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Emergencies Flashcards

1
Q

What are the signs of an air embolism?

A

Decreased CO2

Tachypnoea

Decreased oxygen saturation

Hypotension

Tachycardia

ECG changes

‘Pulmonary wheel murmur’

Pulmonary oedema may develop later

Altered mental status if awake

Cardiopulmonary collapse

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2
Q

What should you do in the event of an Air Embolism?

A

Call for help

Identify a hands-off leader and delegate roles

Turn FiO2 to 100% and stop any nitrous oxide use

Stop the source of air entry

Inform the surgeon to flood surgical field

Use ETCO2 to monitor progression

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3
Q

What are the main risks for air embolism?

A

Operative field above the heart

Spinal surgery

Sitting craniotomy

Large bore IV access

Rapid infusions

C section

Gas insufflation procedures

Head up during central line

RRT, ECMO, Bypass

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4
Q

What are the signs of anaphylaxis?

A

Severe grade reaction

Hypotension

Bronchospasm

High peak airway pressure

Decreased or lack of breath sounds

Tachycardia

Urticara

Cardiac arrest

Oedema

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5
Q

What should you do in the event of a suspected anaphylaxis ?

A

Call for help

Identify a hands off team leader

Turn FiO2 to 100% and consider reducing anaesthesia depth

Adrenalin bolus of 20-100mcg IV repeat 1-2 minutes

OR

Adrenalin IM 0.5mg every 5 minutes as needed

Remove potential causative agents

Secure the airway with ETT

Ensure large bore IV access

Give 2L fluid bolus and elevate legs

If no pulse or systolic BP <50 start CPR and follow PEA algorithm

Obtain and continue with anaphylaxis box cards

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6
Q

What should you next consider with a suspected anaphylaxis ?

A

Adrenalin infusion +/- any other vasopressor

Salbutamol +/- magnesium if bronchospams

Arterial line, central line, blood gases

Tryptase levels test 1 / 4 / 24 afters

Can the operation continue?

Referral to ICU

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7
Q

What is the IM adrenalin dose for children?

A

10mcg [0.01ml/kg] of 1:1000

[min dose 0.1ml]

[max dose 0.5ml]

Repeat every 5 minutes as needed

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8
Q

What is the IM adrenalin dose for adults?

A

0.5mg [0.5ml of 1:1000]

Repeat every 5 minutes as needed

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9
Q

Main causes of anaphylaxis?

A

Antibiotics

Muscle relaxants

Chlorhexidine

Latex

Colloids

Patient blue

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10
Q

What do you do in the event of an unstable bradycardia?

A

Call for help and the resuscitation trolley and attach defib pads

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Stop surgical stimulation

Give atropine 600mcg IV repeat up to 3mg

If atropine ineffective start either adrenalin infusion or transcutaneous pacing

Confirm pulse present if no pulse start CPR and follow cardiac arrest aystole/PEA algorithm

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11
Q

What are the signs of unstable bradycardia?

A

HR <50bpm with hypotension

Acutely altered mental state

Shock

Ischaemic ECG or acute heart failure

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12
Q

What are the signs of bronchospasm?

A

Persistant increased peak airway pressure

Wheezing

ETCO2 slowly increasing slope

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13
Q

What should you do during a bronchospasm emergency?

A

Call for help

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Examine patients chest for wheeze and air entry

Consider other differentials [aspiration, anaphylaxis, ARDS acute respiratory distress syndrome]

Deepen anaesthesia with sevoflurane

Use neuromuscular blocker and consider intubating if LMA

Start drug treatments

Review and adjust ventilator settings [volume control]

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14
Q

What drugs are given during bronchospasm?

A

Salbutamol inhaled 8-12 puffs

Salbutamol IV bolus 250mcg [100mcg/ml]

Magnesium

Adrenalin

ketamine

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15
Q

What are some additional steps to consider during a bronchospasm?

A

ICU review and advice

If concerned about aspiration pass suction catheter down ETT

If haemodynamically unstable may have tension pneumothorax, gas trapping or anaphylaxis

Arterial line and serial ABG’s

Chest X-ray / scan

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16
Q

What are the signs of Cardiac Arrest – asystole / PEA?

A

Non-shockable pulseless cardiac arrest

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17
Q

What should you do in the event of an asystole / PEA?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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18
Q

What drug do you give for an adult cardiac arrest?

