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27 Cards in this Set
- Front
- Back
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Prep for RSI
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s- suction/stylet
o- (pre)-oxygenate a- airway equiptment p- pharmacuticals |
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Indicationd for intubation
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- need for paralysis
Failure to: -maintain patent airway -protect airway from aspiration -adequately clear secreations -maintain adequate oxyngenation/ventiation |
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Adverse physiologic response to intubation (and pretreatment options)
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HTN/tachycardia (Fentanyl)
-Bronchospasm (lidocaine) Increased ICP (lidocaine/fentanyl) |
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SIRS criteria
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temp >100.4 or <96.8
HR >90 RR >20 WBC >12 or >10% bands |
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MODS criteria
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ARDS
DIC hepatic failure renal failure adrenal insufficiency |
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early goal directed therapy
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uop >0.5 cc/kg/hr
CVP 8-12 mm Hg MAP 65-90 ScvO2 >= 70% |
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Options for upper extremity deep peripheral access
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Cephalic vein- radial- typically smaller
Deep brachial vein- Medial- runs with brachial artery/median nerve! Basilic Vein- Ulnar |
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Key points for EJ access
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-trendelenberg
-apply pressure with thumb to midclavicle to distend -Ender vessel midway between angle of mandible and midclavicle |
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Appropriate HR increase for fever
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8 HR points for each 1.8 F (1 C)
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deinition of hyper- or hyopthermia
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fever/hyperthemia > 100.4 F(38 C)
hypothermia <95 F (35 C) |
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cuffed ET tube size- peds
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tube size(internal diameter in mm)= (age in years/4) +3
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hyperpnea/hypopnea
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deep vs shallow breathing
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drugs that can be given via ET tube
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LEAN:
lidocaine epinephrine atropine naloxone + Valium |
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dose for pediatric defibrillation
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initial 2J/kg
then 4J/kg |
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cardioversion
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-synchronized to R wave
-indications: a fib/flutter SVT v tach re-entrant tachycardias |
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defibrillation
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- unsynchronized
-indications V.fib pulseless V tach |
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capnography
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-monitoring of EtCO2 number and waveform
-provides info about ventilation perfusion & metabolism |
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colorimetric EtCO2
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ez cap
color change only tobindicate range of CO2 purple yellow >15 |
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discrepancy btwn ETCO2 and PaCO2
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normal= 0-5 mmHG
higher values indicate Inc dead space, intrinsic lung dz or VQ mismatch |
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EtCo2 post intubation
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waveform (w/ all 4 phases)- Ett through cords
flatline- esophageal placement (or prolonged cardiac arrest/ distal tube or airway obstruction) |
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EtCO2 after intubation
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waveform (with 4 components)- ETT through cords
flatline- esophageal intubation OR complete circulatory failure or obstruction of the tube/ airway distally) |
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EtCo2 and cardiac arrest
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1. use to assess adequacy of compressions
2. use to indicate ROSC (sudden increase) 3. use to indicate cause of arrest higher in primary asphyxia, lower in v. fib |
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use of ETCo2 in breathing patients
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seizure
acute respiratory disease (asses ventilation) unconscious patients/procedural sedation metabolic acidosis |
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ETCO2 waveform in obstructive disease
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upsloping of plateau phase
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lab findings in acute DIC
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platelets- dec
fibrinogen-dec factor v- dec factor viii- dec FDP/d dimer- Inc PT-Inc aPTT- Inc |
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blood product treatment in DIC
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plt transfuse plt
Inc INR-> transfuse FFP Fibrinogen transfuse cryoprecipitate |
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hypoglycemia- tx/pitfalls
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D50
-should raise glucose by 60mg/dL (70kg m) consider clinical hypoglycemia even with normal D stick, esp in poorly controlled DM consider Thiamine 100mg IV to prevent wernicke's encephalopathy |
