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What is the most reliable method of confirming and montioring correct placement of an ET tube? Continuous waveform capnography We have an expert-written solution to this problem! The upper airway consists of... Nose, Mouth, Jaw, Oral Cavity, Pharynx, and Larynx No gas exchange occurs here __________, it's called ____________. Nose to terminal bronchioles, anatomical dead space. (2ml/kg of inspired tidal volume) They conduct airflow towards gas exchange units. Crycothyroid membrane between thyroid and cricoid, avascular structure that connects the thyroid and cricoid cartilage. Site of CRiCOTHYROTOMY- an emergency opening of the airway.
A PaCO2 greater than 45 mmHg indicates: A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. C. Respiratory acidosis PaCO2 normal range 35 - 45 mm Hg Less than 35 likely means hyperventilation Tracheal deviation AWAY from the affected side, decreased breath sounds, and hyperresonance... What's happening? Tension pneumothorax In a tension pneumothorax tracheal deviation goes in what direction? AWAY from affected side. Normal mean pulmonary artery pressure 10 - 20 mmHg Pulmonary hypertension is a mean PA pressure greater than...
Catecholamine mediated vasoconstriction resulting from blood loss shunts blood away from the fetus to the mom. Fetal hypo perfusion is evidenced by.... Fetal tachycardia (140 to 160+) and fetal bradycardia The FRC in a pregnant patient is.... Reduced by the gravid uterus lifting the diaphragm. chest tube placement in a pregnant patient is 1-2 spaces higher Because of the lifted diaphragm What is the cause of physiological anemia in pregnant patients? Hemodilitional anemia occurs. Plasma volume increases 30-50%. Preterm Labor (PTL) abruptio placentae premature separation of the placenta from the uterine wall
On a pregnant patient... Chest compressions must be higher on the sternum. Any preg patient 20 weeks pregnant or more with a uterus above the umbilicus should have the uterus left laterally displaced during compressions to avoid aortocaval compression. A 15 degree tilt of the long board or lateral displacement. What is the Maternal Fetal Triage Index? A valid reliable 5 level triage tool that may assist in the triage of obstetric trauma patients. Displacing the uterus off the vena cava can improve CO by approximately 30%! Continuous fetal monitoring is recommended... for all pregnant patients 20 or more weeks gestation... or (uterus above belly button). Fundal height measurement equals the approximate gestational age in weeks, until week 32. Belly button is 20 weeks Height of last rib is 26 weeks
Sonography has __________ for diagnosis placental abruption, POOR.... they miss 50-80% of abruptions. In addition to routine labs a Prothrombin (PT ) and PTT and serial coags should be drawn. Beta Human Chorionic gonadotropin (BHCG) Measure and record fundal height every 30 minutes. Pediatric Mechanisms of injury and biomechanics Blunt trauma MVC > suffocations > drownings > fires/burns. No. 1 cause of fatalities is TBI. Primary Survey/ Resuscitation Survival rates in pediatric emergency can be directly correlated with 1.RAPID AIRWAY MANAGEMENT, 2.INITIATION OF VENTILATORY SUPPORT, AND
3.EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND intracranial hemorrhages A STEMI is a __________ resulting from a _________. Complete Occlusion of a coronary artery caused by a ruptured Plaque leading to blood clot formation in the coronary. STEMI diagnosis Chest pain + positive cardiac enzyme (TROP. >0.4), and --ST segment ELEVATIONS greater than 1 mm in two or more contagious leads V1-V
- Reciprocal (depressions) changes in leads II, III, AVF STEMI EKG findings STEMI STEMI EKG findings more
- St elevations > 1mm in Limb leads: 1, II, III, avF, avL
- St elevations > 2mm in precordial leads (v1-v6) AND/OR
STEMI Nitro gtt 5 - 10 mcg per minute Titrate by 10 mcg max dose 300 mcg per minute How do you mix epi? Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1 mcg/ ml What's the epi dose for hypotension s/p arrest? 0.1 - 0.5 mcg/kg/min What is the epi dose for anaphylaxis? Pediatric Epinephrine dose PALS 2020 update AHA 2020 BASIC BP
Diastolic BP of at least 25mmhg in infants and at least 35 mmhm in children correlates with better outcomes. PALS Brady with a pulse Assess airway, breathing, mental status Most common cause is hypoxia! could also be hypothermia and or medications. s/s of shock? AMS? hypotensive? Start CPR if any of these Always start CPR if HR < 60 bpm iv access Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution) Repeat Q 3-5 minutes Initial management of pediatric respiratory distress or Failure A
- A-ABC. Support open airway: Comfort or Head tilt chin lift. Jaw thrust. Clear airway if indicated. (suction nose or mouth if indicated) Consider OPA or NPA. IDENTIFY type and Severity of respiratory problems Initial management of pediatric respiratory distress or Failure B
Infants are obligate nose breathers. PALS Management of upper airway obstruction position of comfort, or jaw thrust chin lift 100% FIO2 via non rebreather
- Carefully weigh decision to suction. Don't do it if it's croup of anaphylaxis.
