Special Circumstances Flashcards
(7 cards)
Hypothermia
- Pulse check up to 1 min with US (to confirm resp arrest).
- Double drug interval up to 35deg.
- No drugs until >30 deg.
- Shock VF up to 3x, if no success, defer until >30 deg.
- Prolong CPR until >30 deg.
- Normal CPR (30:2).
Refractory VT/VF - stacked shocks
3x stacked shocks: defib pads available within 20s.
Witnessed + Monitored environment eg ED, Cath lab, ICU.
Charging time <10s.
Drowning - Complications
Lung: ARDS, Aspiration pneumonitis, laryngospasm
CVS: Arrythmia
CNS: Hypoxic Ischaemic Encephalopathy, Seizures
Others: Hypothermia
Drowning - Management
A - Early intubation + Ventilation
B - ARDS - lung protective: TV 6ml/kg, PEEP 10-15, FiO2 0.2-1.0, RR 12-16/min, I:E 1:1.5
C - Warm IVF, IVF resus - 3rd spacing
D - remove wet clothing, bair hugger, Humidified O2
E - correct met acidosis
Rewarming
External: Remove clothing, Bair hugger, Blanket
Internal: Warm IVF, Lavage (Bladder/peritoneal), Humidified O2, ECMO
Pregnancy
Urgent O&G/NICU - > if >24/40
CPR higher on sternum. IV access above diaphragm.
Displace uterus to L 15-30 deg
Early intubation:
- Difficult BVM
- Reduced FRC -> rapid Hypoxia
- Increase aspiration : reduce gastric emptying.
- Use small ETT; airway oedema, friable tissue
Pregnancy - causes of arrest
PE
Amniotic fluid embolism
Eclampsia
Hemorrhage - PPH, Abruption
Ectopic
Resuscitative Hysterotomy
At 4 mins post arrest, aim baby out by 5 mins.
IF >24/40 (palpable uterus 4cm above umbilicus).
- Vertical midline incision through Skin, Subcut tissue.
- Blunt dissect rectus muscle exposing peritoneum.
- Cut/ tear peritoneum, pull laterally exposing uterus.
- Uterus: Vertical incision <28 wks, Horizontal incision >28wks
- Deliver Foetus
Post delivery:
- IV Syntocin 5-10U
- Deliver Placenta & clear uterus of debris.
- Fundus massage to stimulate contraction.
If ROSC
- pack bleeding pts w gauze, suture uterus absorbable sutures
- rpt Syntocin 5-10U
- TXA 1g stat + 1g over 8 hrs
