Section 3: Tintinalli: Resuscitation Chapter 12 - 21

Front 1

Name 5 structural heart disease causes that can lead to ventricular arrhythmias and sudden cardiac death?

Back 1

MI
LVH
Pre-excitation syndromes (WPW)
Brugada syndrome
Long QT syndrome

Front 2

Characteristic EKG findings in Brugada syndrome?

Back 2

Downsloping ST segment elevation in V1-V3

Front 3

Differences in EKG findings in Brugada vs. benign early repolarization?

Back 3

Brugada: Downsloping ST segment elevation in V1-V3 with negative T wave

Repol: Downsloping in V2-V6 with upward concavity, and a positive T wave

Front 4

What electrolyte abnormality increased the risk of digoxin toxicity?

Back 4

Hypokalemia

Front 5

The RCA supplies the SA node __% of the time, and the AV node __% of the time.

Back 5

55
90

Front 6

Dobutamine has activity against which receptors?

Back 6

B1, dopamine, alpha

Front 7

Only _% of people in PEA survive to hospital discharge.

Back 7

2

Front 8

Name the 2 basic airway opening maneuvers.

Back 8

Jaw thrust
Head tilt

Front 9

In a patient with suspected foreign body airway obstruction, what maneuver can be performed if patient is unconcious or supine?

Back 9

Prone Heimlich Maneuver

Front 10

After a patient regain spontaneous repirations and circulation after CPR, patient should be placed in the _______ position.

Back 10

Recovery position = one their side

Front 11

What is the formula for calculating tube placement in the neonate?

Back 11

6 + weight in kg

Front 12

What is the most readily available site for IV access in the newborn?

Back 12

Umbilical vein

Front 13

T/F: Narcan can be given to newborns in which maternal narcotic addiction is suspected.

Back 13

False - contraindicated

Front 14

What medication keeps a patent ductus arteriosis open?

Back 14

PDE1 - continuous infusion

Front 15

What test can help determine if newborns cyanosis is from a cardiac source (right to left shunt) or pulmonary?

Back 15

Place in 100% oxygen, newborns with pulmonary problems, will have pa02 >100, right to left shunts will not.

Front 16

What type of IV fluid should be given to the hypoglycemic infant?

Back 16

D10W

Front 17

Name the congenital cyanotic cardiac disorders.

Back 17

Transposition of the great arteries
Tricuspid atresia
Truncus arteriosus
Total anomalous pulmonary venous return
Pulmonary atresia
Coarctation
hypoplastic left heart syndrome
Primary pulmonary hypertension

Front 18

Neonates born at less than __ weeks are not viable.

Back 18

22

Front 19

The airway is higher and more ________ in the child's neck than in the adult.

Back 19

anterior

Front 20

2 maneuvers for clearing a choking infants airway

Back 20

back blows
chest thrusts

Not heimlich due to risk for abdominal injuries

Front 21

The tidal volume to ventilate children is the same is it is for adults...__ to __ ml/kg

Back 21

10 to 15

Front 22

Mnemonic for what medications can be given through the IV. LEAN

Back 22

Lidocaine, epinephrine, atropine, and naloxone

Front 23

Although the ideal endotracheal doses for drugs other than epinephrine have never been studied, current recommendations are to give how much in comparison IV doses? How many times the dose?

Back 23

2-3 times the IV dose

Front 24

What is the standard initial fluid bolus in children who are hypotensive or dehydrated?

Back 24

20 ml /kg

Front 25

What is the pediatric dose for epinephrine in bradycardia through IV? Endotracheal tube?

Back 25

0.01 mg/kg at (0.1 ml at 1:10000) IV/IO
0.1 mg/kg at (0.1 ml at 1:1000) ET tube

Front 26

________ is the first line treatment of bradycardia.

Back 26

Atropine

Front 27

Bicarbonate therapy has a primary role in treating overdoses of _________ __________ blocking agents such as procainamide, flecainide, and ______________ antidepressants.

Back 27

sodium channel
tricyclic

Front 28

Respiratory rate >__ or grunting in the neonate should always be considered an emergency.

Back 28

60

Front 29

How many J/kg are used in pediatric defibrillation
How many J/kg are used in pediatric cardioversion

Back 29

2 J / kg and can increase to 4 J / kg
0.5 J /kg and can be doubled

Front 30

If hypothermia is thought to be responsible for a cardiac arrest and cardiac electrical activity is present, resuscitation should be continued until a core temp of __ C is obtained.

Back 30

30

Front 31

How do you position pregnant patients when giving pregnant patient's CPR?

Back 31

Place on left side to reduce aortocaval compression.

Front 32

What are the concerns of giving vasopressors such as epinephrine and dopamine to pregnant women?

What is the prefered vasopressor in the setting of hypotension without cardiac arrest?

Back 32

uteroplacental vasoconstriction

They can be used in cardiac arrest.

Ephedrine 5 mg q5min

Front 33

Given concern for aortocaval compression in the pregnant patient, which sites should be avoided when obtaining IV access?

Back 33

Femoral, saphenous

Front 34

T/F D dimer levels are helpful in ruling out PE in pregnancy?

Back 34

False: concentrations progressively increase throughout pregnancy and an elevated d-dimer is not helpful in screening for VTE

Front 35

What is ICED therapy?

Back 35

Induced cooling to eliminate deficits...cooling after cardiac arrest

Front 36

What methods are used to cool patients after cardiac arrest?

