Treatment Guidelines

Question 1

What features indicate pt is at high risk of being peri-arrest? (5)

Answer 1

Hypotension/shock, syncope, ischemic CP or ischemia on 12 lead, heart failure: increased JVP/pulmonary edema, arrhythmias

Question 2

In what patient population is Atropine potentially harmful?

Answer 2

Heart transplant patients. (Denervation of parasympathetic pathways)

Question 3

What is BRASH syndrome?

Answer 3

Bradycardia, renal failure, AV blockade, Shock, Hyper K

Question 4

What are some reversible causes of bradycardia? (5)

Answer 4

Hypoxia, increased parasympathetic tone, drugs/overdose, Hyper K, Myocardial ischemia

Question 5

What is circum-rescue collapse

Answer 5

collapse of a pt in VF or cardiac arrest either before, during or shortly after rescue from cold environment

Question 6

At what body temperature will a pt likely develop cardiac arrhythmias progressing to VF

Answer 6

30 degrees

Question 7

Why should Epi be limited to 3 doses in hypothermic patients?

Answer 7

Drugs are metabolized more slowly and there is a potential for toxic build-up

Question 8

At what ETCO2 level should an improvement in CPR quality be considered

Answer 8

10mmHg

Question 9

What are the components of the Post Arrest checklist? (4)

Answer 9

Airway: Check tube position, air entry, tube tie
Breathing: 1/4-1/3 of BVM, 10-12/min, SPO2 of 94%, PEEP 5cmH2o
Circulation: Rhythm-5 mins for SVT, Map 65, 12 lead
Disability:HOB 30 degrees, Glucose, Temp neutral

Question 10

How much fluid should an adult be resuscitated with?

Answer 10

20mL/kg

Question 11

Cerebral and cardiac dysfunction accompanied by prolonged systemic ischemia (hypoperfusion/cardiac arrest) is known as?

Answer 11

Post cardiac arrest syndrome

Question 12

What is the most common cause of traumatic cardiac arrest?

Answer 12

Haemorrhage

Question 13

What are the reversible causes of traumatic arrest?

Answer 13

Hypovolemia, Hypoxia, Tension Pneumothorax

Question 14

What is the transport window for a pt in cardiac arrest secondary to a traumatic cause?

Answer 14

15 minutes (20 in Vancouver Coastal)

Question 15

When should a pelvic binder be applied in traumatic arrest?

Answer 15

After other reversible causes are treated, unless pelvic fx is suspected as being a leading cause of hemorrhage.

Question 16

What is coagulopathy?

Answer 16

A derangement in hemostasis resulting in either excessive bleeding or clotting

Question 17

What is the calculation for initial and subsequent defibrillation in pediatric patients

Answer 17

2J/kg, repeat at 4J/kg

Question 18

Where are the 2 sites for needle thoracentesis placement

Answer 18

2nd intercostal mid-clavicular

5th intercostal mid-axilla

Question 19

What are the 6 criteria for recognition of life extinct (ROLE)

Answer 19

No palpable pulse for 90 s
No heart sounds for 90s
No breath sounds/resp effort for 90 s
Fixed non-reactive pupils
No response to central stimuli
Observe Asystole or PEA < 30 for 60s

Question 20

What is the Pediatric assessment triangle (PAT)

Answer 20

General appearance (Tone, Inconsolability, Gaze, Color)
Work of breathing
Skin (Circulation)

Question 21

How do you calculate mean and lower BP limits in pediatrics?

Answer 21

Mean: 80+ (2x Age (years))
Lower: 70+ (2x Age (years))

Question 22

How do you calculate the ET tube size in pediatrics?

Answer 22

Uncuffed:(Age/4)+4
Cuffed: (Age/4)+3

Question 23

What is the SIRS criteria?

Answer 23

Systemic Inflammatory Response Syndrome

Tachypnea, Tachycardia, Fever, Increased WBC

Question 24

What is qSOFA

Answer 24

Quick Sequential Organ Failure Assessment

Altered LOC, Tachypnea, Hypotension

Question 25

Exposure to CO with levels above (?) require conveyance to hospital?

Answer 25

Above 10%

Question 26

How long does CO remain bound to hemoglobin?

Answer 26

4-5 hours at R/A 1-2 hours at 100% O2 20 mins in hyperbaric chamber

Question 27

How does a hyperbaric chamber treat CO poisoning?

Answer 27

By producing a 10x increase in the amount of O2 dissolved in plasma, thereby increasing oxygen delivery to the tissue, and increasing CO elimination.

Question 28

What are normal CO levels for a smoker?

Answer 28

2%, may be as high as 9% in heavy smokers

Question 29

What causes a right shift (reduced affinity) in the oxyhemoglobin dissociation curve? (5)

Answer 29

``` Low pH High temp High CO2 High 2,3-BPG Low affinity hb variants ```

Question 30

Organophosphates and Carbamates inhibit what? | Leading to what?

Answer 30

Acetylcholinesterase, causing stimulation of muscinaric (parasympathetic) and nicotinic (sympathetic) receptors

Question 31

What is the mneumonic for organophosphate toxicity?

Answer 31

``` Sludge and the killer B's Salivation Lacrimation Urination Defecation GI upset Emesis Bronchospasm Bronchorrhea Bradycardia ```

Question 32

What is the goal of Atropine in treating organophosphate poisoning? What receptors does it affect?

Answer 32

Control secretions, and correct bradycardia and hypotension. Reverses muscinaric, but not nicotonic

Question 33

What are some symptoms of beta-blocker OD? (7)

Answer 33

``` Bradycardia Hypotension Mental status changes Ventricular dysrhythmias Cardiogenic shock Bronchospasm Hypoglycemia ```

Question 34

What are common ECG findings in beta-blocker OD?

Answer 34

PR prolongation, QRS prolongation, bradydysrhythmia

Question 35

What are the steps in treating beta-blocker OD? | What treatments are unlikely to be successful?

Answer 35

Glucagon-increasing cardiac inotropy by activating adenyl cyclase by a secondary mechanism bypassing beta-blockade Calcium-improve BP and contractility Sodium bicarb- Wide QRS, increases sodium and initiation of action potential Mag sulfate-Torsades, Epi infusion- Increases chrono/ino/dromo-tropy Atropine and pacing are unlikely to be successful

Question 36

What are the common S&S of TCA OD?

Answer 36

Sedation/Unconciousness Seizures Wide complex tachycardia Hypotension

Question 37

What is the cardiac consequence of TCA OD?

Answer 37

Sodium channel blockade

Question 38

What are the common ECG finding of TCA OD?

Answer 38

QRS> 100ms Deep S in I and aVL Tall R in aVR Tachycardia