Emergencies and Resuscitation (HL1, NRP, PALS) Flashcards
(145 cards)
1
Q
Normal UO (infants, young children)
A
1.5-2 mL/kg/hr
2
Q
Normal UO (older children)
A
1 mL/kg/hr
3
Q
Hypotension (<1mo)
A
SBP<60
4
Q
Hypotension (1mo-1yr)
A
SBP<70
5
Q
Hypotension (>1yr)
A
SBP< 70 + (2 x age)
6
Q
Target end tidal CO2 during CPR
A
> 20mmHg
7
Q
Shockable arrest rhythms (2)
A
Vfib and pulseless Vtach
8
Q
Defibrillation doses
A
Initial shock: 2 J/kg
Second shock: 4 J/kg
9
Q
Indication for emergent cardioversion
A
Hemodynamically unstable patients with tachyarrythmias and palpable pulses
10
Q
Cardioversion doses
A
Initial shock: 0.5-1 J/kg
Second shock: 2 J/kg
11
Q
Emergency meds you can administer via ETT
A
NAVEL: naloxone, atropine, vasopressin, epinephrine, lidocaine
12
Q
Target RR during resuscitation
A
20-30 bpm (1 breath every 2-3 sec)
13
Q
Sellick maneuver
A
The use of cricoid pressure to minimize gastric reflux and aspiration
14
Q
How long should preoxygenate prior to endotracheal intubation?
A
At least 3 minutes
15
Q
What should set suction devide to during ET intubation?
A
-80 to -120 mmHg
16
Q
ETT size equation
A
ETT size = (age/4) + 4
17
Q
ETT depth equation
A
ETT depth (cm) = ETT size x 3
18
Q
4 common cuases for ET inbubation failure (alliteration)
A
DOPE:
Displacement
Obstruction, Pneumothorax
Equipment failure
19
Q
Adenosine indication & mechanism (in resuscitation)
A
SVT 2/2 AV node reentry or accesory pathways
Blocks AV node conduction
20
Q
Adenosine dosing (in resuscitation)
A
Initial: 0.1 mg/kg (IV), max 6mg wait 2min between doses
2nd: 0.2 mg/kg (IV), max 12mg
3rd: 0.3 mg/kg (IV), max 12 mg
21
Q
Adenosine side effects (in resuscitation)
A
Sense of doom, brief period of asystole
22
Q
Amiodarone indication and mechanism (in resuscitation)
A
Shock-refractory VF, VT or SVT
K channel blocker, prolongs QT and QRS
23
Q
Amiodarone dosing (in resuscitation)
A
5 mg/kg (IV/IO), max 300mg
24
Q
Amiodarone side effects (in resuscitation)
A
Polymorphic VT, hypotension, decreased cardiac contractility
25
Atropine indication and mechanism (in resuscitation)
Bradycardia (esp in rapid sequence intubation where also decreases oral secretions), cholinergic drug toxicity, 2nd/3rd degree AV block
Anticholinergic increases AV node conduction
26
Atropine dose (in resuscitation)
0.2 mg/kg (IV/IM/IO), min 0.1 mg/dose, max 0.5 mg/dose. *repeat once every 5min* Max total 1mg (child) or 3mg (adolescent).
27
Atropine dose (rapid sequence intubation)
0.4-0.6 mg/kg
28
Atropine side effects
Tachycardia, myocardial ischemia, paradoxical bradycardia with too low dosing
29
Calcium chloride indication
Hypocalcemia, hyperkalemia, CCB overdose
30
Calcium chloride dose
20 mg/kg (IV/IO), max 1g
31
Calcium chloride side effects
Risk of myocardial necrosis, peripheral infoltration leading to tissue injury
32
Dextrose (in resuscitation) dose
0.5-1 g/kg (IV/IO).
Newborn: 5-10 mL/kg D10W
Infant/child: 2-4 mL/kg D25W
Adolescents: 1-2 mL/kg D50W
33
Epinephrine indication and mechanism (in resuscitation)
Asytole, PEA, VF, VT (give within 5 minutes). Diastolic hypotension, bradycardia.
Alpha agonism
34
Epinephrine dosing (in resuscitation)
0.01 mg/kg (IV/IO), max 1mg
Or, 0.1 mg/kg (ET), max 2.5 mg
*repeat every 3-5 min*
35
Epinephrine side effects
Tachycardia, ectopy, tachyarrythmias, hypotension
36
Lidocaine indication and mechanism (in resuscitation)
Shock-refractory VF, VT (second line after amiodarone). Used in ET intubation to prevent increase in ICP. Can use on status asthmaticus.
