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65 Cards in this Set
- Front
- Back
What are the primary survey ABCs?
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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 |
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Where is the pulse checked on child vs adult?
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Adult - Carotid
Child - brachial |
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About what depth do you want your chest compressions to be?
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1 1/2 - 2 inches
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What does the secondary survey consist of?
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A. Airway
B. Breathing C. Circulation D. Differential Diagnosis |
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During the secondary survey, what does airway management involve?
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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 |
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What might a basilar skull fracture present with?
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Blood coming out of ears or Battle's sign(echymosis at base behind ear) or Raccoon's sign (periorbital bruising).
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During the secondary survey, what does breathing management involve?
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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. |
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What are the different oxygen supplementation devices?
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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) |
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During the secondary survey, what does circulation management involve?
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1. Establish IV access
2. ID rhythm 3. Follow appropriate algorithm |
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Which type of IV access is most appropriate during a code?
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Peripheral line access.
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What would be a bad complication of a central line?
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Pneumothorax
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Other than peripheral access what are 2 ways to give medicines?
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Intraosseous
Endotracheal tube |
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Most common causes of PEA?
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H's-->
1. Hypovolemia 2. Hypoxia 3. Hydrogen ion (acidosis) 4. Hyper/Hypokalemia 5. Hypoglycemia 6. Hypothermia T's--> 1. Toxins 2. Tamponade (cardiac) 3. Tension pneumo 4. Thrombosis (coronary and pulmonary) 5. Trauma |
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What is the difference btwn a monophasic and diphasic defibrillator?
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Monophasic - only to 360J; unidirectional; one paddle to the other
Biphasic - only to 200J - bidirectional shock |
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If you determine you have a pulseless rhythm and then determine V-fib or V-tach what do you do?
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Give one shock, no pulse, resume CPR
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypovolemia?
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Narrow complex and rapid rate
History, flat neck veins Volume infusion |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypoxia?
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Slow rate (hypoxia)
Cyanosis, Blood gases, airway problems Oxygenation, ventilation |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hydrogen ion (acidosis)?
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Smaller amplitude QRS complexes
Hx of diabetes, bicarbonate-responsive preexisting acidosis, renal failure Sodium bicarbonate, hyperventilation |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hyperkalemia?
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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 Kayexalate/sorbitol Dialysis (long term) Possibly albuterol |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for HypoKalemia?
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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 |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Hypothermia?
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J or Osborne waves
Hx of exposure to cold Central body temp Algorithm to handle this |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Tablets overdose(TCAs, dig, beta blockers, CCBs)?
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Various ECG effects;
Predominately prolongation of QT interval Bradycardia Empty bottles at scene Pupils Neuro exam Drug screens Intubation Lavage Active charcoal Lactulose per local protocols Specific antedotes and agents per toxidrome |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Cardiac Tamponade?
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Narrow complex
Rapid rate Hx No pulse felt with CPR Vein distention Pericardiocentesis |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Tension pneumothorax?
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Narrow complex
Slow rate(hypoxia) Hx No pulse felt with CPR Neck vein distention Tracheal deviation Unequal breath sounds Difficult to ventilate pt Needle decompression |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Thrombosis, heart - acute massive MI?
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Abnl 12 lead
Q waves ST segment changes T wave inversions Hx, Cardiac markers Fibrinolytic agents; See STEMI case |
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What clues are given from ECG and monitor, Hx/PE, and what treatment is given for Thrombosis, lungs - massive PE?
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Narrow complex
Rapid rate Hx No pulse felt with CPR Distended neck veins Prior (+) test for DVT/PE Surgical embolectomy Fibrinolytics |
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PEA rhythm:
If a narrow complex on monitor you more likely have what type of cause? |
Non cardiac; low volume, low vascular tone
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PEA rhythm:
If a wide complex on monitor you more likely have what type of cause? |
Cardiac cause; or drug and electrolyte toxicity
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What are 2 common non traumatic causes for hypovolemia?
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Occult internal hemorrhage
Severe dehydration |
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What are the drugs that can be delivered by ETT tube?
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N - Narcan
A - Atropine V - Valium E - Epinephrine L - Lidocaine |
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What can asystole look like - how to tell difference?
