA = inc heat loss
Abdominal organs less protected
More likely multi-organ trauma
Developmental/ behavioral challenges
Hypotension is a late finding
Fluid requirements vary by age/ weight

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Weight estimation by age?

(age x 2) + 8

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Most common cause of hypoxemia in children?

V/Q mismatch

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How to reposition airway if on c-spine precautions?

Jaw thrust

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Components of pediatric assessment triangle?

C-B-C

Color, breathing, consciousness

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2 types of respiratory failure?

Type 1 = hypoxic

Type 2 = hypoxia+ hypercarbia

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List 5 sites for IO insertion

proximal tibia
Distal femur
humerus
sternum
ASIS
proximal to medial malleolus

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List 3 contraindications to IO insertion

recently fractured bone, osteogenesis imperfecta, osteopetrosis, IO use in same limb

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Complications of IO use

extravasation, epiphyseal injury, fracture, compartment syndrome, fat embolism, thrombosis

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How does the pediatric airway differ from the adult airway?

larger tongue
larynx more anterior/ superior
epiglottis is U-shaped, floppy
larger occiput
cricoid is the narrowest part

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Equipment required for intubation?

SOAP ME

Suction, oxygen, airways, pharmacology/personnel, monitors/ meds

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How to estimate ETT size?

Age/4 +4 = uncuffed tube (subtract 0.5 for cuffed)

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When is a cuffed tube preferred?

airway diameter may change over course of treatment (ie. inhalational injury, angioedema)
risk of aspiration
need for higher ventilator pressures (bronchiolitis, asthma, CLD)

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Etomidate, what is the advantage, what are 2 disadvantages?

Advantage: rapid onset and recovery, minimal HD effects
Disadvantage: adrenal suppression, vomiting, resp depression, myoclonus

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Ketamine - advantages and disadvantages

Advantages: good for shock/hypotension, preserves airway reflexes and respiratory drive, bronchodilator
DisadvantagesL vomiting ( 5-10%), apnea, laryngospasm, emergence delirium, sialagogue (increases oral secretions)

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When is atropine recommended for intubation, according to ACEP?

recommended for children < 1 years old, those being intubated with succinylcholine or pts with bradycardia

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succinylcholine – 4 contraindications

Elevated CK or K (rhabdo, burns/crush/trauma (usually 48-72 hrs later), muscular dystrophy/myopathies
Risk of malignant hyperthermia

Relative

Increased ICP or increased intraocular pressure (theoretical risk w/ fasciculations that can raise this)
Known pseudocholinesterase deficiency (myasthenia gravis) due to prolonged duration of action

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If intubated patient deteriorates, consider

Displacement of the tube
Obstruction of the tube
Pneumothorax
Equipment failure

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Indications of a difficult airway?

LEMON:
Look 
Evaluate mouth opening/thyromental distance
Mallampati
Opening of the mouth
Neck mobility

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3 ways to manage a difficult airway

LMA
Esophageal combitube
Perilaryngeal sealer 
Bougie
Video laryngoscopy (glidoscope)
Crichothyroidotomy

Good starting ventilator settings?

Pressure-control modes are preferred:

TV 7-10 ml/kg
RR at normal for age
PIP 20-25
PEEP 5-10

Propofol - 4 advantages to using in ED?

Fastest onset action
Fastest recovery time
Reduced ICP
Can be combined with other agents – ketamine, fentanyl
Decreased incidence of post nausea

3 indications for intubation?

inadequate oxygenation
inadequate ventilation
airway protection

What is the chain of survival after OHCA?

rapid access to EMS - rapid CPR - rapid defib - rapid advanced care

Name epinephrine’s main action in CPR?

Increases coronary perfusion pressure - good predictor of ROSC

What are 8 causes of PEA?

5Hs and 5Ts: Hypoxia, hypothermia/hyperthermia, hypoglycemia, hypokalemia/hyperK, H+ (acidosis), Thrombus arterial or venous, tamponade, tension pneumothorax, toxins

Initial defib dose?

2-4 J/kg --> 4J/kg --> max 10 J/kg or 200 J | adult = 200 J

Compression/ventilation rate in CPR when intubated?

Asynchronous | Compressions 100-120 beats/minute but no interruptions + Ventilation 8-10 breaths/minute (or every 6-8 seconds).

2nd line medications for V.fib /pulseless VTach?

lidocaine 1 mg/kg load followed by infusion or amiodarone 5 mg/kg

5 things you do after achieving ROSC?

Prevent secondary injury/ongoing shock target sats 94-99% consider advanced airway if not yet intubated avoid hypotension avoid hypoglycemia avoid hyperthermia treat agitation/ seizures arrange transport to tertiary pediatric center/PICU

Adenosine side effects?

Flushing, Chest discomfort, Nausea, Headache, Transient sinus bradycardia or heart block, Bronchospasm (in asthmatic)

What is the minimum dose of atropine?

Old question - 0.1mg, due to a study showing that very low doses are associated with mild slowing of the HR, but AHA says no minimum for intubation (0.02mg/kg)

What are 2 indications for atropine use in the resuscitation of a pediatric patient?

- Bradycardia with intubation | - Dec secretions

What is the mechanism of action of atropine?

parasympatholytic drug --> increased HR by accelerating the sinus and atrial pacemaker and improving conduction through the AV node

what is the name and location of receptor that acetylcholine acts on?

Acetylcholine receptor Nicotinic and Muscarinic Located at the neuromuscular junction (n) and other post ganglionic neurons (m)

Fentanyl - 3 advantages aside from analgesia and one uncommon complication

HD stability, fast onset and off, fast time to peak effect | S/E: rigid chest

Compare the cardiovascular effects of fentanyl and morphine and explain the difference

Morphine leads to histamine release --> hypotension. | Fentanyl is synthetic opioid, no histamine release, more HD stability

List 4 indications for calcium administration

Calcium chloride = central, calcium gluconate = peripheral | - HyperK, hypoCa, CCB overdose, HypoMg

What is target temperature after ROSC?

For infants and children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, it is reasonable to use either TTM 32°C to 34°C (for 48 hours) followed by TTM 36°C to 37.5°C (for 3 days) or to use TTM 36°C to 37.5°C

Definition of wide QRS?

> 0.09 msec ( 2 small boxes)

Features of SVT?

regular, HR > 220, no waves, not variable

Dose of adenosine?

0.1 mg kg --> 0.2 mg /kg (max 6 mg, 12 mg)

When to stop CPR in NRP?

Stop resuscitation after 10 minutes if HR remains undetectable

What are two actions of epinephrine other than cardiac?

Alpha 1 = vasoconstriction Beta 1 = cardiac contractility, inc HR Beta 2 = bronchodilation

Norepinephrine - main receptor, and effect on HR

alpha receptor = vasoconstriction | No effect on HR (some increase)

Dobutamine - main receptor, and effect on HR

Increase HR, vasodilator (afterload reduction), beta-1 receptor

Recommended laryngoscope sizing?

Size 0 = neonate Size 1 < 2 years old Size 2: 2-10 years old Size 3: >10 years old

How does milrinone work?

Lusitrope - peripheral vasodilation | Phosphodiesterase inhibitor—slows cyclic adenosine monophosphate breakdown