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Flashcards in Stab room Deck (18):

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


What are the physiologic criteria for E-CPR

etCO2 > 10
Measurable lactate
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
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.