Na-channel blocker
37
Lidocaine dosing (in resuscitation)
1 mg/kg (IV/IO), max 100mg
Or, 2-3 mg/kg (ET)
*repeat every 5 minutes* Max 3 mg/kg in the first hour
38
Lidocaine side effects (in resuscitation)
Myocardial depression, AMS, seizures, muscle twitching
39
Mag sulfate indication and mechanism (in resuscitation)
Torsades, hypomagnesemia
Calcium antagonist decreases abnormal depolarizations
40
Mag sulfate dose (in resuscitation)
50 mg/kg (IV/IO), max 2g
41
Mag sulfate side effect
Hypotension, bradycardia
42
Naloxone dose (in resuscitation)
0.1 mg/kg (IV/IO/subQ/IM), max 2g
Or, 0.2-1 mg/kg (ET)
Or, 2-8 mg (IN)
*redose every 2 min prn*
43
Procainamide indication and mechanism (in resuscitation)
Refractory SVT, afib, aflutter, VT
Na-channel blocker
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Procainamide dose (in resuscitation)
Load 15-20 mg/kg (IV/IO) and infuse over 30-60 minutes
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Procainamide side effects
Proarrythmic, polymorphic VT, hypotension
46
Glycopyrrolate indication
Prevents hypersalivation and bradycardia in ET intubation, and preserves pupillary exam iso trauma (compared with atropine)
47
Glycopyrrolate dose (in ET intubation)
0.004-0.01 mg/kg (IV/IO/IM), max 0.1 mg
48
Etomidate (induction agent sedative) pros and cons
Pros: minimal CV side effects, can minimally decrease ICP
Cons: supresses adrenal corticosteroid synthesis, lowers seizure threshold, avoid in septic shock
49
Fentanyl (induction agent analgesic sedative) pros and cons
Pro: minimal CV effects, good in shock
Con: chest wall rigidity, bradycardia, respiratory depression
50
Ketamine (induction agent analgesic sedative) pros and cons
Pros: bronchodilation, abates bradycardia, increases HR and SVR, dissociative amnesia
Cons: hallucinations, hypersalivation, vomiting, laryngospasm
51
Midozolam (induction agent amnestic anxiolytic sedative) pros and cons
Pro: miniman CV effects
Cons: resp depression, hypotension
52
Propofol (induction agent sedative) Pros and cons
Pro: ultra short acting
Cons: myocardial depression, metabolic acidosis, paradoximal hypertension in children, avoid in shock
53
Succinylcholine (induction agent, depolarizing neuromuscular blockade) proc and cons
Pros: rapid onset, short acting, reversible with acetylcholinesterase inhibitor
Cons: hyperkalemia, increased ICP, intraocular and intragastric pressure, bradycardia, malignant hyperthemia
54
Succinylcholine (induction agent, depolarizing neuromuscular blockade) contraindications
NM disease, myopathies, spinal cord injuries, crush injury, burns, renal insufficiency
55
Rocuronium (induction agent, nondepolarizing neuromuscular blockade) pros and cons
Pros: minimal CV effects, reversible with sugammadex
Cons: decreased clearence in hepatic insufficiency, caution in patients with difficult airway
56
How is vecuronium different from rocuronium?
Longer time to paralysis
57
HFNC max flow
2 L/kg/min
(or ~12L/min for infants/toddlers, ~30L/min for children, and ~50L/min for adolescents)
58
Goal tidal volume (Vt) in mechanical ventilation to avoid volutrauma
4-6 mL/kg
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Goal peak inspiratory pressure (PIP) in mechanical ventilation to avoid barotrauma
<35 cmH2O
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Max FiO2 in mechanical ventilation to avoid oxygen toxicity
FiO2 < 60%
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Indications for SBT
FiO2<50%, PEEP=5, PIP<20, RR wnl, acid/base wnl
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What is the first and most sensitive VS change before shock?
Tachycardia
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What is something you should do in all etiologies of shock?
Administer 100% supplemental oxygen
64
Dobutamine mechanism and use (in shock)
Selective B1 agonist
For normotensive, poorly perfused shock
(Beware arrythmias)
65
Dopamine mechanism and use (in shock)
Stimulates NE release, direct alpha agonism at high doses. Ionotrope.
