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30 Cards in this Set
- Front
- Back
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Most epistaxis is from what anatomical site?
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Kiesselbach's plexus
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Non-benign causes of epistaxis
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Osler-Weber-Rendu
squamous cell cancer juvenile nasopharyngeal angiofibroma ITP over anticoagulation |
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Tx of epistaxis
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ABC
pinch and hold for ten minutes if this fails twice, examine and locate bleed, use topical cocaine or Afrin or other vasoconstrictor balloon devices can also tamponade the bleed PACKING follow up with ENT in 48-72 hrs; admit elderly, COPD, cardiac pts |
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Tx of otitis media
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amoxicillin 500 mg TID for ten days.
Bactrim DS, 10 days azithromycin, clindamycin, augmentin |
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Tx for otitis externa
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irrigation
topical cipro, cortisporin or abx/steroid combos use suspension if TM perforation |
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Standard for intubation is ?
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cuffed ETT in trachea
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Criteria for intubation (full)
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1. failure of oxygenation
PO2 < 60 on > 40% FIo2 O2 sat < 85% on MAX O2 2. failure of ventilation: PCO2 > 50 or acute rise of 10 (in copd) 3. aspiration protection inability to swallow (pooled secretions) altered level of consciousness 3. preservation of energy 4. control (intoxication) gag reflex is not reliable sign |
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PO2 of <60 on what FIO2 is criteria for intubation?
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40%
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PCO2 > ?% is criteria for intubation?
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50
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8 Ps of RSI
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plan B
prepare preoxygenate pretreat put to sleep paralyze pass tube prove placement |
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mnemonic for difficult bag valve mask
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BONES
beard/mustache obses NO TEETH elderly (>55) snores any 2 will be >70% likely difficult bag |
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mnemonic for evaluation for difficult intubation
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LEMONS law
look externally (mandible, teeth, palate) evaluate 3/3/2 mallampati OBSTRUCTION neck mobility saturation <85% |
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What is the 3/3/2 eval for intubation?
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3 finger vertically in mouth
3 fingers chin to hyoid 2 fingers hyoid to thyroid |
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base of uvula only seen: what mallampati score?
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3
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preoxygenation criteria for intubation
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5 minutes on 100% o2
8 vital capacity breaths on 100% o2 |
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pretreatment before intubation is particularly important for what 2 classes of people?
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increased ICP
cardiovascularly unstable |
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What is used for pretreatment?
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LOAD
lidocaine opiates atropine (peds; they can get vagal/bradycardic) defasiculating agents so mainly opiates and defasciculating |
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Best opiate for pretreatment? Why?
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fentanyl, rapid onset, short duration
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What is the concerning side effect of etomidate?
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suppresses cortisol production for 24 hours
concern for septic patients |
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most commonly used induction agent in intubation
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etomidate
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What are alternatives to etomidate for induction in RSI?
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ketamine
versed / midazolam (rarely used--need high dose) thiopental (pentothal) propofol (good generally for procedures but less so for sick ED patients) |
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Ketamine is a good choice of induction drug for what type of pt?
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hypotensive; its sfx is to raise HR, BP
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Succinylcholine is [depolarizer, nondepolarizer]
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depolarizer
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duration of succinylcholine
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6-10 minutes
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sfx of succinylcholine
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raises potassium (b/c of fasciculation, muscle contraction)(
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Contraindications to succinylcholine
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acute crush injury
renal failure with high K muscular dystrophy (hypertrophy of endplates, K release) open globe eye injury burns, spinal cord injuries in recent past > 48 hours |
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Mnemonic to remember contraindications to succinylcholine
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old boys' clubs and networks in American can offend girls really fast
old burns, cords neurologic issues acute crush open globe renal failure |
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positioning and technique for intubation:
three most important steps |
sniff position
sweep tongue out of way with blade go in on side, push in then retreat till you see cords |
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nondepolarizers?
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the "curiums"
rocuronium / zemuron vecuronium / norcuron atracurium mivacurium |
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where do you listen to prove placement?
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axilla and EPIGASTRIC
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