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ctjghjkbgf > Resuscitation and Pharmacology > Flashcards

Resuscitation and Pharmacology Flashcards

1
Q

Pediatric differences in anatomy/ physiology and how they relate to trauma (5)?

A
  1. Inc BSA = inc heat loss
  2. Abdominal organs less protected
  3. More likely multi-organ trauma
  4. Developmental/ behavioral challenges
  5. Hypotension is a late finding
  6. Fluid requirements vary by age/ weight
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2
Q

Weight estimation by age?

A

(age x 2) + 8

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3
Q

Most common cause of hypoxemia in children?

A

V/Q mismatch

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4
Q

How to reposition airway if on c-spine precautions?

A

Jaw thrust

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5
Q

Components of pediatric assessment triangle?

A

C-B-C

Color, breathing, consciousness

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6
Q

2 types of respiratory failure?

A

Type 1 = hypoxic

Type 2 = hypoxia+ hypercarbia

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7
Q

List 5 sites for IO insertion

A 
proximal tibia
Distal femur
humerus
sternum
ASIS
proximal to medial malleolus
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8
Q

List 3 contraindications to IO insertion

A

recently fractured bone, osteogenesis imperfecta, osteopetrosis, IO use in same limb

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9
Q

Complications of IO use

A

extravasation, epiphyseal injury, fracture, compartment syndrome, fat embolism, thrombosis

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10
Q

How does the pediatric airway differ from the adult airway?

A
  • larger tongue
  • larynx more anterior/ superior
  • epiglottis is U-shaped, floppy
  • larger occiput
  • cricoid is the narrowest part
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11
Q

Equipment required for intubation?

A

SOAP ME

Suction, oxygen, airways, pharmacology/personnel, monitors/ meds

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12
Q

How to estimate ETT size?

A

Age/4 +4 = uncuffed tube (subtract 0.5 for cuffed)

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13
Q

When is a cuffed tube preferred?

A
  • airway diameter may change over course of treatment (ie. inhalational injury, angioedema)
  • risk of aspiration
  • need for higher ventilator pressures (bronchiolitis, asthma, CLD)
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14
Q

Etomidate, what is the advantage, what are 2 disadvantages?

A

Advantage: rapid onset and recovery, minimal HD effects
Disadvantage: adrenal suppression, vomiting, resp depression, myoclonus

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15
Q

Ketamine - advantages and disadvantages

A 
Advantages: good for shock/hypotension, preserves airway reflexes and respiratory drive, bronchodilator
DisadvantagesL vomiting ( 5-10%), apnea, laryngospasm, emergence delirium, sialagogue (increases oral secretions)
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16
Q

When is atropine recommended for intubation, according to ACEP?

A

recommended for children < 1 years old, those being intubated with succinylcholine or pts with bradycardia

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17
Q

succinylcholine – 4 contraindications

A
  1. Elevated CK or K (rhabdo, burns/crush/trauma (usually 48-72 hrs later), muscular dystrophy/myopathies
  2. Risk of malignant hyperthermia

Relative

  1. Increased ICP or increased intraocular pressure (theoretical risk w/ fasciculations that can raise this)
  2. Known pseudocholinesterase deficiency (myasthenia gravis) due to prolonged duration of action
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18
Q

If intubated patient deteriorates, consider

A
  • Displacement of the tube
  • Obstruction of the tube
  • Pneumothorax
  • Equipment failure
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19
Q

Indications of a difficult airway?

A 
LEMON:
Look 
Evaluate mouth opening/thyromental distance
Mallampati
Opening of the mouth
Neck mobility
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20
Q

3 ways to manage a difficult airway

A 
LMA
Esophageal combitube
Perilaryngeal sealer 
Bougie
Video laryngoscopy (glidoscope)
Crichothyroidotomy
21
Q

Good starting ventilator settings?

A

Pressure-control modes are preferred:

TV 7-10 ml/kg
RR at normal for age
PIP 20-25
PEEP 5-10

22
Q

Propofol - 4 advantages to using in ED?

A
  • Fastest onset action
  • Fastest recovery time
  • Reduced ICP
  • Can be combined with other agents – ketamine, fentanyl
  • Decreased incidence of post nausea
23
Q

3 indications for intubation?

