ICP Panel Prep Flashcards

Question

Thrombolysis Treatment <75 No Renal Failure

Answer 1

Clopidogrel 300mg OR Enoxaparan 30mg IV Tenectaplase weight based IV 15 mins later Enxoparan 0.1mg/kg SC (max dose 100mg)

Answer 2

Clopidogrel 300mg OR Enoxaparan .75mg/kg SC (Max dose 75mg) Tenecteplase half of weight based dose IV

Answer 3

Clopidogrel 300mg OR Heparin 5000IU OR Tenectaplase weight based dosage IV (half dose for >75) 15 mins later Heparin 1000IU infusion per hour

Answer 4

5000 IU (1mL) into 50mL saline to make 100 IU per mL Commence at 10 mL per hour to achieve 1000 IU per hour

Answer 5

Atropine IV 600mcg repeat 600mcg @ 3-5 mins if required Adrenaline infusion 5mcg per min, increase by 5mcg/min at 2 min intervals to max of 20 per min (draw up 3mg of adrenaline into 47 ml D5W) Bolus adrenaline 5mcg intervals as required Transcutaneous Pacing

Answer 6

Modified valsalva x 2 Adenosine 6mg, repeat 12 mg at 2 mins, repeat 12mg at 2 mins if required. Sedate and cardioversion Sedate 2mg Midaz IV, repeat 1mg IV at 2 min intervals to max of 5mg Sync cardiovert 100j, repeat 200j

Answer 7

Caffeine, aminophylline and theophylline block the adenosine receptors and the full incremental dosage may be required. Carbamazepine (‘Tegretol’) can increase the level of atrioventricular block. Reduced dosage by half should be considered. Dipyramole (a platelet aggregation inhibitor) increases the plasma levels and cardiovascular effects of Adenosine. Reducing dose by half should be considered. Heart Transplant recipients should receive half doses.

Answer 8

Magnesium Infusion 2G over 10 mins Repeat once at 10 mins if nil or no response

Answer 9

Amiodorone infusion 5mg/kg IV (Max 300mg) over 20 mins once only (diluted with D5W to make 50ml)

Answer 10

If sedation required 2mg Midazolam IV, repeat 1mg at 2 min intervals max 5mg. Sync cardiovert 100j then repeat 200j if required If reversion amidorone infusion as stable VT

Answer 11

Hypothermic Cardiac Arrest <30°C If VF/VT is present, then Defibrillate 200j. If after 3 defibrillation attempts VF/VT persist, then delay further defibrillation attempts until the patient’s temperature is >30°C. Withhold adrenaline and amiodarone until the patient’s temperature is >30°C. Hypothermic Cardiac Arrest >30°C If VF/VT is present, then Defibrillate 200j every 2 minutes. Administer Adrenaline and Amiodarone as indicated. The standard interval between drug administration should be doubled.

Answer 12

If chest clear 250ml bolus up to 20ml/kg Adrenaline infusion 3mg to make up 50ml D5W. Start at 5mcg / min, increased by 5mcg/min 2 minutely to max of 20mcg Adrenaline bolus upto 100mcg as required

Answer 13

Heparin is a large, negatively charged molecule that does not undergo renal elimination to a significant extent. Instead, it is mainly metabolized in the liver and reticuloendothelial system. Since heparin is not primarily excreted by the kidneys, it does not accumulate in patients with renal failure, and its anticoagulant effect is not significantly altered in this population. Enoxaparin is a low molecular weight heparin (LMWH) that is partially eliminated by the kidneys. It undergoes both renal and hepatic metabolism. In patients with renal failure, the clearance of enoxaparin is reduced, leading to its accumulation in the body.

Answer 14

If BP <100 or HR >100 20 ml/kg normal saline If BP still <100 or HR >100 20ml/kg normal saline After 40ml/kg consult for further 20ml/kg if required

Answer 15

Pt with isolated neurogenic shock can be given up to 500ml Normal Saline bolus to correct hypotension. No further fluid should be given if SCI is the sole injury. Penetrating Trunk Injury, suspected aortic aneurysm or uncontrolled haemorrhage - Accept palpable carotid pulse with adequate conscious state and transport immediately

Answer 16

Prior to removing force: Supplemental oxygen 500ml bolus normal saline If hyperkalemia suspected 50ml sodium bicarb IV

Answer 17

Infant 15-20 ventilations / min Small child 10-15 ventilations / min Large child 8-12 ventilations / min

Answer 18

Infusion: Morphine/Midaz: 0.1-0.2mg/kg/hour OR Fentanyl/Midaz: 1-2mcg/kg/hr + 0.1-0.2mg/kg/hour Bolus: Morphine/midaz: 0.1mg/0.1mg/kg Fent/Midaz: 0.1mg/1mcg/kg as required

