Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ALS2 > Resuscitation in special circumstances > Flashcards

Resuscitation in special circumstances Flashcards

1
Q

How does acidosis affect serum potassium levels?

A

acidaemia causes an increase in serum potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List causes of Hyperkalaemia

A
  • Renal failure
  • Drugs (ACEI, ARB, Spiro, NSAID, BB, trimethoprim)
  • tissue breakdown (rhabdo, tumour lysis, haemolysis, burns)
  • Metabolic acidosis (DKA, renal failure)
  • endocrine (addisons)
  • spurious (clotted)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What ECG changes are seen with hyperkalaemia?

A
  • Tall tented T waves (taller than R wave in more than one lead)
  • short QT interval
  • 1st degree AV block
  • bradycardia
  • ST depression
  • flat or absent P waves
  • Wide QRS
  • Merging of S and T wave (sine wave pattern)
  • VT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define mild hyperkalaemia. Treatment?

A

K5.5-5.9
address cause to correct (drugs/diet etc)
resonium
consider IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define moderate hyperkalaemia. Treatment?

A

K6-6.4, NO ECG changes
Shift K intracellularly - insulin 10U and 25g of glucose. monitor BSL. (onset 15-30min, max effect 30-60min, duration of action 4-6hr
remove K from the body - resonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define severe hyperkalaemia. Treatment?

A

K>6.5
Seek help
ECG, if changes: 5-10mL 10% calcium chloride IV over 2-5min
shift K intracellularly - 10U insulin, 25g glucose. Salbutamol Nebs
Remove K from body - Resonium/Dialysis
consider IV fluids

Consider sodium bicarb 50mmol IV if severe acidosis or renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Considerations for ALS during haemodialysis

A

ALS as normal
stop ultrafiltration (fluid removal)
fluid bolus
return patients blood volume and disconnect from the machine (some dialysis machines are defibrillator-proof tho)
leave dialysis access for drug admin
All Hs and Ts apply, but hyperK and APO are most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the causes for hypokalaemia?

A
  • GI losses (diarrhoea)
  • Drugs (diuretics, laxatives, steroids)
  • Renal (Renal tubular disorders, DI, dialysis)
  • Endo (Cushings, hyperaldosteronism)
  • Metabolic alkalosis
  • magnesium depletion
  • poor intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of hypokalaemia

A
  • nerves and muscles mostly affected
  • fatigue, weakness, cramps
  • constipation
  • in severe cases: rhabdo, ascending paralysis, resp muscle weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the ECG changes in hypokalaemia?

A
  • U waves
  • Flat T waves
  • ST segment changes
  • arrhythmias including AF, esp if on digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment of hypokalaemia periarrest and arrest?

A

Periarrest: 20mmol/hour or can go 2mmol/min for 10 min followed by 10mmol overe 5-10min

Arrest: 5mmol bolus followed by Mag 2g

giving Mg after K helps K uptake and maintenance of intracellular K particularly in the myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal total calcium and ionized calcium levels? What is corrected Ca correcting for?

A

Total Ca: 2.2-2.6 mmol/L
Ionized Ca: 1.1-1.3mmol/L
corrected corrects for serum albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of hypercalcaemia

A
  1. Primary or tertiary hyperparathyroidism
  2. Malignancy
    - sarcoidosis
    - drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of hypocalcaemia

A
  1. chronic renal failure
  2. pancreatitis
  3. calcium channel blocker OD
  4. toxic shock syndrome
  5. Rhabdomyolysis
  6. tumour lysis syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of hypermagnesaemia

A
  • renal failure

- iatrogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of hypomagnesaemia

A
  • GI loss
  • polyuria
  • starvation
  • alcoholism
  • malabsorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of hypercalcaemia

A
  • Painful bones
  • stones (renal and chole)
  • abdominal pain (N/V/D)
  • pysch tones
  • cardiac - hypotension, arrhythmia, arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of hypocalcaemia

A
  • paraesthesia
  • tetany
  • seizures
  • AV block
  • arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of hypermagnesaemia

A
  • confusion
  • weakness
  • resp depression
  • AV block
  • arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Symptoms of hypomagnesaemia

A
  • tremor
  • ataxia
  • nystagmus
  • seizures
  • TdP
  • arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment of hypercalcaemia

A
  • IVT
  • Frusemide
  • hydrocortisone
  • pamidronate
  • treat cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of hypocalcaemia

A
  • CaCl 10% 10-40mL IV

- Mg

23
Q

Treatment of hypermagnesaemia

A
  • consider treating if >1.75mmol/L
  • CaCl 10% 5-10 mL IV (can repeat)
  • Saline diuresis with frusemide
  • HDx
24
Q

Treatment of hypomagnesaemia for different severities

A
  • if severe or symptomatic 2g 50% Mg (8mmol) over 15min
  • TdP: 2g 50% Mg (8mmol) over 1-2min
  • seizure: 2g 50% Mg (8mmol) over 10min
25
Q

What are the sepsis 6?

