Flashcards in Stab room Deck (28):
What is a good alternative to "bagging up" an obese patient that is prone to desaturating quickly
What is the dose of lidocaine in the acute treatment of ventricular arrhythmias?
1 to 1.5mg/kg (usual dose is 100mg)
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.
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)
What are the patient characteristics for E-CPR
Age 18 to 65
Can't be a nursing home resident
No pre-existing organ failure
What are the physiologic criteria for E-CPR
etCO2 > 10
SpO2 > 85% or PaO2 > 50
Need all 3 of these
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"
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.
What is the dose of atracurium?
Ideal body weight.
What size blade should be used for a term newborn? Premie?
Miller 1 for term, miller 0 for premie.
Where should an O2 sat be measured on a newborn?
Right hand - it's preductal
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)
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
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.
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
What is the dose of rocuronium? How long does it last?
1mg/kg. 30 to 40 minutes.
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.
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.
If you want to give positive pressure (BVM or ventilator) to a person with a tracheostomy, what needs to be in place?
The balloon needs to be inflated on the tracheostomy, if it's cuffed. If it doesn't have cuff, need to exchange it for one with a cuff or an endotracheal tube.
When intubating an obese person, if the chest is so high that is making insertion of the blade difficult, what can be done?
Use a snub handle on the blade. Unfortunately, not available for CMAC.
How can intubating in a low volume state precipitate arrest? how to prevent this?
When intubating, venous return is decreased, can precipitate arrest? To prevent this, consider volume resuscitating first if airway management isn't needed immediately.
How should chest tubes be used to rewarm in hypothermia?
Insert 2 on each side, one anterior and one posterior. Put in warm saline in the anterior one, then gravity will cause the saline to exist the lower tube.
Below what temperature should epinephrine not be used?
Below 30 degrees. Doesn't work due to altered pharmacodynamics. Might be harmful.
After what temperature is defibrillation indicated in hypothermia? What should be done below this temperature with regards to defibrillation?
30 degrees. Below this, if a shockable rhythm is present, attempt 3 times, then no further until above 30 degrees.
If a bladder rupture is visualized on a trauma CT scan, what should be done with regards to subsequent imaging?
Gopal recommends getting a CT cystogram at the time of the CT.
What are the ranges of hypothermia? What treatment is indicated at each range?
32 to 35 (Mild) - Shivering will be present, passive rewarming only.
28 to 32 (Moderate) - Bair hugger, endovascular, IV fluids, bladder-thoracic-peritoneal lavage, warmed air
24 to 28 (Severe) - ECMO
Below 24 (Profound) - usually dead
What is the smallest size ET tube that the pediatric bougie will go through?
4.0, but even so, it will be pretty difficult to fit a 4.0 tube over it.