Answer 19

Correct Hypoxia Chest compressions if <60 in infants or <40 in children Adrenaline 10mcg/kg IV repeat 3 minutely as required Normal saline 20ml/kg Consult for pacing if required

Answer 20

Valsalva Adenosine 100mcg/kg IV After 2 mins Adenosine 200mcg/kg IV If unresponsive consider cardioversion If sedation required 50mcg midazolam / kg IV repeat at 2 min intervals (Max 200mcg/kg) Sync cardiovert at 1 j / kg

Answer 21

Paracetamol 15mg/kg Ibuprofen 10mg/kg Fentanyl IN Small child (10-24kg) 25mcg repeat 3 times Fentanyl IN Large child (>25kg) 50mcg repeat 3 times Methoxyflurane 3ml repeat once Morphine IM 0.1mg/kg (max 5mg) consult for further dosages Morphine IV 0.05mg/kg repeat 5 mins. Consult after 0.2mg/kg Fentanyl IV 0.5mcg /kg repeat 5 mins. Consult after 2mcg/kg Medical consult for ketamine 0.5mg/kg

Answer 22

5mg/5ml Nebulised Adrenaline 600mcg/kg IV/IM/Oral Dexamethasone

Answer 23

Salbulatoml pDMI (Repeat 20 mins) 1-5 years 6 puffs >6 years 12 puffs Ipratropium PDMI (Repeat 20 mins max 3 times) 1-5 years 4 puffs >6 years 8 puffs Salbulatmol IB neb 1-5 years 2.5mg Salbutamol + 250mcg IB >6 years 5mg Salbutamol + 500mcg Adrenaline IM 10 mcg per kg max 500mcg repeat 5 mins Normal Saline up to 20ml/kg Dexamethasone 600mcg/kg (max 8mg) IM /IV /ORAL Adrenaline infusion 0.1mcg/kg/min titrated to response or adverse effects Magnesium 50mg/kg (max 2G) Infusion over 20 mins

Answer 24

Ondansatron 0.1 mg/kg IV or IM (max 4mg) only in patients over 2

Answer 25

Glucagon IM <25kg 0.5 IU >25kg 1 IU Glucose IV 10% 500mg/kg or 5ml/kg with 10ml saline flush Repeat same at 5 min intervals as required

Answer 26

10ml kg normal saline IV

Answer 27

Midazolam 0.15mg/kg IV / IM (max 10mg) Repeat IV at 5 mins OR IM at 10 mins Consider intubation

Answer 28

10mcg / kg IM Adrenaline (max 500mg) repeat at 5 min intervals (Salbutamol / IB / adrenaline Neb as per relevant guidelines) Adrenaline infusion commencing at 0.1mcg/kg/min tirated to response max starting rate 10mcg per minutes Saline 20ml/ kg, repeat same then consult

Answer 29

Atropine 20 mcg/kg IV Repeat same at 5 mins

Answer 30

Narcotics: Naloxon 10mcg / kg IM/IV Repeat same IV at 5 mins (Max 400mcg per bolus total max 2mg) TCA overdose: Hyperventilate to aims for CO2 of 25-30 Sodium Bicarbonate 2ml/kg IV over 2 minutes Repeat after 10 mins if symptoms persist

Answer 31

Patients must meet ALL 4 criterion to satisfy the criteria. Capillary Refill >3 seconds Cold Extremities Fast pulse Weak Pulse: For children under one year old, assess the brachial pulse. For all other children assess the radial pulse.

Answer 32

Normal Saline 10ml/kg IV Repeated once after 15 mins Ceftriaxone 50mg / kg if over 1 hour from hospital on consult Adrenaline infusion starting at 0.1mcg/min on consult

Answer 33

Ketamine is an intravenous anesthetic agent (NMDA receptor antagonist). By blocking NMDA receptors, ketamine inhibits the excitatory effects of glutamate, leading to decreased neuronal excitability. This contributes to its analgesic and anesthetic effects. Secondarily also interacts with: Opioid Receptors: Ketamine has some affinity for opioid receptors (may contribute to its analgesic properties), Monoaminergic Receptors (affecting the reuptake of neurotransmitters serotonin, norepinephrine, and dopamine), Cholinergic Receptors (inhibits nicotinic acetylcholine receptors) At lower doses it is a significant analgesic whilst preserving airway reflexes and respiratory drive. There is minimal haemodymanic compromise as Ketamine acts as a sympathomimetic which may lead to transient tachycardia and hypertension. Ketamine produces a dissociative state that in a small number of patients may potentially cause them to have issues with perception resulting in disinhibition or emergence phenomenon.

