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FRCEM ‘23 > Resus > Flashcards

Resus Flashcards

1
Q

What factors predict a difficult airway?

A

HAVNOT
Hx of prev difficult airway
Anatomical abnormalities
Visual clues - obesity/facial hair/>55y/o
Neck immobility
Opening of mouth <3 fingers
Trauma/burns to face +/- bleeding in airway

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2
Q

What are the indications for a resuscitative thoracotomy ?

A

Penetrating thoracic trauma with witnessed signs of life and cardiac arrest in <15 mins
Blunt thoracic trauma with witnessed signs of life and cardiac arrest < 5 mins
Penetrating non-thoracic trauma with witnessed signs of life and cardiac arrest <5 mins

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3
Q

Which nerve is most commonly injured in a resuscitative thoracotomy?

A

Left phrenic nerve - lies over the pericardium of the left ventricle

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4
Q

What are the energies for DC shock in A flutter or SVT?

A

Initial shock 70-120J - give subsequent shocks with stepwise increase in energy.

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5
Q

What are the energies for DC shock in pulsed VT

A

120-150J for initial shock

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6
Q

Hypothermia cardiac arrest alterations?

A

Withhold adrenaline if the core temp <30C.
Check for the presence of vital signs for up to one min.
Chest compression rate unchanged.
If VF persists after three shocks, delay further attempts until the core temp >30.
Increase administration intervals for adrenaline to 6 - 10mins if the core temp is 30 - 34C.

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7
Q

What are the contraindications for sux

A
  • hyperkalaemia
  • burns
  • malignant hyperthermia
  • people with skeletal muscle myopathies
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8
Q

Oxygen cylinder volumes:

A

C = 170L
CD = 460L
D = 340L
E = 680L
F = 1360L

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9
Q

What are exclusion criteria for organ donation?

A

Being under 18
lacking capacity
being in the UK not of your own volition as well as tourists
lived in England less than 12 months

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10
Q

What is the HB target in upper GI bleeds? What if there is unstable ischaemic heart disease?

A

70g/L
90g/L
Or if the patient is shocked. Remember there is a lag to the true Hb

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11
Q

What are the indications for surgery in upper GI bleed post endoscopy?

A

Increasing transfusion requirements post endoscopy
Failure to control bleeding at endoscopy
Significant re-bleed post endoscopy

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12
Q

What are the drugs, timing and dosages in hyperkalaemia?

A

Calcium gluconate 30ml or calcium chloride 10ml over 2-5 mins
Repeat every 10-15 mins if ECG changes persist.
Salbutamol neb 10-20mg
Insulin dextrose - 50units in 50 mls of 50% over 15 mins.

If arrest - give 50mmol (50mls of 8.4%) sodium bicarbonate bolus

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13
Q

What are the six common drug causes of hyperkalaemia?

A

ACEi/ARB’s
K sparing diuretics
Trimethoprim
K supplements/infusions
B-blockers
NSAID’s

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14
Q

What is the dosage of TXA in massive haemorrhage?

A

1g over 10mins then 1g over 8hrs IV

Nb. Can give an initial fluid bolus if 250mls if blood not available.

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15
Q

RF’s for asystole in bradycardia? (4)

A

CHB with broad QRS
Mobitz type II
Ventricular pauses >3s
Recent asystole

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16
Q

What is the dose of intralipid in local anaesthetic toxicity?

A

1.5mg/kg bolus IV
Then 15mg/kg/hr infusion

17
Q

How often can atropine be repeated in bradycardia with life-threatening features?

A

Every 3-5 mins. 500mcg up to 3mg.

Then consider:
Adrenaline 2-10mcg/min
Isoprenaline 5mcg/min

18
Q

When should aminophylline 100-200mg IV be considered in bradycardia?

A

Cardiac transplant (atropine contraindicated)
Inferior MI (as above due to AV node block)
Spinal cord injury

19
Q

What are the doses of amiodarone in cardiac arrest?

A

300mg IV after the third shock
150mg IV after the 5th

Give 300mg IV over 10-20mins if three attempts at DC cardio version unsuccessful in unstable tachy arrhythmia and repeat shock once complete.

Then commence 900mg over 24hr infusion.

Also give 300mg IV over 10-60mins in regular B-road tachycardia ie VT

20
Q

When should you perform a perimortem c-section?

A

Perform writhing 5 mins of arrest if:
If mother >20 weeks pregnant (fundus palpable above umbilicus)
And one of:
No return of spontaneous circulation
Or
Maternal injuries fatal
Or
Prolonged pre-hospital arrest

21
Q

What should you do if transcutaneous pacing is ineffective at max energies?

A

Change pad positions

22
Q

What are the energies for electrical cardio version of tachy arrhythmias?

A

AF - max
A flutter or narrow complex - 70-120J
B-road complex - 120-150J

n.b. For atrial rhythms use AP pad positions

23
Q

What factors would cause you to continue CPR after 20 minutes?

A
  • Young ppl with persistent VF until all reversible factors addressed or therapeutic options exhausted.
  • Hypothermia (warm and dead)
  • Asthma (need to correct hyperinflation)
  • Toxicology arrest (can recover at 4hrs, asystole May be due to drug effect)
  • Thrombolytics given (cont up to 2hrs)
  • Pregnancy prior to resuscitive CS
24
Q

What are reasons to cease CPR?

A
  • ROSC
  • pre-existing chronic illness preventing meaningful recovery (disseminated CA, nursing home dementia pt)
  • Acute illness preventing recovery (non-survivable)
  • no response after 20 mins in the absence of shockable rhythm/reversible cause.
25
Q

What changes can you make in recurrent or refractory VF?

A

Consider increasing the energy.

Consider change of pad position (AP)

Do not use double shock outside of a research setting.

26
Q

Sepsis risk factors include:

A

Hx - new confusion
RR 25+, or >40% fiO2 required to maintain sats over 92 (or 88)
SBP <90 or >40 below normal
HR>130
No urine in 18 hrs
<0.5ml/kg/hr (if catheterised)
Mottled/ashen
Cyanosis to skin, lips, tongue
Non-blanching skin rash

Give broad-spec abx at max dose without delay if they meet any of the above criteria.

27
Q

What makes up a qSOFA score?

A

RR 22+
Altered mental status
SBP<100

Score of 2 or more near onset associated with greater risk of death/prolonged ITU stay.

28
Q

For pt’s 12 and older with a lactate >4 or SBP<90mmHg:

A

Give abx and fluid bolus and contact ICU for consideration of central access +/- inotropes/vasopressors

If 2-4, then give abx and fluid.

<2 abx, consider fluid.

Fluid boils of 500mls over <15mins.

29
Q

What treatment should be offered for trigeminal neuralgia?

A

Carbamazepine

30
Q

What are the treatment options for cluster headaches?

A

High flow oxygen 12L via NRBM
Subcut/nasal triptan acutely.

No arrange provision of home/ambulatory O2

31
Q

What’s is the management for an adrenal crisis?

A

100mg IV/IM hydrocortisone
Then: 200mg hydrocortisone/24hr with continuous IV glucose 5%/24hr or 50mg every 6hrs

Resuscitation with 500ml NaCl boils over 15 mins. Then replace fluids/electrolytes

Rehydration with 3-4L NaCl over 24hr + drinking as able

Paired serum costisol and ACTH

32
Q

Considerations in drowning cases:

A

Hypothermia
Hypoxia and acidosis
Hyperkalaemia - if fresh water due to cell lysis
Surfactant loss - therefore consider elevated PEEP when ventilating

FRCEM ‘23 (12 decks)

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