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ALS 2 > Resuscitation in special circumstances > Flashcards

Resuscitation in special circumstances Flashcards

1
Q

What is the normal value of K+?
What is considered hyper-K+?
What is severe?

What is hypo-K?
What is severe?

A

3.5-5.0mmol/l
>5.5
>6.5

<3.5mmol/l
<2.5mmol/l

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2
Q

If pH decreases, what is likely to happen to k+

if pH increases, what is likely to happen to k+

A

k>

<k

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3
Q

How do recognise hyperkalaemia?

A

Tall peaked waves (greater than R wave)
Paraesthesia
Weakness
Merging s and t waves (Sine waves)

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4
Q

For mild elevation of k+, give? (5.0-5.9)

A

Resonium/polystyrene 15-30g

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5
Q

For moderate (without ECG changes), give? (6.0-6.4)

A

10 Units insulin + 25g dextrose over 15-30 mins, resonium

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6
Q

For severe hyperkalemia without ECG changes, give? (>or equal 6.5)

A

glucose/insulin/IV fluids/ventolin (10-20mg nebs), resonium, ?dialysis

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7
Q

For severe hyperkalemia, with ECG changes, give?

A

Calcium chloride (2-5min), glucose/insulin, ventolin, IVT, resonium, dialysis,

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8
Q

For cardiac arrest with hyperkalemia, give?

A

Rapid injection of: calcium, insulin/glucose, sodium bic.

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9
Q

What is hypokalaemia?

Severe?

What is some clinical signs?

A

<3.5mmol

<2.5mmol

weakness, cramps, constipation, rhabdo

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10
Q

What is the ECG sign of hypokalaemia?

A

U waves / T wave flattening, maybe AF

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11
Q

During cardiac arrest with hypokalaemia, what do you give?

A

MgSo4 (2g) and 5mmol K+

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12
Q

What is the max dose of k+?

A

20mmol/h

rapid infusion can be done where peri arrest (2mmol/min for 10 mins)

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13
Q

Familiarise yourself with p. 134

A
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14
Q

What is sepsis and what is the sepsis six?

A

SIRS or organ failure
lactate >4mmol/l
hypotension
oliguria
confusion

Sepsis six:
Give O2
Blood cultures
Give broad spectrum abx
Fluid resus (250-500ml bolus)
Measure lactate
Measure urine

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15
Q

For opioids, give?

A

naloxone (100mcg titration up to 800mcg)

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16
Q

For Benzos, give?

A

Flumazenil

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17
Q

For TCAs, (amitriptyline, -amine, doxepin), give?

Clinical signs?

When a child arrives in a shockable rhythm, assume?

A

Sodium bic (go for pH 7.45-7.55)

Hypotension, seizures, arrhythmias

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18
Q

Give lipid emulsion to who?

A

Those with local anaesthetic toxicity seen in cardiovascular / cerebral collapse

How much? 1.5ml/kg then 15ml/kg/hr (After 5 mins, give up to two more boluses with 5 mins between), double rate of infusion.

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19
Q

What treats malignant hyperthermia?

A

Dantrolene (eg. MDMA)

20
Q

For asthma, give?

A

2x5mg ventolin with aim of SaO2 greater or equal to 92%
atrovent 500mcg
10mmol MgSo4
pred 50mg / hydrocort 100mg

consider iv ventolin if not possible to give airway
consider aminophylline in severe asthma

Half the doses for kids

21
Q

What signs of tension pneumothorax are there?

A

subcutaneous emphysema
tracheal deviation
unilateral expansion of the chest wall

22
Q

Anaphylaxis is met on what three criteria

A
  1. Sudden onset
  2. Airway, Breathing or Circulatory compromise
  3. Skin / mucosal changes (Sometimes not there)

There can also be gastro sx.

23
Q

Adult anaphylaxis algo

A
24
Q

What modifications should be done in cardiac arrest of pregnant woman?

A

Displace the uterus to the left (esp after 20 weeks)

Add left lateral tilt

If initial resusciation fails, you will need to deliver (preferably in 5 mins) - this helps the mother and a potential viable pregnancy (under 20 weeks not needed, however, needed if 24-25 weeks)

25
Q

What is commotio cardis?