A

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

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19
Q

What are the 4 H’s of a cardiac arrest cause stand for?

A

Hypovolemia/ Haemorrhage

Hypoxia

Hyper/hypokalaemia / metabolic disorders

Hyper/hypothermia

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20
Q

What are the 4 T’s of a cardiac arrest cause stand for?

A

Tension pnumothorax

Tamponade

Thrombosis – pulmonary, coronary, air, fat

Toxins [beta blocker, Ca2+ channel blocker, local anaesthetic, drug error]

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21
Q

How do you treat hyperkalaemia?

A

Sodium bicarbonate

Insulin actrapid

Calcium chloride

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22
Q

What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA

A

Adrenaline 0.01mg/kg of the 0.1mg/ml concentration

Max dose 1mg

Repeat every 3-5 minutes

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23
Q

What are the steps to take during a Cardiac arrest VF / VT

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Defibrillate at 200J then recommence CPR

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

After 3rd cycle consider giving amiodarone 300mg IV

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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24
Q

What are the Defibrillator Instructions?

A

Attach defibrillator pads to patient in the appropriate way

Select energy 200J and press charge

Once charged stop CPR and assess rhythm

If shock advised ensure all staff stand clear of bed

Pressure shock and immediately restart CPR

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25
What are the non-shockable rhythms?
Asystole/PEA
26
What are the shockable rhythms?
VF / VT
27
What are the Starting steps to take with an unanticipated difficult airway?
Call for help and the difficult intubation trolley Identify a hands off leader and delegate roles Turn FiO2 to 100% at high gas flows Use Vortex approach Ensure good neuromuscular relaxation and consider TIVA One person to watch oxygen saturation, declare if <90% Ask hands off leader to count and say airway attempts
28
What are the get ready for CICO steps in an uninticpated difficult airway?
Open FONA [front of neck access] kit on the side of the anaesthesia machine for scalpel and or needle technique Contact ENT senior surgeon to help
29
What are the steps to take during a CICO event during an unanticipated difficult airway?
Declare CICO if oxygen saturations <90% or rapidly falling and all 3 lifeline best effort attempts not successful Options are WAKE UP or FONA For wake up ensure muscle relaxant reversal is complete
30
What are the signs of an unanticipated difficult airway?
Unsuccessful intubation and oxygenation attempts under optimized conditions
31
What are the initial steps should you take during a haemorrhage?
Call for help and ask for blood warmer or rapid infuser +/- cell saver Identify a hands off leader and delegate roles Turn FiO2 to 100% and consider reducing anaesthesia depth Confirm source control attempted by surgeon ask if help is needed Get large bore IV access x 2 Give fluid bolus and vasopressors to maintain organ perfusion Blood request
32
What are the signs of High airway pressures?
Persistant increased peak airway pressure >40cmH20 Hypoxaemia Inadequate ventilation
33
What steps should you take during a high airway pressure event?
Call for help and ask surgeons to stop stimulation Identify a hands off leader and delegate roles Turn FiO2 to 100% Consider TIVA Exclude ligh anaesthesia or inadequate relaxation Switch to manual ventilation Disconnect LMA/ETT from circuit and squeeze bag to assess if the problem is with the airway, breathing or circuit If pressure is normal now problem is with the airway or breathing If pressure is still raised problem is with the circuit Ensure HME filter checked/excluded
34
What steps should you take if its an airway problem during a high airway pressure event?
Review position, check patency by passing suction catheter, consider change of device
35
What steps should you take if it’s a breathing problem during a high airway pressure event?
Review cause by examination Listen to chest Consider ultrasound or chest X-ray
36
What steps should you take if it’s a circuit problem during a high airway pressure event?
Ventilate with AMBU bag TIVA Review circuit
37
What common problems could cause a circuit to create high airway pressures?
