Section 1 Tintinalli

Question 1

First step for airway assessment

Answer 1

ABCs

Question 2

What should be done prior to initiation of advanced airway techniques?

Answer 2

Reposition head with head tilt-chin lift and preoxygenate

Question 3

Size of blade and type for intubation

Answer 3

Curved: no 3 or 4
Straight: no 2 or 3

Question 4

Size of tube for intubation by gender

Answer 4

Women: 7.5 to 8.0 mm cuffed
Men: 8.0 to 8.5 mm cuffed

Question 5

How to confirm placement?

Answer 5

End tidal co2, capnography, tube length 23 men and 21 women from 2 cm above carina

Question 6

Complications of intubation

Answer 6

Esophageal intubation or mainstream leading to hypoxia or Neuro injury

Question 7

Conditions which can cause difficulty bagging

Answer 7

2 of the following:
Facial hair
Obesity
No teeth
Advanced age
Snoring

Question 8

Conditions which can cause difficulty intubating

Answer 8

Facial hair
Obesity
Short neck
Short/long neck
Airway deformity

Question 9

Which drugs can be used for RSI in what dosages?

Answer 9

Fentanyl - 3 mcg/kg, normotensive pt with aortic dissection, intracranial pressures, cardiac ischemia

Etomidate - 0.3 milligrams/kg, good for most pt

Propofol - 0.5 - 1.5 milligrams/kg, normotensive pt

Ketamine - 1 - 2 milligrams/kg, pt with bronchospasm and hypotensive

Question 10

Definition of failed airway

Answer 10

3 unsuccessful attempts

Question 11

Paralytic used for RSI with dose and indication

Answer 11

Succinylcholine - 1.0 to 1.5 milli/kg, rapid onset rapid off, not used in Neuro musc disorders, burns cuz of hyperkalemia, denervation injury

Rocuronium - 1 milli/kg non depolarizing

Question 12

TX of sinus arrhythmia

Answer 12

No tx

Question 13

PAC causes

Answer 13

Stress, fatigue, alcohol, tobacco, coffee, copd,dig tox, cad,

Question 14

PAC tx

Answer 14

1. Stop Meds
2. Tx underlying disorders
3. If get tachy sustained beta-antagonist like metoprolol

Question 15

Tx of unstable Brady

Answer 15

Transcutaneous pacing

Question 16

Tx of sx Bradycardia

Answer 16

Atropine 0.5 mg IV push 3-5 min

Epi 2-10 mcg/min or dopamine 3-10 mcg/kg/min

Question 17

Tx of sinus tachy

Answer 17

diagnose and treat underlying cause

Question 18

SVT causes

Answer 18

rheumatic heart disease, acute pericarditis, MI, mitral valve prolapse

Question 19

TX of SVT unstable

Answer 19

cardioversion, synchronized

Question 20

Tx of SVT stable

Answer 20

1. vagal maneuvers
2. adenosine 6 mg, IV flush, then 2 min 12 mg, then 12 mg
3. Ca channel blockers (dilt 20 or verapamil 3-10 mg), beta blockers esmolol 500, metoprolol 5, propranolol 0.1
4. dig 0.4-0.6

Question 21

afib causes

Answer 21

idiopathic, HTN, ischemic heart disease, rheumatic hear disease, alc use, COPD, thyrotoxicosis

Question 22

afib tx unstable

Answer 22

synchronized cardiovert

Question 23

afib tx stable

Answer 23

• longer than 48 hours, heparin before cardioversion or echo before cardio
• rate control: dilt 20 mg then IV infusion or another dilt in 15 min
• -> verapamil, metoprolol, dig, procainamide (WPW)
• impaired cardiac function (EF

Question 24

MAT tx

Answer 24

treat underlying disorder

• rate control with verapamil or dilt
• mg
• fix potassium

Question 25

diagnosis of nonsustained vtach?

Answer 25

3 or more PVCs in a row

Question 26

tx of vtach, pulseless

Answer 26

unsynchronized cardioversion at 100J, same as unstable patients

Question 27

tx of vtach, stable

Answer 27

amio 150 mg over 10 min, bolus every 10 min up to 2 g

Question 28

tx of vtach (torsades)

Answer 28

overdrive pacing at 120, mg sulfate 1-2g over 60-90 seconds, isoproterenol

Question 29

tx of vfib

Answer 29

- defib at 200 J and 360, CPR, check pulse and defib - 2 rounds of CPR unsuccessful give amio 300 mg IV push, lidocaine 1.5 mg/kg IV for 3 doses with the CPR defib cycle - 3rd CPR cycle give epi 1 mg IV push or vasopression 40 units IV push with flush - mg sulfate

Question 30

tx of second degree Mobitz 2 AV block

Answer 30

atropine 0.5 to 1 mg IV bolus q 5 min up to 2 mg | - transcutaneous cardiac pacing, transvenous pacing

Question 31

tx of 3rd degree AV block

Answer 31

transcutaneous pacing in unstable pt | - transvenous pacing

Question 32

TX of PEA

Answer 32

intubate, CPR, epi 1:10000 every 3 to 5 min, or ET tube

Question 33

formula for size of ET tube in children

Answer 33

(16 + age)/4

Question 34

common cause of dysrhythmias in infants and children

Answer 34

respiratory insufficiency or hypoxia

Question 35

defib dose in children?

Answer 35

2 J/kg with 1-2 min CPR

Question 36

synch cardioversion in children?

Answer 36

0.5 J/kg

Question 37

Sx of hyponatremia?

Answer 37

nausea, weakness, HA, agitation, hallucination, cramps, confusion, lethargy, seizures

Question 38

tx of hyponatremia?

Answer 38

- NS for volume deficits - euvolemic or hypervolemic, restrict fluids - severe rapid hyponatremia give hypertonic saline at 25-100 mL/h, corrected at 0.5 mEq/L/h or 1.0, no more than 12 per day

Question 39

cause of hypovolemic hyponatremia?

Answer 39

extrarenal (3rd spacing burns, sweating, vomiting, diarrhea) renal diuretic, aldosterone deficiency, salt wasting, osmotic diuresis

Question 40

cause of euvolemic hyponatremia

Answer 40

siADH, stress/pain, myxedema, asddison, sheehan, drugs, water intox

Question 41

cause of hypervolemic hyponatremia

Answer 41

renal failure (urine Na >20) cirrhosis, CHF, nephrotic

Question 42

cause of hypervolemic hyponatremia

Answer 42

renal failure (urine Na >20) cirrhosis, CHF, nephrotic syndrome (urine Na