A

Actual or near cardiac arrest caused by blunt impact to the chest

26
Q

In trauma, prolonged CPR (no response in 20 min), has what?

A

Poor survival and CPR needs to be stopped

27
Q

In tension pneumothorax, where is the needle put for needle decompression?

A

2nd intercostal, mid clavicle

Or

5th intercostal mid axilla

28
Q

When does a cardiac tamponade occur?

A

In cardiac surgery or trauma. The pericardial sac is filled with fluid under pressure.

Ultrasound can help diagnose

29
Q

What is the treatment of cardiac tamponade?

A

In trauma, immediate thoracotomy is needed

30
Q

What is submersion?

A

When the face is underwater -> Asphexia -> Cardiac arrest

Less than 10 min - good outcomes

More than 25 min - bad outcomes

31
Q

What is immersion?

A

Head above water like with life vest -> Hypothermia

32
Q

What is the role of hydrostatic pressure in drowning? (common in long immersion)

A

Hydrostatic pressure causes redistribution of fluid from periphery to central which is sensed by the body as hypervolemia that leads to diuresis, natriuresis, kaliuresis

When you get them out of the water, keep horizontal otherwise cardiovascular collapse can occur

33
Q

When drowning, what rhythm comes first?

A

Bradycardia

34
Q

What airway breathing modifications may be needed after drowning?

A

Early intubation

Peep may need to be as high as 15-20cm H2O but you start with 5-10.

35
Q

What form of measurement should be used in hypothermia (less than 35 degrees celsius)? (severe is less than 28 degrees celsius)

A

Thermocouple tympanic
Low reading thermometer (using lower third of the oesophagus) - rectal and urinary are not recommended in severe hypothermia

36
Q

What are some physiological principles of hypothermia that effects resucitation?

A
  1. Cellular oxygen consumption reduces by 6% for every 1 degree drop
  2. At 18 degrees celsius, the brain can tolerate circulatory arrest for 10x longer than at 37 degrees celsius
  3. Intermittent CPR is possible with min CPR and <5 mins of not
  4. Avalanche victims that have been under for >60 mins are unlikely to survive.
  5. Avalanche victims are unlikely to survive with potassium >8mmol/L
  6. Arrhythmias often revert to normal as the body warms
37
Q

How long do you check for signs of life in a hypothermic patient?

A

1 min (Palpate, ECG, maybe Doppler)

38
Q

Should you withhold ALS drugs in the hypothermic patient and when do you start giving?

A

Yes and give when core temperature is 30 degrees or greater

39
Q

If VF persists after 3 shocks, then what in hypothermic patient?

A

Delay until temperature >28 degrees-30degrees

40
Q

What are the stages and the general rewarming strategies?

A

Stage 1: 32-35 (shivering) - Blankets, foil, cap, let them exercise as more effective than shivering -> send to normal hospital
Stage 2-5: Chemical heat packs to the trunk -> Hospital with ECMO

In hospital rewarm with warm air ventilation and warmed fluids.

Passive rewarming can cause peripheral vasodilation.

41
Q

In hypothermia, watch for afterdrop, which is?

A

A continuing fall in body temperate after removal from the cold environment

42
Q

What is heat stroke?

A

> 40.6 degrees celsius + systemic inflammatory response, change in mental state and some organ dysfunction

Elderly are at greater risk

Signs and sx:
core temp

hot, dry skin or sweating

fatigue, headache, d+v, fainting

arrthymia / hypotension

ARDS

CNS like seizures / coma

liver / renal failure

rhabdo

43
Q

What is the general principles of cooling?

A

Do it rapidly

Cool drinks

Fanning the undressed patient and spraying tepid water

Ice packs over axillae, groins, neck

Cool IV fluids

Intravascular cooling catheters

44
Q

What causes death from electrical shock?

A

Tetany does not help (can’t let go)

Respiratory / Cardiac arrest

VF can be initiated by the electricity causes R on T

Tissue damage occurs

Hand to hand is the worst pathway

45
Q

What should you treat / look out for in electric shock?

A

Burns

Early intubation

IV fluids / urine output

ALS 2 (14 decks)

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