Section 1 Tintinalli Flashcards
First step for airway assessment
ABCs
What should be done prior to initiation of advanced airway techniques?
Reposition head with head tilt-chin lift and preoxygenate
Size of blade and type for intubation
Curved: no 3 or 4
Straight: no 2 or 3
Size of tube for intubation by gender
Women: 7.5 to 8.0 mm cuffed
Men: 8.0 to 8.5 mm cuffed
How to confirm placement?
End tidal co2, capnography, tube length 23 men and 21 women from 2 cm above carina
Complications of intubation
Esophageal intubation or mainstream leading to hypoxia or Neuro injury
Conditions which can cause difficulty bagging
2 of the following: Facial hair Obesity No teeth Advanced age Snoring
Conditions which can cause difficulty intubating
Facial hair Obesity Short neck Short/long neck Airway deformity
Which drugs can be used for RSI in what dosages?
Fentanyl - 3 mcg/kg, normotensive pt with aortic dissection, intracranial pressures, cardiac ischemia
Etomidate - 0.3 milligrams/kg, good for most pt
Propofol - 0.5 - 1.5 milligrams/kg, normotensive pt
Ketamine - 1 - 2 milligrams/kg, pt with bronchospasm and hypotensive
Definition of failed airway
3 unsuccessful attempts
Paralytic used for RSI with dose and indication
Succinylcholine - 1.0 to 1.5 milli/kg, rapid onset rapid off, not used in Neuro musc disorders, burns cuz of hyperkalemia, denervation injury
Rocuronium - 1 milli/kg non depolarizing
TX of sinus arrhythmia
No tx
PAC causes
Stress, fatigue, alcohol, tobacco, coffee, copd,dig tox, cad,
PAC tx
- Stop Meds
- Tx underlying disorders
- If get tachy sustained beta-antagonist like metoprolol
Tx of unstable Brady
Transcutaneous pacing
Tx of sx Bradycardia
Atropine 0.5 mg IV push 3-5 min
Epi 2-10 mcg/min or dopamine 3-10 mcg/kg/min
Tx of sinus tachy
diagnose and treat underlying cause
SVT causes
rheumatic heart disease, acute pericarditis, MI, mitral valve prolapse
TX of SVT unstable
cardioversion, synchronized
Tx of SVT stable
- vagal maneuvers
- adenosine 6 mg, IV flush, then 2 min 12 mg, then 12 mg
- Ca channel blockers (dilt 20 or verapamil 3-10 mg), beta blockers esmolol 500, metoprolol 5, propranolol 0.1
- dig 0.4-0.6
afib causes
idiopathic, HTN, ischemic heart disease, rheumatic hear disease, alc use, COPD, thyrotoxicosis
afib tx unstable
synchronized cardiovert
afib tx stable
- longer than 48 hours, heparin before cardioversion or echo before cardio
- rate control: dilt 20 mg then IV infusion or another dilt in 15 min
- -> verapamil, metoprolol, dig, procainamide (WPW)
- impaired cardiac function (EF
MAT tx
treat underlying disorder
- rate control with verapamil or dilt
- mg
- fix potassium
diagnosis of nonsustained vtach?
3 or more PVCs in a row
tx of vtach, pulseless
unsynchronized cardioversion at 100J, same as unstable patients
tx of vtach, stable
amio 150 mg over 10 min, bolus every 10 min up to 2 g
tx of vtach (torsades)
overdrive pacing at 120, mg sulfate 1-2g over 60-90 seconds, isoproterenol
tx of vfib
- defib at 200 J and 360, CPR, check pulse and defib
- 2 rounds of CPR unsuccessful give amio 300 mg IV push, lidocaine 1.5 mg/kg IV for 3 doses with the CPR defib cycle
- 3rd CPR cycle give epi 1 mg IV push or vasopression 40 units IV push with flush
- mg sulfate
tx of second degree Mobitz 2 AV block
atropine 0.5 to 1 mg IV bolus q 5 min up to 2 mg
- transcutaneous cardiac pacing, transvenous pacing
tx of 3rd degree AV block
transcutaneous pacing in unstable pt
- transvenous pacing
TX of PEA
intubate, CPR, epi 1:10000 every 3 to 5 min, or ET tube
formula for size of ET tube in children
(16 + age)/4
common cause of dysrhythmias in infants and children
respiratory insufficiency or hypoxia
defib dose in children?
2 J/kg with 1-2 min CPR
synch cardioversion in children?
0.5 J/kg
Sx of hyponatremia?
nausea, weakness, HA, agitation, hallucination, cramps, confusion, lethargy, seizures
tx of hyponatremia?
- NS for volume deficits
- euvolemic or hypervolemic, restrict fluids
- severe rapid hyponatremia give hypertonic saline at 25-100 mL/h, corrected at 0.5 mEq/L/h or 1.0, no more than 12 per day
cause of hypovolemic hyponatremia?
extrarenal (3rd spacing burns, sweating, vomiting, diarrhea)
renal diuretic, aldosterone deficiency, salt wasting, osmotic diuresis
cause of euvolemic hyponatremia
siADH, stress/pain, myxedema, asddison, sheehan, drugs, water intox
cause of hypervolemic hyponatremia
renal failure (urine Na >20)
cirrhosis, CHF, nephrotic
cause of hypervolemic hyponatremia
renal failure (urine Na >20)
cirrhosis, CHF, nephrotic syndrome (urine Na