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Fine v- fib. Try to swith btwn leads on monitor to tell.
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Some S/S of bradycardia?
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Syncopal
Pallor Hypotensive Poor capillary refill Diaphoretic |
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What is the difference btwn defibrillation and synchronized cardioversion?
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Defib - high level joules to stop rhythm
Syn Cardio- lower energy; Avoids R on T phenomenon because follows R waves then shocks |
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With hypotension and shock what are three types of problems - and how to treat?
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1. Volume problem - Fluids first then pressor
Fluids 2L, Blood, Specific intervensions, consider pressors. 2. Pump problem Vasopressors 3. Rate problem Brady or Tach algorithm |
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If a pt is brought back from thier arrythmia (spec tachy), what drugs are given based on BP?
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Systolic <70
NorEpi drip Dopamine Dobutamine (D's could be supplements or if BP isnt that low) 70-100 c/ S/S shock Dopamine Dobutamine 70-100 c/ no s/s shock Dobutamine >100 Nitroglycerin Nitroprusside (vasodilates coronaries but watch BP drop) |
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PALS:
Cardiopulmonary arrest? |
Heart stops
Unresponsive Apnea No central palpable pulse |
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PALS:
Respiratory distress? |
Increased work of breathing
Tachypnea Nasal flaring Use of accessory muscles Inspiratory retractions |
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PALS:
Respiratory failure? |
Inadequate oxygenation/ ventilation or both
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PALS:
Shock? |
Cannot perfuse (deliver O2 or metabolic substrates)
Cold, clamped down, delayed capillary refill |
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PALS:
Difference btwn compensated and decompensated shock? |
Both have poor tissue perfusion but with compensated you can maintain BP; decompensated you cannot
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PALS:
Trend of cardiopulmonary arrest as kids age? |
<1yr:resp dz's, SIDS
1-2 yrs:injuries >2yrs:add asthma and suicide |
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PALS:
What level of resuscitation rarely results in intact neurological survival? |
2 doses of Epi or those lasting >10-25 minutes
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PALS:
Important anatomical differences btwn children and adults? |
Children:
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 |
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PALS:
Narrowest portion of airway in infants vs adults? |
Adult: Vocal cords
Peds: Cricoid cartilage |
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PALS:
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 |
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PALS:
Normal HR in peds? |
0-28d(neonate)- 80-200
1-12mo(Infant)- 80-180 1-10yo(child)- 60-180 10+yrs (adult)- 60-160 |
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PALS:
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 |
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PALS:
4 Major causes of shock? |
1. Hypovolemic
2. Obstructive 3. Distributive - 3rd spacing neurogenic 4. Cardiogenic |
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PALS:
Difference btwn the chain of survival for peds vs adults? |
Adult- early EMS/defib activation; Shock saves
Kids- Early CPR; respiration saves |
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PALS:
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 |
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PALS:
Type of ETT to use in <10yo? |
Uncuffed unless higher airway pressures are needed(Asthma, Pneumonia, ARDS, etc).
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PALS:
Formula for ETT tubes? |
Uncuffed: Age/4 + 4
Cuffed: Age/4 + 3 |
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PALS:
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 |
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PALS:
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 |
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PALS:
Order of preferred sites for IV access? |
1. Peripheral intravenous
2. Intraosseous Avoid epiphyseal plate Contraindications--> fx in extremity Previous insertion attempt Infxn of overlying bone 3. Central intravenous 4. Saphenous vein cut down |
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PALS:
Femoral Vein Access? |
Lateral to Medial
NAVEL |
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PALS:
MCC shock worldwide? |
Hypovolemia
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PALS:
Fluid therapy for kids with and without cardiac issues? |
Without: 20cc/kg
With: 10cc/kg |
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PALS:
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 |
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PALS:
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 |
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PALS:
PALS: 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 |
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PALS:
In children with severe head injury, submersion, and shock what can be a marker of severe ischemic insult? |
Hyperglycemia
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PALS:
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 |
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PALS:
What usually causes a bradyarrythmia in a child? |
Hypoxia
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PALS:
Post arrest what temperature would need to be treated? |
>37.5 or 99.5
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