Back 36

Fentanyl, midazolam, vecuronium, asa
2L iced LR
Expose body
Ice soaked sheets, temperature foley
Target temp of 33C

Front 37

What is the formula for anion gap?

Back 37

Na - (HCO3 + Cl)

Front 38

What is the normal range for anion gap?

Back 38

8-16

Front 39

In metabolic acidosis, PCO2 falls by _ mm hg for every _ meq/l fall in HCO3 in normal respiratory compensation.

Back 39

1
1

Front 40

In acidotic states, potassium increases or decreases?

Back 40

Increases. For every 0.10 drop in pH, K+ will increase by 0.5 meq/l, however, it is likely to drop rapidly when pH returns to normal.

Front 41

Elevated osmolal gaps are seen in what 2 types of poisonings? What else will be elevated on BMP?

Back 41

methanol
Ethylene glycol

Anion gap

Front 42

When does alcoholic ketoacidosis occur in an alcoholic patient?

Back 42

After the patient has stopped binge drinking, alcohol itself does not cause an anion gap, it will increase osmolar gap.

Front 43

Causes of non-anion gap acidosis?

Back 43

GI loses, diarrhea
K+ sparing diuretics
hypoaldosterism
Urinary tract obstruction
RTA
Acetazolamide

Front 44

Bicarbonate therapy should or should not be used in the ED treatment of mild to moderate metabolic acidosis?

Back 44

Should not, can cause paradoxical worsening of acidosis

Front 45

Indications for bicard therapy in metabolic acidosis?

Severe hypobicarbonatemia = <_
Severe acidemia: pH < 7.__ with signs of shock or myocardial irritability that is not rapidly responsive to supportive measures.

Back 45

4
7.20

Front 46

Conditions that cause metabolic alkalosis and hypertension?

Back 46

RAS
Renin secreting tumors
adrenal hyperplasia
hyperaldosteronism
cushing syndrome
liddle syndrome
licorice
fludrocortisone

Front 47

Why do you have to be concerned with giving O2 to a patient with severe COPD?

Back 47

They have chronic elevated CO2 and the main stimulus to breath may be hypoxia.

Front 48

What is the treatment of respiratory acidosis?

Back 48

increase alveolar ventilation

Front 49

What is the normal alveloar-arterial oxygen gradient in a healthy individual?

Back 49

<15

Front 50

What factors shift the oxyhemoglobin curve to the right?

Back 50

Acidosis, Increased Pco2, hyperthermia, increased 2-3-DPG

Front 51

What serum markers is a better predictor of shock than vital signs?

Back 51

lactate

Front 52

Osmolar gap increase by how much for 100 mg/dl of alcohol?

Back 52

22

Front 53

Seizures are quite likely at a sodium of <___. What are other symptoms of hyponatremia?

Back 53

113

fatigue, cramping, nausea, vomiting, confusion, anorexia

Front 54

If correction of _____________ happens more rapidly than the brain can recover solute, the higher plasma osmolality may result in fluid shift into the brain which is referred to as central pontine myelinolysis.

Back 54

hyponatremia

Front 55

In true hyponatremia, the plasma osmolality is _______, in factious hyponatremic states, the plasma osmolality is ______ or ________.

Back 55

reduced

normal, increased

Front 56

In correcting hyponatremia, the rise in sodium should be no greater than __ to __ ml/hr. What can be used to treat this? In what situation can the rate be increased to correct it faster?

Back 56

0.5 - 1
3% saline solution when having seizure, coma, severe hyponatremia

Front 57

Describe patients response to vasopressionin the setting of central vs. peripheral diabetes insipidus?

Back 57

Central: will have good response (not making enough ADH)
Peripheral: Won't respond

Front 58

What is the risk of correcting hypernatremia too quickly with IV fluids?

Back 58

Cerebral edema, don't correct more than 10-15 meq/L per day

Front 59

For every 0.1 increase in pH, potassium decreases by how much?

Back 59

0.5

Intracellular shifiting

Front 60

Calcium should be avoided in treating hyperkalemia when the patient is on what cardiac drug?

Back 60

Digitalis, bc it potentiates the toxic cardiac effects

Front 61

EKG changes in hyperkalemia:

6.5-7.5?
7.5 - 8?
10 - 12?

Back 61

Prolonged PR interval, tall peaked T waves, short QT

Flattening of P wave, QRS widening

QRS degradation

Front 62

A 1 gram decrease in albumin results in a __ drop in calcium. Despite the change in bound calcium, there is no change in what other kind of calcium?

Back 62

0.8.

Ionized

Front 63

Which is more potent in treating hypokalemia, calcium gluconate or calcium chloride?

Back 63

calcium chloride, 3x's more potent

Front 64

What electrolyte derangement can be seen in pancreatitis?

Back 64

hypocalcemia, broken down fat combines with Ca++.

Front 65

Describe chvostek's sign and trousseau's sign. With what condition are they present?

Back 65

Chvostek - tap the facial nerve
Trousseua - carpal spasm after applying bp cuff for 3 minutes

Front 66

What is the characteristic EKG finding in hypocalcemia?

Back 66

Long QT

Front 67

Treatment of what other electrolyte abnormality is important if present, before treating hypocalcemia?

Back 67

hypomagnesemia

Front 68

What is the mnemoic for symptoms and signs of hypercalcemia?

Back 68

Stones (nephrolithiasis)
Bones (osteolysis)
Moans (psychiatric disorders)
Groans (PUD, pancreatitis, constipation)

Front 69

What is the emergency department treatment of hypercalcemia?

Back 69

IV fluids
No longer recommended to treat with lasix