For shock with poor contractility
66
Milrinone mechanism and use (in shock)
Type 3 PDEi, ionodilator, improve CO with minimal effect on HR
For normotensive shock with myocardial dysfunction
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Epinephrine mechanism and use (in shock)
B1/B2/A1 agonist
Hypotensive shock, cold septic shock
68
Norepinephrine mechanism and use (in shock)
B1/A1 agonist
Warm shock, low SVR
69
Phenylephrine mechanism and use (in shock)
Pure A1 agonist
General vasoconstrictor
(Beware reflex bradycardia)
70
Vasopressin (ADH) use (in shock)
For cardiac arrest, refractory hypotension in septic shock, and GI hemorrhage
71
Blood product dose in hemorrhagic shock
10 mL/kg boluses of PRBCs
72
IM epi dose in anaphylaxis
0.01 mg/kg/dose, max 0.3mg/dose.
*redose every 5-15 minutes*
73
Definition of pulmonary hypertension
Resting mean pulmonary arterial pressure (PAP) >25 mmHg among children >3 months
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Hypertensive emergency definition
BP acutely >99%ile with signs of end organ damage (encephalopathy, vision disturbance, CHF, AKI)
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Hypertensive urgency definition
BP acutely >99%ile with NO signs of end organ damage
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What is a goal rate of correction of BP in hypertensive emergency/urgency?
reduce BP by 25% in the first 8 hours, then gradual normalization over the next 24-48 hours
77
4 meds you can use in a tet spell
ketamine (increases SVR, sedating), morphine (sedating, suppresses hyperpnea), phenylephrine (increases SVR), propranolol (increases ventricular filling)
78
Lethargy
depressed consciousness resembling sleep from which a patient may be briefly aroused by stimulation
79
Stupor
depressed consciousness resembling sleep from which a patient may be briefly aroused only with profound stimulation
80
GCS: what are the categories and how many points each?
EVM: Eye 4, Verbal 5, Movement 6
81
Initial management of symptomatic hyponatremia
3-5 mL/kg bolus of 3% HTS over 15-30 minutes until seizure stops or serum sodium >125
82
Complex febrile seizure definition
At least one of the following: duration >15 minutes, more than one within 24 hours, or focal onset
83
What pressure is diagnostic of elevated ICP?
At least 20 mmHg
84
When does the PDA close?
DOL 5-10
85
PE ECG finding
Sinus tachy with S1Q3T3
86
5 H's (reversible causes of PEA arrest)
Hypoxia, hypothermia, hypoglycemia, hyper/hypokalemia, hypovolemia, H+ (acidosis)
87
5 T's (reversible causes of PEA arrest)
Tension pneumo, tamponade, thrombus (PE, MI), toxins, trauma
88
Can FAST exam rule out IAI?
No. Sensitivity is not high enough. Willstill need CT or serial FAST exams.
89
Gold standard for diagnosis of IAI?
CT AP
90
5 P's of compartment syndrome
Pulselessness, pain, pallor, parasthesias, paresis
91
What about tetatus in trauma
DONT FORGET TO THINK ABOUT IT
92
NRP: first 3 things to pay attention to after birth?
Term gestation? Good tone? Breathing or crying? (i.e. Term Tone Breathing)
93
NRP: if neonate is not term, not good tone, or not breathing or crying, what do you do? (5 things)
1. Warm
2. Dry (if >32 weeks old)
3. Stimulate
4. Position airway
5. Suction if needed (in cases of complete airway obstruction)
94
NRP: target temperature
36.5 - 37.5 C
95
NRP: if infant is apneic/gasping OR HR<100, what do next (3)?
Start PPV within 60 seconds (RR 40). Place continuous pulse ox. Consider cardiac monitoring.
96
NRP: if infant has labored breathing or persistent cyanosis only with HR>100, what do next (3)?
Start pulse ox. Oxygen as needed. Consider CPAP (PEEP 5-8).
97
NRP: what to do if HR <100 despite PPV?
Ensure adequate ventilation. Intubate or larygneal mask. Cardiac monitor.
98
NRP: HR<60, what do next? (4 things to do or consider)
1. Intubate or supraglottic airway.
2. Start chest compressions (compression ventilation ratio 3:1) and recheck pulse every 60 seconds.
3. Start umbilical vein cath for epi. Redose epi every 3-5 minutes.
4. Consider hypovolemia, hypoglycemia and pneumothorax.
99
NRP: Newborn resuscitation is usually required due to _____.
Respiratory failure/ issues with ventilation.
100
NRP: 4 questions for OB to assess perinatal risk
1. Gestational age
2. Umbilical cord management plan
3. Meconium color
4. Any other risk factors?
101
NRP: ineligible infants, cord clamping may be delayed for how long?
30-60 seconds
102
NRP: what is the purpose of the initial rapid evaluation at birth?
to determine if the infant can stey with mom or needs to be moved to the radiant warmer
103
NRP: what ventilation parameneters should be used for PPV in term infants?
