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65 Cards in this Set

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What are the primary survey ABCs?
1. Unresponsive - activate EMS and call for defibrillator

A. Airway - head tilit-chin lift or jaw thrust

B. Breathing - Look Listen Feel, Give 2 breaths.

C. Circulation - check central pulse, if none, start compressions.

D. Defibrillation - attach monitor and defibrillate
Where is the pulse checked on child vs adult?
Adult - Carotid
Child - brachial
About what depth do you want your chest compressions to be?
1 1/2 - 2 inches
What does the secondary survey consist of?
A. Airway
B. Breathing
C. Circulation
D. Differential Diagnosis
During the secondary survey, what does airway management involve?
Provid advanced airway management.
Oropharyngeal airway(unconscious,no gag reflex)
Nasopharyngeal Airway(not with basilar skull fracture or head injury)

Bag Valve mask - provide positive pressure ventilation
ETT, LMA, FastTrachLMA, Combitube
What might a basilar skull fracture present with?
Blood coming out of ears or Battle's sign(echymosis at base behind ear) or Raccoon's sign (periorbital bruising).
During the secondary survey, what does breathing management involve?
Confirm placement of airway.
- Visualize tube through cords
- Ausculation over epigastr.
and over R/L lateral and anterior chest wall.
- End tidal CO2 Detector or continuous CO2 monitor
- Esophageal detector device

Secure airway with C-collar and commercial tube holder.

Ascultate for equal breath sounds.

Confirm adequate oxygenation and ventilation.
What are the different oxygen supplementation devices?
1. Nasal cannula(Max 44% @ 6L) any higher and the nasal tissues will be dried out.

2. Face mask (60% O2 at 6-10L) humidified air

3. Face mask with O2 reservoir (up to 90-100%)

4. Venturi mask - COPD

5. Bag valve mask (10-12 brpm every 6s)

6. Endotracheal tube (preoxygenate first)
During the secondary survey, what does circulation management involve?
1. Establish IV access
2. ID rhythm
3. Follow appropriate algorithm
Which type of IV access is most appropriate during a code?
Peripheral line access.
What would be a bad complication of a central line?
Other than peripheral access what are 2 ways to give medicines?
Endotracheal tube
Most common causes of PEA?
1. Hypovolemia
2. Hypoxia
3. Hydrogen ion (acidosis)
4. Hyper/Hypokalemia
5. Hypoglycemia
6. Hypothermia

1. Toxins
2. Tamponade (cardiac)
3. Tension pneumo
4. Thrombosis (coronary and pulmonary)
5. Trauma
What is the difference btwn a monophasic and diphasic defibrillator?
Monophasic - only to 360J; unidirectional; one paddle to the other

Biphasic - only to 200J - bidirectional shock
If you determine you have a pulseless rhythm and then determine V-fib or V-tach what do you do?
Give one shock, no pulse, resume CPR
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypovolemia?
Narrow complex and rapid rate

History, flat neck veins

Volume infusion
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypoxia?
Slow rate (hypoxia)

Cyanosis, Blood gases, airway problems

Oxygenation, ventilation
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hydrogen ion (acidosis)?
Smaller amplitude QRS complexes

Hx of diabetes, bicarbonate-responsive preexisting acidosis, renal failure

Sodium bicarbonate, hyperventilation
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hyperkalemia?
Hyper and hypokalemia cause wide complex QRS

T waves taller and peaked
P waves get smaller
QRS widens
Sine wave PEA

Hx of renal failure, diabetes, recent dialysis fistulas, medications

Sodium bicarb
Glucose+ insulin
Calcium chloride
Dialysis (long term)
Possibly albuterol
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for HypoKalemia?
Hyper and hypokalemia cause wide complex QRS

T waves flatten
Prominent U waves
QRS widens
QT prolongs
Wide complex tachycardia

Abnormal loss of K+
Diuretic use

Rapid but controlled infusion of K+
Add Mg if cardiac arrest
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypothermia?
J or Osborne waves

Hx of exposure to cold
Central body temp

Algorithm to handle this
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Tablets overdose(TCAs, dig, beta blockers, CCBs)?
Various ECG effects;
Predominately prolongation of QT interval

Empty bottles at scene
Neuro exam

Drug screens
Active charcoal
Lactulose per local protocols
Specific antedotes and agents per toxidrome
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Cardiac Tamponade?
Narrow complex
Rapid rate

No pulse felt with CPR
Vein distention

What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Tension pneumothorax?
Narrow complex
Slow rate(hypoxia)

No pulse felt with CPR
Neck vein distention
Tracheal deviation
Unequal breath sounds
Difficult to ventilate pt

Needle decompression
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Thrombosis, heart - acute massive MI?
Abnl 12 lead
Q waves
ST segment changes
T wave inversions

Hx, Cardiac markers

Fibrinolytic agents; See STEMI case
What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Thrombosis, lungs - massive PE?
Narrow complex
Rapid rate

No pulse felt with CPR
Distended neck veins
Prior (+) test for DVT/PE

Surgical embolectomy
PEA rhythm:
If a narrow complex on monitor you more likely have what type of cause?
Non cardiac; low volume, low vascular tone
PEA rhythm:
If a wide complex on monitor you more likely have what type of cause?
Cardiac cause; or drug and electrolyte toxicity
What are 2 common non traumatic causes for hypovolemia?
Occult internal hemorrhage
Severe dehydration
What are the drugs that can be delivered by ETT tube?
N - Narcan
A - Atropine
V - Valium
E - Epinephrine
L - Lidocaine
What can asystole look like - how to tell difference?
Fine v- fib. Try to swith btwn leads on monitor to tell.
Some S/S of bradycardia?
Poor capillary refill
What is the difference btwn defibrillation and synchronized cardioversion?
Defib - high level joules to stop rhythm

Syn Cardio- lower energy; Avoids R on T phenomenon because follows R waves then shocks
With hypotension and shock what are three types of problems - and how to treat?
1. Volume problem - Fluids first then pressor
Fluids 2L, Blood, Specific intervensions, consider pressors.

2. Pump problem

3. Rate problem
Brady or Tach algorithm
If a pt is brought back from thier arrythmia (spec tachy), what drugs are given based on BP?
Systolic <70
NorEpi drip
(D's could be supplements or if BP isnt that low)

70-100 c/ S/S shock

70-100 c/ no s/s shock

(vasodilates coronaries but watch BP drop)
Cardiopulmonary arrest?
Heart stops
No central palpable pulse
Respiratory distress?
Increased work of breathing
Nasal flaring
Use of accessory muscles
Inspiratory retractions
Respiratory failure?
Inadequate oxygenation/ ventilation or both
Cannot perfuse (deliver O2 or metabolic substrates)
Cold, clamped down, delayed capillary refill
Difference btwn compensated and decompensated shock?
Both have poor tissue perfusion but with compensated you can maintain BP; decompensated you cannot
Trend of cardiopulmonary arrest as kids age?
<1yr:resp dz's, SIDS
1-2 yrs:injuries
>2yrs:add asthma and suicide
What level of resuscitation rarely results in intact neurological survival?
2 doses of Epi or those lasting >10-25 minutes
Important anatomical differences btwn children and adults?
Airway much smaller

Tongues much bigger

Larynx more cephalad and anterior (C3-4) vs C5

Epiglottis long, floppy, narrow, angled away from long axis of trachea

<10yo - narrowest portion of airway below vocal cords(dont need cuff)

Shorter airway
Narrowest portion of airway in infants vs adults?
Adult: Vocal cords
Peds: Cricoid cartilage
Normal resp rates in peds?
0-28d(neonate)- 30-60
1-12mo(Infant)- 20-40
1-10yo(child)- 15-25
10+yrs (adult)- 60-160
Normal HR in peds?
0-28d(neonate)- 80-200
1-12mo(Infant)- 80-180
1-10yo(child)- 60-180
10+yrs (adult)- 60-160
Classifications of shock - compensated vs decompensated?
Decompensated (<5th percentile for age)

0-28d(neonate)- <60
1-12mo(Infant)- <70
1-10yo(child)- 70+(2 x age)
10+yrs (adult)<90

Caveat- any fall >10mmHg from baseline considered possible decompensation
4 Major causes of shock?
1. Hypovolemic
2. Obstructive
3. Distributive - 3rd spacing
4. Cardiogenic
Difference btwn the chain of survival for peds vs adults?
Adult- early EMS/defib activation; Shock saves

Kids- Early CPR; respiration saves
What do you do with an unresponsive child?
Witnessed arrest-->
ABC + use AED asap

Un witnessed -->
ABC + 5 cycles of CPR then used AED or defib
Type of ETT to use in <10yo?
Uncuffed unless higher airway pressures are needed(Asthma, Pneumonia, ARDS, etc).
Formula for ETT tubes?
Uncuffed: Age/4 + 4
Cuffed: Age/4 + 3
What causes should you think of for acute decompensation in an intubated patient?
1. Displacement of tube
2. Obstruction of tube
3. Pneumothorax
4. Equipment Failure
Chest compression variation for peds?
Infant: 2 finger, 1/3-1/2 depth of chest; 30:2 or 15:2(with 2 people)

Child 1-8 yo: heel of one hand over lower half of sternum, other the same

Child (8+): Adult 2 hand method, compress 1.5-2inches; 30:2 for 1 and 2 rescuer
Order of preferred sites for IV access?
1. Peripheral intravenous
2. Intraosseous
Avoid epiphyseal plate
fx in extremity
Previous insertion attempt
Infxn of overlying bone
3. Central intravenous
4. Saphenous vein cut down
Femoral Vein Access?
Lateral to Medial
MCC shock worldwide?
Fluid therapy for kids with and without cardiac issues?
Without: 20cc/kg
With: 10cc/kg
Once intravascular volume has been restored, what do you initiate?
D5 1/4NS at:

Infants <10kg:4mL/kg/hr

**Children 10-20kg:
40mL/hr + 2ml/kg/hr

Children >20kg:
60ml/hr + 1ml/kg/hr

On Braslow tape
If initial fluid boluses are unsuccessful what is done next?
10-15 ml/kg of PRBCs
Warmed preferred
Rapid infusion in severe hypovolemia and shock
Meds that can be administered through ETT tube if peripheral access is unavailable?
N - Nalaxone (narcan)
A- Atropine
V - Vasopressin
E - Epi
L - Lidocaine

ETT dose x 2
Mix c/ >10cc saline or H20
In children with severe head injury, submersion, and shock what can be a marker of severe ischemic insult?
Tx for hypoglycemia?
Glucose Bolus:
2-4ml/kg of 25% IV dextrose soln
Glucose infusion:
D5 1/4 NS at maint rate

Frequent finger stick measurement
What usually causes a bradyarrythmia in a child?
Post arrest what temperature would need to be treated?
>37.5 or 99.5