A
  1. inadequate oxygenation
  2. inadequate ventilation
  3. airway protection
24
Q

What is the chain of survival after OHCA?

A

rapid access to EMS - rapid CPR - rapid defib - rapid advanced care

25
Q

Name epinephrine’s main action in CPR?

A

Increases coronary perfusion pressure - good predictor of ROSC

26
Q

What are 8 causes of PEA?

A

5Hs and 5Ts:
Hypoxia, hypothermia/hyperthermia, hypoglycemia, hypokalemia/hyperK, H+ (acidosis), Thrombus arterial or venous, tamponade, tension pneumothorax, toxins

27
Q

Initial defib dose?

A

2-4 J/kg –> 4J/kg –> max 10 J/kg or 200 J

adult = 200 J

28
Q

Compression/ventilation rate in CPR when intubated?

A

Asynchronous

Compressions 100-120 beats/minute but no interruptions + Ventilation 8-10 breaths/minute (or every 6-8 seconds).

29
Q

2nd line medications for V.fib /pulseless VTach?

A

lidocaine 1 mg/kg load followed by infusion or amiodarone 5 mg/kg

30
Q

5 things you do after achieving ROSC?

A

Prevent secondary injury/ongoing shock

target sats 94-99%
consider advanced airway if not yet intubated
avoid hypotension
avoid hypoglycemia
avoid hyperthermia
treat agitation/ seizures
arrange transport to tertiary pediatric center/PICU

31
Q

Adenosine side effects?

A

Flushing, Chest discomfort, Nausea, Headache, Transient sinus bradycardia or heart block, Bronchospasm (in asthmatic)

32
Q

What is the minimum dose of atropine?

A

Old question - 0.1mg, due to a study showing that very low doses are associated with mild slowing of the HR, but AHA says no minimum for intubation (0.02mg/kg)

33
Q

What are 2 indications for atropine use in the resuscitation of a pediatric patient?

A
  • Bradycardia with intubation

- Dec secretions

34
Q

What is the mechanism of action of atropine?

A

parasympatholytic drug –> increased HR by accelerating the sinus and atrial pacemaker and improving conduction through the AV node

35
Q

what is the name and location of receptor that acetylcholine acts on?

A

Acetylcholine receptor
Nicotinic and Muscarinic
Located at the neuromuscular junction (n) and other post ganglionic neurons (m)

36
Q

Fentanyl - 3 advantages aside from analgesia and one uncommon complication

A

HD stability, fast onset and off, fast time to peak effect

S/E: rigid chest

37
Q

Compare the cardiovascular effects of fentanyl and morphine and explain the difference

A

Morphine leads to histamine release –> hypotension.

Fentanyl is synthetic opioid, no histamine release, more HD stability

38
Q

List 4 indications for calcium administration

A

Calcium chloride = central, calcium gluconate = peripheral

- HyperK, hypoCa, CCB overdose, HypoMg

39
Q

What is target temperature after ROSC?

A

For infants and children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, it is reasonable to use either TTM 32°C to 34°C (for 48 hours) followed by TTM 36°C to 37.5°C (for 3 days) or to use TTM 36°C to 37.5°C

40
Q

Definition of wide QRS?

A

> 0.09 msec ( 2 small boxes)

41
Q

Features of SVT?

A

regular, HR > 220, no waves, not variable

42
Q

Dose of adenosine?

A

0.1 mg kg –> 0.2 mg /kg (max 6 mg, 12 mg)

43
Q

When to stop CPR in NRP?

A

Stop resuscitation after 10 minutes if HR remains undetectable

44
Q

What are two actions of epinephrine other than cardiac?

A

Alpha 1 = vasoconstriction
Beta 1 = cardiac contractility, inc HR
Beta 2 = bronchodilation

45
Q

Norepinephrine - main receptor, and effect on HR

A

alpha receptor = vasoconstriction

No effect on HR (some increase)

46
Q

Dobutamine - main receptor, and effect on HR

A

Increase HR, vasodilator (afterload reduction), beta-1 receptor

47
Q

Recommended laryngoscope sizing?

A

Size 0 = neonate
Size 1 < 2 years old
Size 2: 2-10 years old
Size 3: >10 years old

48
Q

How does milrinone work?

A

Lusitrope - peripheral vasodilation

Phosphodiesterase inhibitor—slows cyclic adenosine monophosphate breakdown

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