Blocked HME filter Water in circuit Kinked/compressed Valves sticky
38
What can cause airway or breathing problems?
Anaphylaxis Aspiration Abnormal anatomy Bronchospasm Blocked or displaced LMA/ETT Inadequate depth of anaesthesia Inadequate muscle relaxation Malignant hyperthermia Pneumothorax Pulmonary oedema atelectasis
39
What is atelectasis?
The collapse of part or all a lung Caused by a blockage of the air passages [bronchus or bronchioles]
40
What are the signs of hypotension?
Unexplained drop in blood pressure refractory to initial treatment
41
Why is the solution SAGM added to RBC? {Sodium Adenine Glucose Manitol}
It extends the shelf life of RBC up to 42 days of increased functional viability
42
What steps should you take during a hypotension emergency?
Call for help and the resuscitation trolley Identify a hands off leader and delegate roles Turn FiO2 to 100% and consider reducing the anaesthesia depth Check pulse, BP, ECG and equipment If Bradycardia, Tachycardia or Cardiac Arrest see specific checklist Open IV / Pressurised fluid bolus / consider blood products Optimize venous return with Trendelenburg positioning / low PEEP Vasopressor treatment Mild hypotension - phenylephrine, ephedrine, metaraminol Severe / refractory – adrenaline, noradrenaline or vasopressin Identify cause of hypotension
43
What additional steps should be taken during a hypotension emergency?
Arterial line CVC ABG Hourly urine output monitoring Consider echo Referral to ICU
44
What surgical events can cause a hypotension emergency?
Mechanical / surgical manipulation Insufflation during laparoscopy Retraction and vagal stimulation Vascular compression
45
Can sepsis cause a hypotension emergency event?
Yes
46
What are the signs of hypoxia?
Low oxygen saturation <92% or cyanosis
47
What should you do during a hypoxia emergency?
Call for help Identify a hands-off leader and delegate roles Turn FiO2 to 100% at high gas flows Confirm ETCO2 capnography and morphology Confirm pulse oximeter position and patient colour Hand ventilate and assess patient / circuit Check; Airway – Examine device +/- suction tube, laryngoscopy Breathing – chest sounds, movement and lung compliance Circulation – blood pressure, pulse and rhythm Circuit – HME filter, tubing, one-way valves, anaesthesia machine Depth and relaxation
48
What are the signs of laryngospasm?
Sustained closure of the vocal cords resulting I the partial or complete loss of the patients airway
49
What steps should you take during a laryngospasm emergency?
Call for help Identify a hands off leader and delegate roles Turn FiO2 to 100% at high gas flows Stop any stimulation If has LMA remove and clear airway using suction if needed Apply mask, jaw thrust and CPAP 30Cm H20 +/- Oropharyngeal airway Deeping anaesthesia using propofol Relaxation using IV suxamethonium Plan to intubate if sats are <92%
50
Can laryngospasm break with sufficient time and hypoxia?
yes
51
Does ongoing laryngospasm increase the risk of negative pressure pulmonary oedema, bradycardia, cardiac arrest and aspiration?
yes
52
What is the intubation dose of propofol for adults?
1-2mg/kg
53
What is the intubation dose for suxamethonium IV?
2mg/kg
54
What is the intubation dose for suxamethonium IM?
4mg/kg
55
How much propofol do you give to break a laryngospasm event?
20% of an induction dose 0.25-0.5mg/kg
56
What are the signs of local anaesthetic toxicity?
Sudden alteration in mental status Tonic clonic seizure Arrhythmias or cardiovascular collapse Sinus bradycardia Conductional blocks Asystole Ventricular tacharrthymias
57
What's steps should you take for a local anaesthetic toxicity emergency event?
Stop giving the local anaesthetic Call for help and the resuscitation trolley and intralipid Identify a hands off leader and delegate roles Turn FiO2 to 100% Assess airway, breathing, circulation and treat accordingly If haemodynamically unstable consider intralipid Hyperventilation may be helpful Treat seizures with propofol
58
What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?
1.5mg/kg over 1 minute [100ml for 70kg] If remains unstable Repeat 2 more doses at 5-minute intervals max
59
What is the infusion dose of 20% intralipid?
15ml/kg/hr [1000ml/hr for 70kg] If remains unstable double infusion rate
60
Is propofol a substitute for intralipid?
No
61
What can trigger a Malignant Hyperthermia?
Volatile anaesthetic agents Suxamethonium
62
What are the signs for malignant hyperthermia?