Answer 34

Known hypersensitivity Age <1 year Traumatic Head Injury Hypertension BP > 180mm Hg sys, 100mm Hg Dia Suspected Acute Coronary Syndrome Suspected Heart Failure Known Hydrocephalus or raised intraoccular pressure

Answer 35

Age > 60yrs Prior administration of midazolam or other CNS depressant drugs Significant hypovolaemia Globe injury Complex facial injuries and factures Impaired respiratory function Symptoms of psychosis

Answer 36

Dissociation and trance like state Potential transient hypertonicity and nystagmus Disinhibition – disturbed perception Emergence Hypertension, Tachycardia CNS and rarely respiratory depression Hypersalivation Vomiting Laryngospasm

Answer 37

Draw up 1ml (5mg) of GTN with 49ml D5W (makes solution of 5mg in 50ml)

Answer 38

Start 10 mcg/min / 6ml/hour in conjunction with CPAP. Increase in 10 mcg intervals every 3-5 minutes. Consider decreasing if BP drops below 120systolic.

Answer 39

20 - 40mg IV (if evidence of fluid overload)

Answer 40

A hypertonic crystalloid solution which contains sodium and bicarbonate ions in a solution of high pH This raises Raises pH by increasing plasma bicarbonate levels, which are known to buffer excess hydrogen ion concentration

Answer 41

Symptomatic Tricyclic Antidepressant (TCA) overdose or hyperkalaemia Crush Syndrome with evidence of hyperkalaemia Cardiac arrest with suspected hyperkalaemia or TCA overdose

Answer 42

100ml Sodium bic given over 3 minutes Consider consult for further dosages

Answer 43

Both 0.5mg / kg Max dose paed 20mg Max dose adult 40 mg

Answer 44

Furosemide is a potent loop diuretic that acts on the kidneys to ultimately increase water loss from the body. Causes venous dilatation and reduces venous return

Answer 45

Nil of significance

Answer 46

Hypotension

Answer 47

Hypotension Dysrhythmia due to electrolyte imbalance

Answer 48

A local anaesthetic agent. Prevents initiation and transmission of nerve impulses causing local anaesthesia (1% solution). Specifically targets voltage-gated sodium channels located on the membranes of nerve cells and inhibits sodium influx. This inhibition of sodium ion movement effectively stops the depolarization of the neuron, preventing the initiation and propagation of the action potential. Also is class 1B antiarrhythmic: works by blocking fast voltage-gated sodium channels (reduces the rate of depolarization/phase 0 during the action potential). Decreases the automaticity of these abnormal pacemaker cells

Answer 49

Known hypersensitivity Bradycardia with inadequate perfusion Evidence of 2° or 3° heart block

Answer 50

When using Lignocaine 1% as diluent for IM Ceftriaxone it is important to rule out inadvertent IV administration due to potential CNS complications

Answer 51

Asthma Pts <16 Pts with inadequate respiratory effort Heart failure with hypotension GCS <13 Pneumothorax Facial injury or facial deformity Epistaxis

Answer 52

600ml blood loss first 24 hours or excessive haemorrage 1-6 weeks post partum High flow oxygen 10-15L Fundal massage / void bladder / infant suckle Oxytocin 10 IM repeat 10 IM at 5 minutes Oxytocin 20 units in 20ml NS infusion at 10 units per hour TXA 1G over 10 minutes External aortic compression Bimanual aortic compression

Answer 53

Causes contraction of the uteration and vascular smooth muscle General Vasocontriction

Answer 54

Known allergy Past history of pre-eclampsia Hypertension

Answer 55

Adrenaline infusion 3mg of 1:1000 Adrenaline added to 47ml D5W = 60mcg/ml Infusion rate 1mls/hr = 1mcg/min titrated up or down according to response

Answer 56

Adrenaline Infusion pump unavailable Mix 500mcg (0.5ml) of 1:1000 Adrenaline with 500ml Normal Saline = 1mcg/1ml Start Adrenaline infusion at 10ml/min (10mcg/min - 200 drops per minute) titrating up or down according to response.