A

Give

  • O2
  • broad spectrum ABx
  • fluid resus 250-500mL boluses to a max of 30mL/kg

Take

  • blood cultures
  • lactate
  • urine output
26
Q

Routes and doses of naloxone?

A

IV - 100-400mcg
IM - 400-800mcg
SC - 800mcg

titrate to effect to a total dose of 10mg

beware of precipitating opioid withdrawal

duration of action of naloxone is 45-75min, resp depression can occur for 4-5hr post OD, monitor need for ongoing Naloxone

27
Q

What is the reversal agent for benzodiazepine overdose? What are the consideratons when using this drug

A

Flumazenil - cannot be used with history of seizures

can cause seizures, arrhythmia, hypotension and withdrawal in pt with benzo dependence and co-ingsetion with proconvulsant meds (TCAs)

28
Q

What are the symptoms and effects of a TCA overdose? Treatment?

A

hypotension, seizures, coma, arrhythmias

cardiac effects mediated by anticholenergic and sodium channel blocking effects producint a broad complex tachy

hypotension results from alpha 1 block

other anticholenergic effects - mydriasis, fever, dry skin, delirium, tachycardia, ileus, urinary retention

Consider sodium bicarbonate if ventricular conduction abnormalities aim pH 7.45-7.55 which increase protein binding and sodium load

29
Q

Symptoms and treatment of local anaesthetic toxicity

A

Symptoms: Agitation, confusion, loss of consciousness, seizure. Cardiovascular collapse with sinus bradycardia, conduction block, VT

Once recognized control seizures and do normal ALS

if no circulatory arrest: treat hypotension/arrhythmia as normal and consider IV lipid emulsion

if circulatory arrest: normal CPR, give lipid emulsion (recovery may take >1hr). Propofol may not be used as a substitute

Lipid emulsion:
immediately: 20% lipid emulsion 1.5mL/hg over 1 min and infusion at 15mL/kg/hr
after 5min: can repeat bolus if ongoing cardiovasc instability (up to 3 boluses including the first all 5 min apart). Can double infusion rate to 30mL/kg/hr at any time after 5 min if indicated

do not exceed a cumulative dose of 12mL/kg

30
Q

Why might SaO2 decrease in an asthmatic post-bronchodilator?

A

beta-agonists cause bronchodilation and vasodilation which initially increases intrapulmonary shunting

31
Q

Management options for asthma

A
  • oxygen aiming SaO2 >92%
  • salbutamol 2x 5mg nebs at a time 20minutely
  • Pred 50mg or HCT 100mg 6hourly
  • ipratropium bromide 500mcg nebs 20minutely
  • Mg 10mmol over 20minutes
  • aminophylline
  • ketamine/propofol/sevoflurane/paralysis
  • NIV/Intubation
  • ECLS
32
Q

When should intubation be considered in Asthma?

A

the last line, best avoided

consider if:

  • decreasing conscious state
  • persisting or worsening hypoxaemia
  • deteriorating resp acidosis
  • agitation/confusion
  • progressive exhaustion
  • arrest
33
Q

Define Anaphylaxsis

A

-acute illness with typical skin features (urticarial rash/erythema/flushing/angioedema) AND resp or cardio or GI symptoms
OR
- any acute onset of hypotension/bronchospasm/upper airway obstruction where anaphylaxis is considered possible

usually occurs within 30min but can take up to 2 hours to develop

34
Q

Treatment for anaphylaxis

A
  • Adrenaline 0.5mg IM (0.5mL of 1:1000) or a 0.3mg epipen to middle third outer thigh. rpt in 5min if no improvement
  • steroids. oral pred 1mg/kg up to 50mg. HCT 5mg/kg up to 200mg
  • IVT bolus
  • if stridor or upper airway obstruction neb adrenaline
  • if wheeze neb salbutamol
  • if ongoing shock inotropic support

observe for biphasic reaction

35
Q

When should mast cell tryptase be taken for anaphylaxis?

A

Ideally 3 samples

  1. ASAP
  2. 1-2hr post-onset (this one at a minimum)
  3. 24hr post symptoms
36
Q

Modifications to ALS for pregnancy

A
  • get help from O+G/neonatologist/anos early
  • after 20/40 need to go left lateral if a firm surface (tilting bed/theatre bed) is possible. otherwise manually displace uterus to the L to avoid IVC access.
  • if concern for IVC compression IV/IO needs to be above the diaphragm
  • early ETT as increased risk for asp
  • prepare for CS early
37
Q

Reversible causes of arrest in pregnancy?