Unexpected increase in ETCO2 Unexplained tachycardia Unexplained tachypnoea Arrhythmias Prolonged masseter muscle spasm after suxamethonium Hyperthermia is a late sign
63
What steps should you take during a Malignant hyperthermia emergency?
Call for help and the MH box / Trolley Identify a hands off leader and delegate roles Remove precipants Stop volatile anaesthesia and start TIVA Hyperventilate with 100% oxygen at high flow of 15L/min Consider changing soda lime if quick and easy Do not waste time changing the circuit, machine or filter if event is actively happening Start dantrolene Obtain and continue with the MH box cards
64
What are additional consideration steps to take during a MH event?
IV access, central line, arterial line Blood tests every 30 minutes Temperature probe and commence active cooling Catheter – urine output aim should be 2ml/kg/hr Discuss with ICU
65
How do you prepare the dantrolene?
20mg vial mixed with 60mls sterile water
66
What is the bolus dose of dantrolene?
2.5mg/kg [60kg = 8 vials]
67
How long after immediate treatment of dantrolene should you consider giving another repeat bolus?
10 minutes if still symptomatic
68
How does dantrolene work?
Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells preventing electrical impulses traveling to muscles and preventing muscle contractions
69
What complications can MH cause?
Acidosis – treat with hyperventilation, sodium bicarbonate Arrhythmias Disseminated intravascular coagulation [DIC] -abnormal blood clotting Hyperkalaemia – high potassium levels in blood Hyperthermia – cold fluids, ice Hypotension – fluid bolus, vasopressor Cardiovascular collapse and cardiac arrest
70
What are the signs of unstable tachycardia?
Shock Syncope – loss of consciousness Severe heart failure Myocardial ischaemia [obstructed blood flow to heart] Altered mental status Heart Rate > 150 BPM Mean arterial pressure <65
71
What are the signs of stable tachycardia?
Mean arterial pressure >65 and no adverse features
72
What steps should you take with a tachycardia emergency?
Call for help and the resuscitation trolley Identify a hands off leader and delegate roles Turn FiO2 to 100% Stop surgery and perform DRABCDE review Identify any reversible causes and tailor treatment to patient
73
What steps should you take with an unstable tachycardia emergency?
If conscious use gentle sedation Cardioversion with synchronised shock Review rhythm and confirm cardiac output If problem persists repeat cardioversion up to 3 times Amiodarone 300mg IV over 10-20 minutes
74
What steps should you take with a stable tachycardia emergency?
Review rhythm and check underlying causes Arterial line and bloods Consider drug treatment Seek expert help from cardiology or ICU
75
How to set up a cardioversion with synchronised shock
Apply pads and select DEFIB Select 50-150J energy Press SYNC button Check SYNC success – confirm marking ^ on R waves Charge and deliver shock safely If synchronisation not possible use high energy unsynchronised shocks
76
What is SVT?
Supraventricular tachycardia
77
What is PEA?
Pulseless electrical activity
78
When is amiodarone given and what dose?
After third shock for VF and VT that is unresponsive to shock delivery, CPR and vasopressor 300mg
79
How can you raise concerns of ideas during the crisis?
Your input may be crucial Probe – make observation or ask clarifying question Alert – suggest problem and offer possible alternative Challenge – address person using their name, directly question plan or decision Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient
80
What should your checks be during any crisis?
Oxygen delivery FiO2, FGF, bellows or bag moving Airway – ETT or LMA patent Breathing – Sats ETCO2 waveform, tidal volumes and rate Circulation – Rate, rhythm, ischaemia, BP, Peripheries Depth – MAC or TIVA value, BIS or entropy Surgery – ask how is the operation going? Review blood loss
81
What does BCIS stand for?
Bone cement implantation syndrome
82
What are the patient signs of BCIS?
Hypoxia Hypotension Or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion
83
True or False: a small current may be sufficient to induce ventricular fibrillation
True
84
True or false: macro shock cannot cause ventricular fibrillation
False
85
What is the adult cardiac arrest adrenaline dose? Include units
1mg
86
What is the adult anapahylaxis adrenaline dose? Include units
0.5mg
87
What is the paediatric cardiac arrest adrenaline dose? mcg/kg
10 mcg/kg
