resuscitation trigger

Question 1

Decreased SVR
Decreased preload
Mixed CO

is what kind of shock

Answer 1

distributive shock

Question 2

Increased SVR
Decreased Preload
Decreased CO

Answer 2

Hypovolemic shock

Question 3

Increased SVR
Increased preload
Increased afterload
Decreased CO

Answer 3

cardiogenic shock

Question 4

decreased preload
increased SVR
decreased CO

Answer 4

obstructive shock

Question 5

etiologies of sepsis, neurogenic shock and anaphylaxis are all causes of what type of shock

Answer 5

distributive

Question 6

hemorrhage, capillary leak, GI loss and burns are all causes of what kind of shock

Answer 6

hypovolemic

Question 7

MI, dysrhythmias, HF, and valvular disease are all etiologies of what kind of shock

Answer 7

cardiogenic

Question 8

PE, pericardial tamponade, and tension pnx are all etiologies of what kinds of shock

Answer 8

obsructive

Question 9

what is the pathophysiology behind cardiogenic shock?

Answer 9

Left Ventricular failure to deliver o2.

leads to hypotension, systemic vasoconstriction, increased cardiac ischemia

Question 10

how do you treat cardiogenic shock initially in the ED

Answer 10

1. airway
2. continuous cardiac monitoring
3. IV access
4. fluid bolus and vasopressors

do PCI or CABG

Question 11

this is characterized by widespread inflammation and organ distress initiated by any type of microorganism

Answer 11

septic shock

Question 12

what four things must be present to be considered septic shock

Answer 12

1. sepsis
2. required resuscitation
3. required vasopressors
4. elevated lactate

Question 13

an elevated lactate with normal vital signs indicates the possibility of __________ in a patient with suspected sepsis

Answer 13

occult shock

Question 14

what is the first line med for refractory hypotension in septic shock? how much fluids do we typically give to these paients?

Answer 14

Norepinephrine

• 1-2 bolus to start out
• if not better and no evidence of volume overload, you can give more.
• 3-5 L often needed in the first 6 hours.

Question 15

this type of shock results from blood pooling in the distal circulations with resultant hypotension

Answer 15

neurogenic shock

Question 16

pt presenting with warm and dry skin, bradycardia, and hypotension. what type of shock is possible in this patient if all other causes of hypotension are ruled out? how would you treat this?

Answer 16

neurogenic shock

vasopressors

Question 17

look at this in case she cray

Answer 17

Question 18

what motion moves the hyoid bone anteriorly and lifts the epiglottis away from the laryngeal inlet?

Answer 18

extension of the neck with anterior displacement of the mandible

this is not sniffings

Question 19

what position may relieve upper airway obstructions and require less neck extension

Answer 19

forward flexion of the neck in addition to extension

(place folded towel , not rolled, or foam rubber device under pts occiput)

Question 20

do you do sniffing or neck extension for airway in pts with cervical spine injury?

Answer 20

NOOOOO

Question 21

if no gag reflex is present, what kind of airway can you place

Answer 21

oropharyngeal airway

Question 22

if a patient has an intact gag reflex or has facial trauma, what kind of airway can you use

Answer 22

nasopharyngeal

Question 23

beard, obesity, old, no teeth and snoring are all things that would make ___________ difficult

Answer 23

mask ventilation

Question 24

beard, obesity, short neck, short/long chin, and airway deformities are all things that would make ______________ difficult

Answer 24

intubation

Question 25

IV Etomidate is the MC _______

Answer 25

RSI sedative

Question 26

what patients should avoid propofol as a RSI sedative

Answer 26

hypotensive paients

Question 27

ketamine as an RSI sedative would be particularly useful in what patients

Answer 27

pts w bronchospasms or hypotension

Question 28

what is the preferred medication among the paralytics? why?

Answer 28

succinylcholine -> fast on/off

Question 29

you are intubating a patient who has gone into hypovolemic shock after being admitted to the hospital 6 day ago with widespread burns. her BP is 70/38 and she has a HR of 168. what medications are you going to use prior to the RSI? why?