Flow: 10 L/min
FiO2: 21%
PIP: 20 mmHg (MAX 40)
PEEP: 5 mmHg
RR: 40-60 bpm
104
NRP: how should to estimate HR in neronatal resuscitation?
Auscultate the number of beats in 6 seconds and multiply by 10
105
NRP: in PPV, what FiO2 to use for infants <35 weeks?
21-30%
106
NRP: if PPV started but HR still <100 after 15 seconds, what do next? (hint: alliteration)
MR. SOPA to assess quality of PPV:
Mask adjustment
Reposition head
Suction mouth
Open mouth
Pressure: gradually increase up to 40 mmHg
Advanced airway
107
NRP: when should you consider placing an orogastric tube to decompress air from the stomach?
When an infant received CPAP or PPV for longer than several minutes
108
NRP: When can you d/c PPV?
When the infant has a atsbale HR above 100
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NRP: What is the most important indicator of successful PPV?
An increasing HR
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NRP: how long after starting PPV should you check the HR?
15 seconds
111
NRP: do not start compression or give meds until the infant has received adequate PPV (with chest rise) for how many seconds?
30 seconds
112
NRP: how do you measure how deep to place a orogastric tube?
From the nasal bridge to the earlobe and then from the earlobe to a point halfway between the xiphoid process and the umbilicus
113
NRP: where should you place a pulse ox in a neonate?
R hand or wrist (preductal)
114
NRP: if a neonate has adequate ventilation and HR but an O2 sat below expected ranges per minutes after birth, what shoudl you do?
Apply free flowing oxygen
115
NRP: how much must a neonate weight to use a largyngeal mask?
2kg
116
NRP: True or False. Intubare before starting compressions.
True
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NRP: equation to determine insertion depth for neonatal ETTs?
Distance between nasal septum to tragus + 1 cm
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NRP: how deep and where to do neonatal compressions?
1/3 the AP diameter, two thumbs together on the sternal body just below the imaginary line connecting the baby's nipples
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NRP: what is the compression to respiration ration and duration?
3:1, one cycle lasts 2 seconds
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NRP: how often should the HR be reassessed during compressions?
Every 60 seconds
121
NRP: what concentration of epi formulation should you use for resuscitation?
0.1 mg/mL
122
NRP: what are your two access options in neonatal resuscitation?
Umbilical vein (UVC) or IO (bonus: ETT!)
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NRP: suggested initial epi dose?
0.02 mg/kg (range 0.01 - 0.03)
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NRP: epi should be administered quickly with a stop cock and how many mLs of saline?
3 mL
125
NRP: if you suspect hypovolemia and want to use a volume expander, what crystalloid should you use, at what dose, over what time period?
9%NS at 10 mL/kg, over 5-10 minutes
126
NRP: what is the first step in resp distres in an infant with Robin sequence?
Prone positioning
127
NRP: for a patient with Robin sequence and respiratory distress, what is the second step after prone positioning
Place an endotracheal tube through the nose and into the pharynx
128
PALS: how long should yo feel for pulse before starting compressions?
10 seconds
129
PALS: what two pulses is it acceptable to feel for?
Carotid or femoral
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PALS: what pulse should you feel for in an infant?
Brachial
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PALS: if an infant or child has a pulse but is not breathing or breathing irregularly, what should you do?
Give 1 rescure breath every 2-3 seconds (RR 20-30)
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PALS: what is the compression to ventilation ratio for an infant or child if you are the SOLE rescuer?
30 : 2
134
PALS: what is the compression to ventilation ratio for an infant or child if there are TWO rescuers?
15 : 2
135
PALS: BP cuff should be X% the length of the humerus
50-75%
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PALS: hypoglycemia in the newborn definition
<45
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PALS: hypoglycemia in the child defnition
<60
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PALS: how to describe pediatric consciousness? (mneumonic)
AVPU
Alert
response to Voice
response to Pain
Unresponsive
139
PALS: mneumonic for secorndary assessment/history?
SAMPLE: Signs and Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading up to the event
140
PALS: What to do if c/f foreign body spiration in infant?
5 back blows and 5 chest thrusts
141
PALS: where to place pigtain catheter to decompress a tension pneumo in a child?
Second intercostal space at the midclavicular line (same as adults)
142
PALS: what gauge catheter to use to decompres a tension pneumo in a child?
18 ot 20 gauge
143
PALS: in what 3 situations of bradycardia is atropine better than epi?
1. cholinergic toxicity
2. increased vagal tone
3. primary bradycardia
144
PALS: sinus tach is usually less than X bpm in children
180
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