88
What is the paediatric amiodarone cardiac arrest dose? mg/kg
5 mg/kg
89
What is the energy dose for paediatric defibrillation? J/kg
4 J/Kg
90
What is the energy dose for adult defibrillation?
200J
91
What is the intralipid bolus dose in ml/kg?
1.5ml/kg
92
Which emergency causes tachycardia, hypotension, urticaria and bronchospasm?
Anaphylaxis
93
Which emergency causes visual disturbances, confusion, bradycardia and hypotension?
Local toxicity
94
What emergency causes tachycardia, tachypnoea, hypotension, and hyperkalaemia?
Malignant hyperthermia
95
Which medication can be used to increase potassium uptake in malignant hyperthermia, reducing hyperkalaemia?
Insulin
96
Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?
Sodium Bicarbonate
97
True or false – nitrous oxide is a triggering agent for malignant hyperthermia
False
98
Which blood test is used to confirm anaphylaxis after the incident?
Tryptase
99
When should tryptase be taken after an anaphylaxis event? A - Immediately and after 24 hours B- 1 hour, 4 hours and 24 hours C - Immediately, 2 hours and 6 hours D - When I can be bothered doing a blood gas
B
100
MTP box 1 contains what? A) 4 RBC, 4 FFP B) 2 RBC, 2 FFP C) 4 RBC, 4 FFP, 3 Cryo D) 4 RBC, 4 FFP, 1 Platelets
B
101
MTP box 2 contains what? A - 4 RBC, 4 FFP, 3 Cryo B - 2 RBC, 2 FFP C - 4 RBC, 4 FFP, 1 Platelets D - 4 RBC, 4 FFP
A
102
MTP box 3 contains what? A 2 RBC, 2 FFP B 4 RBC, 4 FFP, 1 Platelets C 4 RBC, 4 FFP, 3 Cryo D 4 RBC, 4 FFP, 1 Cryo
B 4 RBC, 4 FFP, 1 Platelets
103
Which boxes are repeated in an MTP? A - 1 & 2 B - 3 & 4 C - 1 & 4 D - 2 & 4
B
104
What does DRSABCD stand for?
Check for DANGER Check for a RESPONSE SEND for help Check the AIRWAY Check for BREATHING Start CPR DEFIBRILLATION
105
Continuous Positive Airway Pressure, Propofol and Suxamethonium is textbook treatment for what emergency? A - Bronchospasm B - Laryngospasm C - Difficult intubation D - Anaphylaxis
B
106
Bronchospasm may be treated with: A -Salbutamol via ETT or IV B - Adrenaline C - Volatile anaesthetics (increased MAC) D - All the above
D
107
Five common causes of anaphylaxis?
Latex Colloid Antibiotics Muscle relaxant Chlorhexidine Patient blue sugamadex -[likelihood appears to be dose-related]
108
What are 5 symptoms of anaphylaxis?
Difficult/noisy breathing Wheeze/Persistent cough Swelling of the face and tongue Swelling/tightness in the throat Difficulty talking Persistent dizziness/ loss of consciousness Abdominal pain and vomiting Hives, welt and body redness/rash Hypotension
109
What are the signs and symptoms of Local Anaesthetic Toxicity?
Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness Convulsions and loss of consciousness Hypotension, bradycardia, and respiratory arrest
110
What are the early signs and symaptoms of Malignant hyperthermia?
Prolonged muscle spasm after Suxamethonium Tachycardia Tachypnoea in a spontaneous breathing patient Increased CO2 Cardiac arrhythmias
111
What are the Developing Signs and Symptoms of Malignant hyperthermia?
Rapid increase in temperature (0.5 degrees every 15 minutes) Respiratory and metabolic acidosis Hyperkalaemia Profuse sweating Decrease SpO2 Mottled skin Cardiac instability Muscular rigidity
112
What are the Late Signs and Symptoms of Malignant hyperthermia?
Cola coloured urine Increase CK serum Coagulopathy Severe muscle ache Cardiac Arrest
113
What does TACO stand for and what is it?
Transfusion Related Circulatory Overload Pulmonary oedema primarily caused by volume excess Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.
114
What does TRALI stand for and what is it?
Transfusion Related Acute Lung Injury Repaid onset of excess fluid in the lungs. Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest
115
What is Acute Haemolytic Transfusion Reaction AHTR
A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)
116
What is ROSC?
Return of spontaneous circulation Generally detected by arterial pulse palpation and end tidal CO2 monitoring
117
What is the flow rate of a 14g cannula?
Just gravity - 250ml/min Pressurized – 380ml/min
118
What is the flow rate of a RIC line?
1000ml/min
119
What is the normal heart rate range for a child?
70-160 BPM
120
Discuss the immediate management of an airway fire;