Answer 29

- Ketamine as the sedative d/t hypotension - rocuronium as paralytic. see below -NOT succinylcholine (paralytic) because burn >5 days old

Question 30

you are intubating a patient with a hx of myasthenia gravis and a BP of 118/76, what is your choice of medications for this RSI

Answer 30

- etomidate or propofol would both be fine sedatives - Idk what paralytic to use but DONT USE RECRONIUM OR SUCCINYLCHOLINE!!!! both CI in myesthenia gravis

Question 31

what increases the risk of hyperkalemia with the use of succinylcholine

Answer 31

burns older than 5 days and denervation injury older than 7 days.

Question 32

what the hell is this chart, idk

Answer 32

Question 33

A peripheral access line must be proximal and well secured in order to use it to administer what medication

Answer 33

vasopressors

Question 34

sclerosing agents, conc glucose or electrolytes, and cytotoxic chemo agents are CI in what

Answer 34

infusion via peripheral line

Question 35

shock at 200J and initiate CPR

Answer 35

V fib Vtach WITHOUT a pulse

Question 36

what medications can be used after administration of epinephrine

Answer 36

amiodarone or lidocaine

Question 37

DO NOT SHOCK, instead assess ABCDEs, reversible causes, give EPI and continue CPR

Answer 37

dysrhythmias-asystole/PEA

Question 38

if youre feeling up to it, look at this chart

Answer 38

Question 39

when do you use vagal maneuvers, adenosine (12, 6, 6), and rate control if all else fails.

Answer 39

SVT (AVNRT and AVRT)

Question 40

manage with BB, CCB and cardioversion if resistent

Answer 40

Afib/flutter

Question 41

how would you treat Afib with RVR, hypotension, MI, or pulmonary edema

Answer 41

URGENT cardioversion!

Question 42

when is electric cardioversion unlikely to succeed in an unstable afib patient? what do you do instead?

Answer 42

if the pt has long-standing afib initiate hemodynamic resuscitation and ventricular rate control.

Question 43

rate control, oral anticoags, and follow up in 3-4 weeks is used in what pts

Answer 43

stable low risk afib

Question 44

when do you use procainamide/amiodarone

Answer 44

Vtach WITH a pulse if no pulse, shock at 200j

Question 45

if a pt with arrhythmias has a HR of 42 with a BP of 80/50 what is the treatment

Answer 45

emergent transcutaneous pacing this is also the treatment when there are bradyarrhythmias with structural disease of infranodal conduction system

Question 46

Mobitz type II 2nd degree HB and 3rd degree HB are the most associated heart blocks with whatt?

Answer 46

with needing emergent treatment (cardioversion)

Question 47

what are the 4 clinical features of a BRUE

Answer 47

1. cyanosis/pallor 2. absent/decreased/irregular bleeding 3. marked change in tone 4. altered level of response

Question 48

what are the 4 RFs of BRUEs in peds pts

Answer 48

1. feeding difficulties 2. recent URI symptoms 3. <2mo old 4. hx previous episodes

Question 49

in order to be low risk for recurrence a peds pt, what all has to be present

Answer 49

1. >60 days old 2. if preemie, must have GA>=32 wks os postconceptual age of 45+weeks 3. 1 BRUE only 4. BRUE <1min 5. No CPR needed 6. no concerning historical features 7. no concerning PE findings

Question 50

what is the pH limit that warrants NO resuscitation in SIDS baby:(

Answer 50

do NOT resuscitate if pH<6

Question 51

how high does temp have to be to stop resuscitation in a peds pt who had electrical activity and hypothermia on arrival.

Answer 51

30C

Question 52

7 indications for ETT

Answer 52

1. resp failure 2. Apnea 3. reduced LOC (GCS<8) 4. rapid change in mental status 5. airway injury or impending airway compromise 6. high risk for aspiration 7. trauma to larynx