Answer 57

Symptomatic signs and symptoms: Rate related severe or persistent chest pain Shortness of breath with crackles

Answer 58

Unstable signs and symptoms: Congestive cardiac failure Systolic BP < 80mmhg GCS < 13 Rapidly deteriorating

Answer 59

HR >100 Sustained >30 seconds QRS>0.12secs Mostly regular AV dissociation / absence of p waves

Answer 60

Less than adequate perfusion Positive R wave >3mil in AVR Progressively widening QRS >0.12 QT prolongation > 1/2 R-R interval QTc >500msec

Answer 61

Pharmacology: A naturally occurring Alpha and Beta-adrenergic stimulant, primarily acts on adrenergic receptors, which are divided into two main types: alpha (α) receptors and beta (β) receptors. Beta 1: Increases pulse rate by increasing S.A. Node firing rate, Increases conduction velocity through the A.V. Node, Increases myocardial contractility, Increases the irritability of the ventricles Beta 2: Causes bronchodilatation, Causes Glycogenolysis and Lipolysis Alpha: Causes peripheral vasoconstriction and subsequent Increased Peripheral Resistance.

Answer 62

Droperidol exerts its effects primarily by antagonizing dopamine receptors in the brain. By blocking dopamine receptors, droperidol reduces the activity of dopamine, which can help alleviate symptoms of agitation, psychosis, and hyperactivity. This leads to a calming effect on the patient, contributing to sedation. Highly effective in preventing and treating nausea and vomiting (antagonist of dopamine D2 receptors. These receptors are found in high concentrations in the chemoreceptor trigger zone (CTZ) of the brain, which is an area that detects toxins in the blood and triggers the vomiting reflex.)

Answer 63

Maintains a constant positive pressure throughout the respiratory cycle which keeps the alveoli splinted open assisting gas exchange by increasing the surface available for gas exchange reducing VQ mismatch. Increasing intrathoracic pressure may also reduce preload (elevated pressure in thoracic cavity compresses large veins reducing return to the heart).

Answer 64

Principally, a vascular smooth muscle relaxant: Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload) and Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces after load). GTN is metabolized primarily in vascular smooth muscle cells to produce nitric oxide. NO activates guanylate cyclase in the vascular smooth muscle, increasing the production of cyclic guanosine monophosphate (cGMP). Elevated cGMP levels lead to the dephosphorylation of myosin light chains, resulting in relaxation of smooth muscle cells and vasodilation. The effects of reducing preload and afterload: reduce myocardial oxygen demand, reduce systolic, diastolic and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure, Mild collateral coronary arterial dilatation may improve blood supply to ischemic areas of myocardium, Mild tachycardia secondary to slight fall in blood pressure.

Answer 65

Smaller Airway Relatively larger tongue and smaller oral cavity Infants have a relatively larger occiput Infants are nose breathers first 4-6 months of age Trachea is more cartilaginous and soft - The narrowest part of a paediatric airway is the cricoid cartilage (compared with the vocal cords in adults). This is located just below the vocal cords.

Answer 66

Histamine binds to H1 receptors in the smooth muscle lining the bronchi, causing bronchoconstriction. Leukotrienes are much more potent than histamine in causing bronchoconstriction. Increase smooth muscle contraction, mucus production, and vascular permeability. Prostaglandin D2 is a potent mediator that can exacerbate hypotension and bronchoconstriction.

Answer 67

Histamine is a potent vasodilator Leukatrines increased vascular permeability Prostaglandin D2 is a potent mediator that can exacerbate hypotension and bronchoconstriction

Answer 68

Acute stage of treatment high focus on timely adrenaline administration and supportive measures. Typically used in the post-acute phase to prevent a recurrence of symptoms and manage lingering inflammation. Any benefits are unproven

Answer 69

The electrical impulse delivered by the pacing device depolarizes the heart muscle cells, causing them to contract. This depolarization essentially forces the heart to beat at the desired rate set on the pacing device.

Answer 70

Suspected pnueomothorax with decreasing conscious state AND/OR reduction of perfusion.

Answer 71

Hypovolaemia, Oxygenation, Tension Pneumothorax, Tamponade

Answer 72

Midazolam binds to specific sites on the GABAa receptor, a ligand-gated chloride channel. When midazolam binds to the GABAa receptor, it increases the receptor's affinity for GABA. This potentiation enhances the inhibitory effects of GABA. The enhanced GABA binding leads to increased opening of the chloride channels, allowing more chloride ions to enter the neuron. The influx of chloride ions into the neuron causes hyperpolarization of the neuronal membrane. Hyperpolarization makes it more difficult for the neuron to reach the threshold potential needed to fire an action potential. This hyperpolarization effectively reduces neuronal excitability, thereby dampening abnormal electrical activity that characterizes seizures.

Answer 73

Peaked T waves P wave widening/flattening, PR prolongation Bradyarrhythmias: sinus bradycardia, high-grade AV block with slow junctional and ventricular escape rhythms, slow AF Conduction blocks (bundle branch block, fascicular blocks) QRS widening with bizarre QRS morphology