Week 1 review questions Flashcards
what are the benefits and drawbacks of the VL device?
Benefits:
- auditing tool
- teaching tool
- everyone can see where you are at in your laryngoscope.
- able to sit back further from airway. (infection control)
Drawbacks:
-White/pink out
- camera smearing with fluids
- may be temperamental in extremes of temp.
- hard in poor light
What are cannon waves and what are they indicative of?
These are pulsations of the Jugular vein able to be seen when the atria and ventricle are opposing each other. In the case of VT ventricles would be contracting closing the mitral valve while atria is attempting to contract meaning that blood may push back on the superior vena cava.
also known as A waves
Ref: Goyal A, Basit H, Bhyan P, et al. A Wave. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499925/
If you have a QRS axis of -60 what type of axis deviation do you have?
L) axis deviation.
When pacing has been applied, what may indicate pseudo capture?
- no pulse.
- no t waves (t wave are signs of muscle repolarisation hence if non are seen the muscle wasn’t actually depolarised)
What is the optimal plasma concentration for Ketamine for analgesia.
this is seen between 60-100ng/ml. above this we begin to see dissociative states.
Ref: Zanos P, Moaddel R, Morris PJ, et al. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms [published correction appears in Pharmacol Rev. 2018 Oct;70(4):879]. Pharmacol Rev. 2018;70(3):621-660. doi:10.1124/pr.117.015198
List 4 post ROSC syndromes:
- Postcardiac arrest brain injury (Disruption on both a micro- and macro- circulatory levels may result in either ischaemia or hyperaemia)
- Postcardiac arrest myocardial dysfunction (Although the heart initially becomes hyperkinetic, likely due to circulating catecholamines, global hypokinesis often follows
Usually resolves within 72 hours) - Systemic ischaemia/reperfusion response (The response of the body is similar to the septic shock with activation of the immune and complement systems, and release of inflammatory cytokines and a wide range of cellular responses)
- Persistent precipitating pathology (The cause of the arrest may continue to impact physiological parameters)
What is the mechanism or broadly how does atropine work to increase HR?
Atropine is a muscarinic acetylcholine receptors antagonist blocking parasympathetic effects at both the SA and AV node. It has greater effects on the SA over the AV node.
https://go.drugbank.com/drugs/DB00572
What are the 3 criteria required for SAAS intubation?
- Reduced conscious state.
- impending need to intubate (ie. high risk of gastric emptying or difficult extrication)
- immediate risk/need (ie. bariatric pt’s requiring increased pressures or significantly soiled airway)
What is the 2nd dose of amioderone available in ROSC if pt has already received 300mg in cardiac arrest?
a. 150mg
b. 300mg
c. Do not give subsequent dose
d. non of the above
a. 150mg
If the QRS is predominately positive in lead I and negative in AVF, what is the axis:
a. Normal
b. High axis deviation
c. Left axis deviation
d. north-west axis
c. Left axis deviation
What are the likely causes of narrow vs wide complex PEA’s?
Narrow:
- tamponade
- tension pneumothorax
- PE
- mechanical hyperinflation
- acute MI (myocardial rupture)
Wide:
-severe hyperK+
-Na+ channel blocker toxicity
- agonal rhythm
- acute MI (pump failure)
Patient calls because of swollen testicle, what could it be?
thanks Owen!
- R) sided heart failure.
- cancer
- trauma
- infection
In bradycardia what does the DIVE acronym stand for?
D- drugs
I- infarction
V- Vagal stimulation
E- environment/electrolytes
Wide QRS complexes at <130BPM. What are the causes and the risk with giving amioderone?
The risk is having patients with a Na channel problem (Na-channel blocker tox and/or hyperK+) and giving them another Na channel blocker in amioderone. Generally these patients need something to balance the equation such as calcium. In the case of Na channel blocker toxicity, sodium bicarbonate may also increase protein binding of the drug and reduce the availability of the drug for action at Na channels.
HypoCa+
Laryngospasm happens to your patient - what can you do as an ICP
- Call for help
- Remove stimuli.
-Oxygenation and ventilation may still be achievable with cautious strategies that have increased risk of gastric insulation’s. - FONA will bypass the occlusion. Laryngospasm however may be transient.
- Larson’s point manœuvre is an option.
- Consult for bougie oxygenation if still in situ
https://litfl.com/laryngospasm/
What are the causes of a wide complex PEA?
a. tension pneumothorax
b. hyperK+
c. other metabolic causes
d. tamponade
e. Pulmonary embolism
f. agonal rhythm
b. hyperK+
c. other metabolic causes
f. agonal rhythm
Negative potential side effects of Amiodarone include:
a. hypotension
b. laryngospasm
c. cardiac dysfunction
d. respiratory depression
e. prolonged half-life in bariatric patients
a. hypotension
c. cardiac dysfunction
e. prolonged half-life in bariatric patients (may be a benefit or a hinderance)
If the post-ROSC intubated patient remains persistently hyperaemic. what can be used to improve SpO2?
a. PEEP
b. increased ventilation rate.
c. ensure adequate O2 reserve
d. posture
e.apply nasal cannula
f. OGT
g. closed suction
a. PEEP
b. increased ventilation rate.
c. ensure adequate O2 reserve
d. posture
f. OGT
g. closed suction
in different situations all of these may be applicable but this is my answer. I would be interested in who wrote this to let me know if this is right.
