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Flashcards in Stab room Deck (18):
1

What is a good alternative to "bagging up" an obese patient that is prone to desaturating quickly

ILMA

2

What is the dose of lidocaine in the acute treatment of ventricular arrhythmias?

1 to 1.5mg/kg (usual dose is 100mg)

3

How often can lidocaine be redone in the acute treatment of ventricular arrhythmias, and at what dose? What is the max dose

0.5 to 0.75mg/kg can be repeated every 5 to 10 minutes. Max dose is 300mg in 1 hour.

4

What types of lines should we place for E-CPR?

Right femoral vein - smak catheter
Left femoral artery - smak catheter
(But with patients with larger body habitus, consider cordis catheter, as we have had a case where we lost the smak catheters)

5

What are the patient characteristics for E-CPR

Age 18 to 65
Witnessed arrest
Can't be a nursing home resident
No pre-existing organ failure

6

What are the physiologic criteria for E-CPR

etCO2 > 10
Measurable lactate
SpO2 > 85% or PaO2 > 50
Need all 3 of these

7

On bedside ultrasound, how should the IVC be interpreted if tamponade is being considered?

Per Rob, "you can't have tamponade if the IVC is collapsing"

8

In a patient with tamponade complicating aortic dissection, how could pericardiocentesis make things worse? Does it have a role?

Pericardiocentesis in this situation would likely result in a higher cardiac output, increasing the dp/dt forces, which may worsen the dissection, and promote more blood from going from the true lumen in to the false lumen. That said, if a patient is truly in shock and under perfused, pericardiocentesis should still be performed if there is a delay to OR, but only remove as much as is necessary to improve the hemodynamics.

9

What is the dose of atracurium?

0.5mg/kg.
Ideal body weight.

10

What size blade should be used for a term newborn? Premie?

Miller 1 for term, miller 0 for premie.

11

Where should an O2 sat be measured on a newborn?

Right hand - it's preductal

12

What is the very first things I should be doing when an obtunded patient is being brought in to the stab room, particularly one that is being bagged

1. Check for a pulse
2. Ultrasound prior to transfer to the cart
(remember the 26 yo who died who came in being bagged and blue, who I didn't recognize arrest promptly in)

13

What are the ECG findings of right heart strain?

1. Right axis deviation
2. Big R wave in V1 and V2
3. SI, QII, TIII
4. T wave inversions in precordial leads

14

What is the dose of physostigmine? What are potential complications? How long does it last?

Give 2mg IV over 5 minutes. Seizure and bradycardia, especially if pushed too fast. Lasts about 1 hour.

15

What are 2 situations in which to potentially use a King instead of an ILMA for a supraglottic airway?

1. Compromised ability to oxygenate - a king seals in such a way that it can have a higher driving pressure in the setting of a reduced lung compliance. ARDS and difficult to oxygenate patients are a good one.
2. A king may be able to seat in setting where the airway anatomy is somewhat distorted

16

What is the dose of rocuronium? How long does it last?

1mg/kg. 30 to 40 minutes.

17

What is the reversal agent for rocuronium? What is the dose? What agents does it work for?

Sugammadex. 16mg/kg for immediate reversal. Smaller doses are listed for less urgent reveral. Rocuronium and vecuronium.

18

What is the starting dose and range of clevidipine?

Starting: 1mg to 2mg / hr. Can be doubled every 90 seconds. Range: Max is probably 16mg/hr. Each 1mg probably lowers the SBP 2 to 4 mmHg per uptodate.