Stop laser immediately Turn O2 off Call for help Establish a hands-off team leader and delegate roles Use saline swabs to put out fire Get the fire extinguisher and fire blanket and attempt to extinguish the fire Turn off medical gases and disconnect ventilator Remove ETT and remove flammable material from airway Pour saline into airway After fire extinguished re-establish tube and reintubate and reestablish ventilation Using AMBU bag with room air Assess airway for injury Emergency tracheostomy if intubation failed
121
Give 5 reasons why a women would require an emergency LSCS
Prolonged labour Foetal distress Cord prolapses Exhaustion Placenta problem
122
Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;
3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells This can lead to problems such as oedema, reduced cardiac output and hypotension 3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids
123
Define vasovagal;
Over activity of the vagus nerve resulting to a temporary fall in blood pressure, heart rate, fainting
124
Discuss first degree burn;
Effect the outer layer of skin – superficial
125
Discuss second degree burn;
Involves the epidermis and part of the lower layer of skin - dermis
126
Discuss third degree burn;
Destroys the epidermis and dermis This may go into the subcutaneous tissue
127
Discuss fourth degree burn;
Go through both layers of skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone
128
Explain the rule of nines and how it is used to estimate the extent of a burn's injury;
Dividing the bodies surface area into percentages to calculate the extent of the burns injury Front + back of head and neck = 9% Front + back of each arm = 9% Chest = 9% Stomach = 9% Upper back = 9% Lowerback = 9% Front and back of each leg and foot 9% each side Genital area = 1%
129
Explain common complications associated with burns surgery;
Blood loss – debrided tissue bleeds freely Hypothermia Infection Breathing problems Fluid loss Difficult placement of monitoring and IV
130
Define ACVPU;
Alert Confusion [new onset or worsening] confusion Voice Pain Unresponsive
131
Define GCS;
Glasgow coma scale
132
What are the 3 consciousness ratings of the Glasgow coma scale?
Severe - 3-8 Moderate - 9 - 12 Mild - 13-15
133
What are the 3 assessments for the Glasgow coma scale?
Eye opening Spontaneous – 4 To sound – 3 To pressure – 2 None - 1 Verbal response Orientated – 5 Confused – 4 Words – 3 Sounds – 2 None - 1 Motor response Obey commands -6 Localising - 5 Normal flexion - 4 Abnormal flexion - 3 Extension - 2 None - 1
134
State normal range of an ICP measurement;
5-12mmHg
135
Normal CBP pressure range
8-12mmHg
136
State the relationship between CSF, CBF and ICP;
CSF, CBF, ICP are constant so an increase in one should cause a reciprocal decrease in one both remaining two Vice versa
137
Briefly explain the relationship between CPP/MAP and ICP
Cerebral perfusion pressure is the effective pressure that results in blood flow to the brain CPP = Mean Arterial Pressure – Intracranial Pressure
138
Define CPP;
Cerebral perfusion pressure
139
Explain Cushing's triad;
Refers to a set of signs that are indicative of increased intracranial pressure Consists of bradycardia Irregular respirations Widened pulse pressure Increase between systolic and diastolic pressure
140
What is the normal range for CO2?
35-45 mmHg
141
Define AHTR
Acute haemolytic transfusion reaction
142
Is this arterial waveform normal, under or over damped?
Normal
143
Is this arterial waveform normal, under or over damped? And what can cause it?
Overdamped Loose connections Air bubbles Kinks Clots Spasms No volume or low pressure in pressure bag and tubing
144
Is this arterial waveform normal, under or over damped?
Underdamped Increased vascular resistance Hypothermia tachycardia Excessive movement of the catheter within the artery leading to false high systolic or a false low diastrolic pressure
145
What is this capnography trace?
Oesophagus intubation Low level ETCO2 that quickly tapers off
146
What is this capnography trace?
CPR
147
What is this capnography trace?
ROSC Return of spontaneous circulation
148
What is this capnography trace?
Airway obstruction or apnoea Interrupted breaths
149
What is this ECG trace?
Sinus Arrhythmia
150
What is this ECG trace?
Normal sinus Rhythm
151
What is this ECG trace?
Sinus tachycardia
152
What is this ECG trace?
Sinus bradycardia
153
What is this ECG trace?
Paroxysmal supraventricular tachycardia PSVT Rate changes abruptly and unexpectedly
154
What is this ECG trace?
Ventricular tachycardia
155
What is this ECG trace?
Ventricular Fibrillation
156
What is this ECG trace?
asystole

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