Treatment Guidelines Flashcards
What features indicate pt is at high risk of being peri-arrest? (5)
Hypotension/shock, syncope, ischemic CP or ischemia on 12 lead, heart failure: increased JVP/pulmonary edema, arrhythmias
In what patient population is Atropine potentially harmful?
Heart transplant patients. (Denervation of parasympathetic pathways)
What is BRASH syndrome?
Bradycardia, renal failure, AV blockade, Shock, Hyper K
What are some reversible causes of bradycardia? (5)
Hypoxia, increased parasympathetic tone, drugs/overdose, Hyper K, Myocardial ischemia
What is circum-rescue collapse
collapse of a pt in VF or cardiac arrest either before, during or shortly after rescue from cold environment
At what body temperature will a pt likely develop cardiac arrhythmias progressing to VF
30 degrees
Why should Epi be limited to 3 doses in hypothermic patients?
Drugs are metabolized more slowly and there is a potential for toxic build-up
At what ETCO2 level should an improvement in CPR quality be considered
10mmHg
What are the components of the Post Arrest checklist? (4)
Airway: Check tube position, air entry, tube tie
Breathing: 1/4-1/3 of BVM, 10-12/min, SPO2 of 94%, PEEP 5cmH2o
Circulation: Rhythm-5 mins for SVT, Map 65, 12 lead
Disability:HOB 30 degrees, Glucose, Temp neutral
How much fluid should an adult be resuscitated with?
20mL/kg
Cerebral and cardiac dysfunction accompanied by prolonged systemic ischemia (hypoperfusion/cardiac arrest) is known as?
Post cardiac arrest syndrome
What is the most common cause of traumatic cardiac arrest?
Haemorrhage
What are the reversible causes of traumatic arrest?
Hypovolemia, Hypoxia, Tension Pneumothorax
What is the transport window for a pt in cardiac arrest secondary to a traumatic cause?
15 minutes (20 in Vancouver Coastal)
When should a pelvic binder be applied in traumatic arrest?
After other reversible causes are treated, unless pelvic fx is suspected as being a leading cause of hemorrhage.
What is coagulopathy?
A derangement in hemostasis resulting in either excessive bleeding or clotting
What is the calculation for initial and subsequent defibrillation in pediatric patients
2J/kg, repeat at 4J/kg
Where are the 2 sites for needle thoracentesis placement
2nd intercostal mid-clavicular
5th intercostal mid-axilla
What are the 6 criteria for recognition of life extinct (ROLE)
No palpable pulse for 90 s No heart sounds for 90s No breath sounds/resp effort for 90 s Fixed non-reactive pupils No response to central stimuli Observe Asystole or PEA < 30 for 60s
What is the Pediatric assessment triangle (PAT)
General appearance (Tone, Inconsolability, Gaze, Color)
Work of breathing
Skin (Circulation)
How do you calculate mean and lower BP limits in pediatrics?
Mean: 80+ (2x Age (years))
Lower: 70+ (2x Age (years))
How do you calculate the ET tube size in pediatrics?
Uncuffed:(Age/4)+4
Cuffed: (Age/4)+3
What is the SIRS criteria?
Systemic Inflammatory Response Syndrome
Tachypnea, Tachycardia, Fever, Increased WBC
What is qSOFA
Quick Sequential Organ Failure Assessment
Altered LOC, Tachypnea, Hypotension
Exposure to CO with levels above (?) require conveyance to hospital?
Above 10%
How long does CO remain bound to hemoglobin?
4-5 hours at R/A
1-2 hours at 100% O2
20 mins in hyperbaric chamber
How does a hyperbaric chamber treat CO poisoning?
By producing a 10x increase in the amount of O2 dissolved in plasma, thereby increasing oxygen delivery to the tissue, and increasing CO elimination.
What are normal CO levels for a smoker?
2%, may be as high as 9% in heavy smokers
What causes a right shift (reduced affinity) in the oxyhemoglobin dissociation curve? (5)
Low pH High temp High CO2 High 2,3-BPG Low affinity hb variants
Organophosphates and Carbamates inhibit what?
Leading to what?
Acetylcholinesterase, causing stimulation of muscinaric (parasympathetic) and nicotinic (sympathetic) receptors
What is the mneumonic for organophosphate toxicity?
Sludge and the killer B's Salivation Lacrimation Urination Defecation GI upset Emesis Bronchospasm Bronchorrhea Bradycardia
What is the goal of Atropine in treating organophosphate poisoning? What receptors does it affect?
Control secretions, and correct bradycardia and hypotension. Reverses muscinaric, but not nicotonic
What are some symptoms of beta-blocker OD? (7)
Bradycardia Hypotension Mental status changes Ventricular dysrhythmias Cardiogenic shock Bronchospasm Hypoglycemia
What are common ECG findings in beta-blocker OD?
PR prolongation, QRS prolongation, bradydysrhythmia
What are the steps in treating beta-blocker OD?
What treatments are unlikely to be successful?
Glucagon-increasing cardiac inotropy by activating adenyl cyclase by a secondary mechanism bypassing beta-blockade
Calcium-improve BP and contractility
Sodium bicarb- Wide QRS, increases sodium and initiation of action potential
Mag sulfate-Torsades,
Epi infusion- Increases chrono/ino/dromo-tropy
Atropine and pacing are unlikely to be successful
What are the common S&S of TCA OD?
Sedation/Unconciousness
Seizures
Wide complex tachycardia
Hypotension
What is the cardiac consequence of TCA OD?
Sodium channel blockade
What are the common ECG finding of TCA OD?
QRS> 100ms
Deep S in I and aVL
Tall R in aVR
Tachycardia