A
  1. Haemorrhage - Ectopic, abruption, praevia, uterine rupture, placenta accretia/incretia/percretia
  2. preeclampsia/eclampsia
  3. amniotic fluid embolism
  4. PE
  5. acquired or congenital cardiovascular disease
  6. drugs (from Mg in preeclampsia, LA toxicity)
38
Q

Management of haemorrhage in pregnancy

A
  • IVT/MTP
  • TXA and correction of coagulopathy
  • Oxytocin, ergometrine, prostaglandins, uterine massage
  • uterine suture/pack/balloon
  • IR to embolize
  • surgery
39
Q

What is the aim for the timing of a perimortem Csection. how does gestation effect need for CS and likelihood of infant survival?

A
  • aim is to deliver within 5 min of arrest
  • <20/40 doesnt need perimortem CS, foetus unlikely to compramise maternal CO and viability is not possible
    -20-23/40 initiate PMCS for mothers viability, infant survival is unlikely
    >24/40 initiate to facilitate survival of both
40
Q

why do drowning victims experience diuresis?

A

Aspirated water exerts hydrostatic pressure which draws volume centrally, body interprets this as hypervolaemia and causes diuresis

they are usually hypovolaemic due to this

41
Q

What submersion times are associated with good outcomes? bad outcomes?

A

duration <10min associated with a very high chance of a good outcome
>25min have low chance of a good outcome

42
Q

define hypothermia, classify mild-severe

A

Hypothermia is a core body temp <35
mild 32-35
mod 28-32
severe <28

43
Q

how should core body temperatures be taken?

A

Lower third of the esophagus

bladder and rectal temps lag behind this

44
Q

how is ALS modified in hypothermia

A

delay drugs until CORE temp >30 as metabolism is slowed and can cause toxic plasma levels. between 30-35 double time intervals

45
Q

Arrhythmias associated with hypothermia?

A

brady then AF then VF

46
Q

What is “Afterdrop”?

A

the continued fall in core temp after removal from cold stress due to heat redistribution within the body

has been attributed to returning of cold blood due to peripheral vasodilation (when first reheated)

47
Q

Treatment for hypothermia?

A

Rewarm with combination of external and internal techniques (warm air ventilation, warm IVF, warm peritoneal levage, baer hugger)

if core <32 and K <8 consider VAECMO

48
Q

Describe the pathophysiology of malignant hyperthermia. triggers? Tx?

A

MH-susceptible (MHS) patients have genetic skeletal muscle receptor abnormalities that allow excessive myoplasmic calcium accumulation in the presence of certain anesthetic triggering agents. The specific mechanisms by which anesthetics interact with these abnormal receptors and trigger an MH crisis have not been defined, but appear to involve magnesium-induced dysregulation of calcium transport through the ryanodine receptor

Triggers= volatile anaesthetics and succinylcholine

Tx= dantrolene (works on RYR1 to stop Ca going from SR to muscle cell)

49
Q

describe the pressure immobilization technique for a snake bite

A
  • apply a bandage firmly and tight over the bite site a finger may not easily slide between the bandage and skin. a 10-15cm wide elasticized bandage is preferred but crepe or clothing will work
  • apply a further bandage from distal (fingers/toes) to proximal covering as much of limb as possible (aim is to restrict lymphatic flow)
  • split or sling the limb to further immobilize
50
Q

Which spider bite is bad?

A

Funnel web

Red back and white tail rarely cause problems. dont pressure immobilize redback or white tail bites

51
Q

Symptoms and treatment for funnel web spider bite

A 
2 phases
initially:
- pain 
- tachy, HTN, vasoconstriction 
- perioral tingling, tongue fasciculation 
- profuse sweating, watery eyes, headache
- copious secretions of saliva and bronchorrhoea 
- abdo pain N/V, gastric dilation 
- muscular twitching 
- dyspnoea, non cardiogenic APO
- alt GCS
Secondary:
- worsening APO
- shock
- drop GCS
- Apnoea

Treatment:

  • pressure immobilization
  • antivenom
  • atropine for secretions
  • intubate for resp failure and high ICP
  • NGT for gastric dilation
  • paralysis for ETT and fasciculations
52
Q

What are the symptoms of irukandji syndrome? ( lots of jellyfish do this, they have only 4 tentacles and some are too small to be seen)

A
  • mod sting pain
  • severe cramping pain everywhere
  • impending doom
  • N/V
  • dyspnoea
  • sweating
  • heart failure, APO, hypertensive stroke

treatment is supportive :(

These jellys only north of bundaberg/geraldton

53
Q

Box jellyfish (Chironex Fleckeri) sting symptoms and treatment

A
  • severe pain at sting site
  • whip like marks on skin
  • restless and agitated
  • N/V
  • Dyspnoea and trouble swallowing/speaking
  • arrhythmia
  • resp/cardiac arrest
  • paralysis of the heart

Treatment:

  • apply vinegar (dont do this in nontropical regions, can cause nematocyst discharge for some jellys making it worse. use hot water in nontropical regions)
  • antivenom
  • magnesium
  • analgesia
  • ventilation
54
Q

What are some normal ECG varients in bariatric patients?

A
  • low voltage
  • LAD
  • flattened inferior-lateral T waves, atrial enlargement, false positive criteria for inferior MI

ALS2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions