Chapter 1 - Resuscitation

Question 1

Indications to Intubate

Answer 1

1. Failure to maintain patent airway (obstruction vs trauma)
2. Loss of protective reflex (inability to swallow or GCS <8)
3. Failture to oxygenate or ventilate (hypoxia)
4. Anticipated clinical deterioration (status, trauma, OD)

Question 2

Complications of Intubation

Answer 2

1. Broken teeth/soft tissue injury
2. Laryngospams
3. Main stem intubation
4. Post-intubation hypotension -? 2/2 meds vs pneumo

Question 3

RSI Sequence (6Ps)

Answer 3

Preparation - IV access, sniffing/positioning
Preoxygenation - 3 min on 100% O2 or 6 breaths
Pretreatment - can blunt adverse effects of intubation but evidence not great. Consider lidocaine for reactive airways/ICP, fentanyl to reduce tachy in MI, Atropine in peds
Paralysis with induction
Placement of tube
Postintubation management

Question 4

Induction medications

Answer 4

1. Etomidate 0.3mg/kg
2. Ketamine 1-2mg/kg
3. Propofol (not used as often 2/2 hypotension) 1.5mg./kg

Question 5

Paralytic medications

Answer 5

1. Succinylcholine 1.5mg/kg, onset 45sec (do not use in crush injuries, hyperK, or stroke due to worsening hyperK and increased ICP)
2. Rocurronium 1mg/kg, onset 60sec

Question 6

Postintubation meds

Answer 6

Based on ICU studies start with:

1. Fentanyl 25-50mcg or Ketamine 20-30mcg bolus then infusion
2. If required add sedation - propofol 10-30mg or midaz 0.5-5mg

Question 7

Peds anatomic differences for intubation

Answer 7

1. Large occiput
2. Smaller airway diameter
3. Anterior/superior laryxn
4. Large epiglottis
5. Variable trachea length

Question 8

Cricothyrotomy

Answer 8

1. Sterilize
2. Crichothyroid membrane (between thyroid cartilage and cricoid cartilage)
3. Midline vertical incision through skin
4. Horizontal incision through membrane
5. Widen membrane whole
6. Place ET tube

Question 9

SVT treatment

Answer 9

1. vagal manoeuvres
2. Dilt 10mg
3. Adenosine 6mg rapid push then 12mg rapid push

Question 10

Digoxin toxicity ecg

Answer 10

Atrial tachycardia with AV block (typically 1:2)

Question 11

Afib treatment

Answer 11

If unstable -> cardioversion
If stable -> rate control with B-blocker vs rhythm control.
Can try chemical cardioversion with procainamide
CHADS for anticoagulation

Question 12

Causes of VT

Answer 12

Structural heart disease (CAD vs MI)
Trauma
Hypothermia
Hypoxia
Severe lytes (hypokalemia, hypomagnesium, hypoCa)
Long QT (anti meds, congenital)

Question 13

VT Treatment

Answer 13

Unstable -> if no pulse cardiovert, if has pulse synchronized cardiovert
Stable -> Amiodarone 150mg over 10min then infusion of 1mg/min. Second line is lidocaine 1mg/kg IV q5min to max 3mg/kg/h. Or synchronized cardiovert

Question 14

WPW treatment

Answer 14

1. Narrow complex tachy (orthodromic) -> same as SVT

2. Wide complex tachy (antidromic) -> procainamide or synchronized cardioversion

Question 15

Neonatal Resuscitation Pathway

Answer 15

Start with airway!! Each step after 30 sec

1. Warm and stimulate
2. PPV
3. Intubate
4. CP
5. Drugs -> epi 0.1-0.3mL/kg, glucose 5mL/kg D10

Question 16

Hs and Ts of cardaic arrest

Answer 16

H:

1. Hypoxia
2. Hyper/hypoK
3. Hydrogen ion (acidosis)
4. Hypoglycemia
5. Hypothermia
6. Hypovolemia

T:

1. Tension penumo
2. Thrombosis (cardiac)
3. Thrombosis (PE)
4. Tamponade
5. Toxin

Question 17

Uses of Magnesium and dose

Answer 17

1-2g IV

1. Torsades or polymorphic VT
2. Preeclampsia
3. Severe asthma

Question 18

Neurogenic shock treatment

Answer 18

Happens with injury above T6

MAP 85-90 with dopamine