resuscitation trigger Flashcards
Decreased SVR
Decreased preload
Mixed CO
is what kind of shock
distributive shock
Increased SVR
Decreased Preload
Decreased CO
Hypovolemic shock
Increased SVR
Increased preload
Increased afterload
Decreased CO
cardiogenic shock
decreased preload
increased SVR
decreased CO
obstructive shock
etiologies of sepsis, neurogenic shock and anaphylaxis are all causes of what type of shock
distributive
hemorrhage, capillary leak, GI loss and burns are all causes of what kind of shock
hypovolemic
MI, dysrhythmias, HF, and valvular disease are all etiologies of what kind of shock
cardiogenic
PE, pericardial tamponade, and tension pnx are all etiologies of what kinds of shock
obsructive
what is the pathophysiology behind cardiogenic shock?
Left Ventricular failure to deliver o2.
leads to hypotension, systemic vasoconstriction, increased cardiac ischemia
how do you treat cardiogenic shock initially in the ED
- airway
- continuous cardiac monitoring
- IV access
- fluid bolus and vasopressors
do PCI or CABG
this is characterized by widespread inflammation and organ distress initiated by any type of microorganism
septic shock
what four things must be present to be considered septic shock
- sepsis
- required resuscitation
- required vasopressors
- elevated lactate
an elevated lactate with normal vital signs indicates the possibility of __________ in a patient with suspected sepsis
occult shock
what is the first line med for refractory hypotension in septic shock? how much fluids do we typically give to these paients?
Norepinephrine
- 1-2 bolus to start out
- if not better and no evidence of volume overload, you can give more.
- 3-5 L often needed in the first 6 hours.
this type of shock results from blood pooling in the distal circulations with resultant hypotension
neurogenic shock
pt presenting with warm and dry skin, bradycardia, and hypotension. what type of shock is possible in this patient if all other causes of hypotension are ruled out? how would you treat this?
neurogenic shock
vasopressors
look at this in case she cray
what motion moves the hyoid bone anteriorly and lifts the epiglottis away from the laryngeal inlet?
extension of the neck with anterior displacement of the mandible
this is not sniffings
what position may relieve upper airway obstructions and require less neck extension
forward flexion of the neck in addition to extension
(place folded towel , not rolled, or foam rubber device under pts occiput)
do you do sniffing or neck extension for airway in pts with cervical spine injury?
NOOOOO
if no gag reflex is present, what kind of airway can you place
oropharyngeal airway
if a patient has an intact gag reflex or has facial trauma, what kind of airway can you use
nasopharyngeal
beard, obesity, old, no teeth and snoring are all things that would make ___________ difficult
mask ventilation
beard, obesity, short neck, short/long chin, and airway deformities are all things that would make ______________ difficult
intubation
IV Etomidate is the MC _______
RSI sedative
what patients should avoid propofol as a RSI sedative
hypotensive paients
ketamine as an RSI sedative would be particularly useful in what patients
pts w bronchospasms or hypotension
what is the preferred medication among the paralytics? why?
succinylcholine -> fast on/off
you are intubating a patient who has gone into hypovolemic shock after being admitted to the hospital 6 day ago with widespread burns. her BP is 70/38 and she has a HR of 168. what medications are you going to use prior to the RSI? why?
- Ketamine as the sedative d/t hypotension
- rocuronium as paralytic. see below
-NOT succinylcholine (paralytic) because burn >5 days old
you are intubating a patient with a hx of myasthenia gravis and a BP of 118/76, what is your choice of medications for this RSI
- etomidate or propofol would both be fine sedatives
- Idk what paralytic to use but DONT USE RECRONIUM OR SUCCINYLCHOLINE!!!! both CI in myesthenia gravis
what increases the risk of hyperkalemia with the use of succinylcholine
burns older than 5 days and denervation injury older than 7 days.
what the hell is this chart, idk
A peripheral access line must be proximal and well secured in order to use it to administer what medication
vasopressors
sclerosing agents, conc glucose or electrolytes, and cytotoxic chemo agents are CI in what
infusion via peripheral line
shock at 200J and initiate CPR
V fib
Vtach WITHOUT a pulse
what medications can be used after administration of epinephrine
amiodarone or lidocaine
DO NOT SHOCK, instead assess ABCDEs, reversible causes, give EPI and continue CPR
dysrhythmias-asystole/PEA
if youre feeling up to it, look at this chart
when do you use vagal maneuvers, adenosine (12, 6, 6), and rate control if all else fails.
SVT (AVNRT and AVRT)
manage with BB, CCB and cardioversion if resistent
Afib/flutter
how would you treat Afib with RVR, hypotension, MI, or pulmonary edema
URGENT cardioversion!
when is electric cardioversion unlikely to succeed in an unstable afib patient? what do you do instead?
if the pt has long-standing afib
initiate hemodynamic resuscitation and ventricular rate control.
rate control, oral anticoags, and follow up in 3-4 weeks is used in what pts
stable low risk afib
when do you use procainamide/amiodarone
Vtach WITH a pulse
if no pulse, shock at 200j
if a pt with arrhythmias has a HR of 42 with a BP of 80/50 what is the treatment
emergent transcutaneous pacing
this is also the treatment when there are bradyarrhythmias with structural disease of infranodal conduction system
Mobitz type II 2nd degree HB and 3rd degree HB are the most associated heart blocks with whatt?
with needing emergent treatment (cardioversion)
what are the 4 clinical features of a BRUE
- cyanosis/pallor
- absent/decreased/irregular bleeding
- marked change in tone
- altered level of response
what are the 4 RFs of BRUEs in peds pts
- feeding difficulties
- recent URI symptoms
- <2mo old
- hx previous episodes
in order to be low risk for recurrence a peds pt, what all has to be present
- > 60 days old
- if preemie, must have GA>=32 wks os postconceptual age of 45+weeks
- 1 BRUE only
- BRUE <1min
- No CPR needed
- no concerning historical features
- no concerning PE findings
what is the pH limit that warrants NO resuscitation in SIDS baby:(
do NOT resuscitate if pH<6
how high does temp have to be to stop resuscitation in a peds pt who had electrical activity and hypothermia on arrival.
30C
7 indications for ETT
- resp failure
- Apnea
- reduced LOC (GCS<8)
- rapid change in mental status
- airway injury or impending airway compromise
- high risk for aspiration
- trauma to larynx