- give nebulizer epinephrine particularly if swelling is beyond the tongue.
- Give inhaled or IV cortical steroids
- OPA for AMS and NPA for ams with a gag.
- consider cpap.
- Only experienced intubation should be considered ensure pt can be ventilated prior to paralytic
- prepare for difficult airway (needle cricothyroidotomy) In infants and children, retraction of the skin, muscles, and other tissues around the clavicle and between the ribs indicates: A. shallow breathing. B. labored breathing. C. see-saw breathing. D. normal breathing.
PALS Management of upper airway obstruction caused by croup. PALS Management of Anaphylaxis In addition to ABC....
- Administer IM epic by auto injector or regular syringe every 10 to 15 minutes as needed. Repeat doses may be needed.
- Treat bronchospasm with albuterol MDI or Nebulizer
- Give continuous nebulizer treatment if needed.
- **For severe respiratory distress anticipate further airway swelling and prepare for endotracheal intubation PALS Management of anaphylaxis continues To treat hypotension:
- Place child in trendelenburg position as tollerated
- administer isotonic crystalloid (NS/LR) at 20ml/kg repeat as needed.
- For hypotension unresponsive to fluids and IM epinephrine, start a gtt at 0.05- 2 mcg/kg/min titrate to effect Pals Management of anaphylaxis continues finally... Administer Diphenhydramine 1mg/kg and an H2 blocker, ranitadine IV.
- Administer methylprednisolone or equivalent IV
- Corticosterorids IV
- Magnesium Sulfate 25-50mg/Kg via slow IV bolus over 15 to 30 minutes. MAX 2g
- Labs as indicated PALS Management of Severe Asthma In Addition to all of the interventions for moderate to sever asthma...
- Consider Terbutaline 10mcg/Kg load over 5 minutes SQ or as a gtt 0. mcg/kg/min or IM epi as an alt.
- Bipap
- If refractory hypoxemia intubate. Epi Dose, Flight nurse trick 0.1ML/kg no matter what concentration according to Bill. PALS Defibrillation dose 2 J/kg PALS Cardioversion dose 0.5-1 J/KG
PALS Calcium Dose & Indication Only for known/suspected hypocalcemia 20 mg/kg Calcium Chloride SLOW IV push PALS Increased ICP Cushings Triad Caused by increased ICP and impending herniation.
- Irregular Breathing
- Hypertension
- Tachycardia In adults it's bradycardia Hyperventilate the patient to prevent further increases in ICP
- hypertonic saline, Osmotic agents (dose?)
- Treat pain and agitation aggressively once airway is established.
- Avoid hyperthermia PALS management of respiratory distress due to poisoning
- Support airway
- give antidote
- call poison control
PaCO2: 35- 45 PaO2: 80- 100 HCO3: 22- 26 chemistry panels (renal, hepatic, comprehensive, metabolic) Na+ 135- 145 Cl- 95 - 105 K+ 3.5-4. Cr 0.6-1. Glucose 70- 100 Magnesium 1.7-2. Magnesium 1.7-2. K+ (potassium) 3.5-5.0 mEq/L Na+ 135 - 145 mEq/L
Glucose 70 - 110 mg/dL Cr (Creatinine) 0.6-1.3 mg/dL Systemic Vascular Resistance (SVR) the force opposing the movement of blood within the blood vessels [(MAP-CVP) / CO] x Normal: 750-1600 dynes/sec SVR Formula & Normal (MAP - CVP / ) x 80 Normal 750-1600 dynes/sec hemodynamic changes in Hypovolemic hemorrhagic shock HR Increased SBP Decreased SVR Increased CVP Decreased
