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EM quiz readings > resuscitation trigger > Flashcards

resuscitation trigger Flashcards

1
Q

Decreased SVR
Decreased preload
Mixed CO

is what kind of shock

A

distributive shock

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2
Q

Increased SVR
Decreased Preload
Decreased CO

A

Hypovolemic shock

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3
Q

Increased SVR
Increased preload
Increased afterload
Decreased CO

A

cardiogenic shock

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4
Q

decreased preload
increased SVR
decreased CO

A

obstructive shock

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5
Q

etiologies of sepsis, neurogenic shock and anaphylaxis are all causes of what type of shock

A

distributive

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6
Q

hemorrhage, capillary leak, GI loss and burns are all causes of what kind of shock

A

hypovolemic

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7
Q

MI, dysrhythmias, HF, and valvular disease are all etiologies of what kind of shock

A

cardiogenic

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8
Q

PE, pericardial tamponade, and tension pnx are all etiologies of what kinds of shock

A

obsructive

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9
Q

what is the pathophysiology behind cardiogenic shock?

A

Left Ventricular failure to deliver o2.

leads to hypotension, systemic vasoconstriction, increased cardiac ischemia

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10
Q

how do you treat cardiogenic shock initially in the ED

A
  1. airway
  2. continuous cardiac monitoring
  3. IV access
  4. fluid bolus and vasopressors

do PCI or CABG

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11
Q

this is characterized by widespread inflammation and organ distress initiated by any type of microorganism

A

septic shock

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12
Q

what four things must be present to be considered septic shock

A
  1. sepsis
  2. required resuscitation
  3. required vasopressors
  4. elevated lactate
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13
Q

an elevated lactate with normal vital signs indicates the possibility of __________ in a patient with suspected sepsis

A

occult shock

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14
Q

what is the first line med for refractory hypotension in septic shock? how much fluids do we typically give to these paients?

A

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.
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15
Q

this type of shock results from blood pooling in the distal circulations with resultant hypotension

A

neurogenic shock

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16
Q

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?

A

neurogenic shock

vasopressors

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17
Q

look at this in case she cray

A
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18
Q

what motion moves the hyoid bone anteriorly and lifts the epiglottis away from the laryngeal inlet?

A

extension of the neck with anterior displacement of the mandible

this is not sniffings

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19
Q

what position may relieve upper airway obstructions and require less neck extension

A

forward flexion of the neck in addition to extension

(place folded towel , not rolled, or foam rubber device under pts occiput)

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20
Q

do you do sniffing or neck extension for airway in pts with cervical spine injury?

A

NOOOOO

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21
Q

if no gag reflex is present, what kind of airway can you place

A

oropharyngeal airway

22
Q

if a patient has an intact gag reflex or has facial trauma, what kind of airway can you use

A

nasopharyngeal

23
Q

beard, obesity, old, no teeth and snoring are all things that would make ___________ difficult

A

mask ventilation

24
Q

beard, obesity, short neck, short/long chin, and airway deformities are all things that would make ______________ difficult

A

intubation

25
Q

IV Etomidate is the MC _______

A

RSI sedative

26
Q

what patients should avoid propofol as a RSI sedative

A

hypotensive paients

27
Q

ketamine as an RSI sedative would be particularly useful in what patients

A

pts w bronchospasms or hypotension

28
Q

what is the preferred medication among the paralytics? why?

A

succinylcholine -> fast on/off

29
Q

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?

A
  • Ketamine as the sedative d/t hypotension
  • rocuronium as paralytic. see below
    -NOT succinylcholine (paralytic) because burn >5 days old
30
Q

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

A
  • etomidate or propofol would both be fine sedatives
  • Idk what paralytic to use but DONT USE RECRONIUM OR SUCCINYLCHOLINE!!!! both CI in myesthenia gravis
31
Q

what increases the risk of hyperkalemia with the use of succinylcholine

A

burns older than 5 days and denervation injury older than 7 days.

32
Q

what the hell is this chart, idk

A
33
Q

A peripheral access line must be proximal and well secured in order to use it to administer what medication

A

vasopressors

34
Q

sclerosing agents, conc glucose or electrolytes, and cytotoxic chemo agents are CI in what

A

infusion via peripheral line

35
Q

shock at 200J and initiate CPR

A

V fib

Vtach WITHOUT a pulse

36
Q

what medications can be used after administration of epinephrine

A

amiodarone or lidocaine

37
Q

DO NOT SHOCK, instead assess ABCDEs, reversible causes, give EPI and continue CPR

A

dysrhythmias-asystole/PEA

38
Q

if youre feeling up to it, look at this chart

A
39
Q

when do you use vagal maneuvers, adenosine (12, 6, 6), and rate control if all else fails.

A

SVT (AVNRT and AVRT)

40
Q

manage with BB, CCB and cardioversion if resistent

A

Afib/flutter

41
Q

how would you treat Afib with RVR, hypotension, MI, or pulmonary edema

A

URGENT cardioversion!

42
Q

when is electric cardioversion unlikely to succeed in an unstable afib patient? what do you do instead?

A

if the pt has long-standing afib

initiate hemodynamic resuscitation and ventricular rate control.

43
Q

rate control, oral anticoags, and follow up in 3-4 weeks is used in what pts

A

stable low risk afib

44
Q

when do you use procainamide/amiodarone

A

Vtach WITH a pulse

if no pulse, shock at 200j

45
Q

if a pt with arrhythmias has a HR of 42 with a BP of 80/50 what is the treatment

A

emergent transcutaneous pacing

this is also the treatment when there are bradyarrhythmias with structural disease of infranodal conduction system

46
Q

Mobitz type II 2nd degree HB and 3rd degree HB are the most associated heart blocks with whatt?

A

with needing emergent treatment (cardioversion)

47
Q

what are the 4 clinical features of a BRUE

A
  1. cyanosis/pallor
  2. absent/decreased/irregular bleeding
  3. marked change in tone
  4. altered level of response
48
Q

what are the 4 RFs of BRUEs in peds pts

A
  1. feeding difficulties
  2. recent URI symptoms
  3. <2mo old
  4. hx previous episodes
49
Q

in order to be low risk for recurrence a peds pt, what all has to be present

A
  1. > 60 days old
  2. if preemie, must have GA>=32 wks os postconceptual age of 45+weeks
  3. 1 BRUE only
  4. BRUE <1min
  5. No CPR needed
  6. no concerning historical features
  7. no concerning PE findings
50
Q

what is the pH limit that warrants NO resuscitation in SIDS baby:(

A

do NOT resuscitate if pH<6

51
Q

how high does temp have to be to stop resuscitation in a peds pt who had electrical activity and hypothermia on arrival.

A

30C

52
Q

7 indications for ETT

A
  1. resp failure
  2. Apnea
  3. reduced LOC (GCS<8)
  4. rapid change in mental status
  5. airway injury or impending airway compromise
  6. high risk for aspiration
  7. trauma to larynx

EM quiz readings (43 decks)

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