Shock
Name 2 signs and symptoms of shock
Tachycardia (or possibly bradycardia)
Hypotension
Altered mental status
End-organ dysfunction (ie decreased urine output)
A patient is in SVT and is hypotensive and has GCS of 8. What is the treatment for SVT in this patient and what is the dosage?
synchronized cardio version, 1J/kg
True/False: You should start every drowning patient on prophylactic antibiotics.
False
Name 2 ways that you can help treat hypothermia in a drowning victim
Take off wet clothes.
Use heat lamp.
Put blankets over patient.
Give warmed IV fluids.
Where are the stopwatches located in the department that can be used to time for CPR?
by sink in ICU
by backboard in ER
Name 2 causes of obstructive shock
pneumothoraxes
hemothorax
pulmonary embolism
cardiac tamponade
You are actively doing CPR for a patient in asystole. What is the medication you should give and what is the dosage?
adrenaline, 10mcg/kg
Patient has non-fatal drowning incident and comes to ER with no symptoms. What is the minimum time you should observe patient?
8 hours
How does hypothermia affect the heart rate?
Causes bradycardia for age
A patient has asystole. Adrenaline is given immediately and CPR is started. How many minutes should you wait to give another dose of adrenaline?
4 minutes
A previously healthy 2 month old child is brought to the emergency room because of dehydration. He has been having profuse diarrhea for 3 days.
Vital signs: HR: 220 beats/min BP: 66/40mmHg RR: 30 T: 37c
Physical exam: He is lethargic. His anterior fontanelle and eyes are sunken. He has a thready pulse and cold extremities with capillary refill of 5 seconds.
What type of shock is he in?
Hypovolemic
A patient is in PEA. What is the next step?
CPR
Hypoxia
Are routine steroids recommended in drowning patients?
No
Name one thing that you should always get when doing CPR
Backboard
Stopwatch
Defibrilator
A 6-week-old male infant is brought to the emergency department with poor feeding for 2 days, rapid breathing, excessive sweating, especially during feeds and lethargy.
VS: HR: 190 bpm, BP 60/30, RR 65/min, T 37
Physical exam: Delayed capillary refill, weak peripheral pulses, heart murmur, fine crackles bilaterally.
What type of shock does this patient have?
Cardiogenic
A patient is in pulseless ventricular tachycardia. What is the treatment and dosage?
Administer shock, 4Joules/kg
Patient has evidence of cerebral edema, what are 2 interventions you should perform?
Avoid instances that can increase ICP - hypoxemia, hypercarbia, hypotension, pain, urinary retention or agitation
Elevate HOB to 30degrees
Maintain euthermia
Maintain normoglycemia
Give 2 things you can educate families on to help prevent drownings.
Patients with epilepsy are increased risk of drowning.
Precaution using drugs/alcohol near water.
Teach children how to swim.
Teach families with pools CPR.
Children should never be left alone in a bathtub.
What is the ratio of compressions:breaths for a 2 week old neonate?
3:1
A 16-year-old boy is brought to the hospital after sustaining a blunt injury to his upper back after being hit by a car.
Vital signs HR: 60beats/min BP: 70/30mmHg
Physical exam
His is initially alert and appears flushed. His hands and feet are warm. He cannot move his legs. A foley catheter is placed and he has no urine output. During your assessment, his heart rate drops to 48 beats/minute. He complains of feeling nauseous and becomes lethargic.
Neurogenic (distributive)
How do vagal maneuvers treat SVT?
Causes activation of the vagal nerve stimulates parasympathetic nervous system aka “rest and digest”
-Slows HR, slows conduction velocity of AV node, decreases strength of contraction
Goal: break SVT reentry loop which can normalize HR
If patient dove into shallow water and hit their head, what should you put on patient as a precaution?
cervical spine collar
Name 2 indications for intubation of a drowning victim
Signs of neurologic deterioration or inability to protect airway
Inability to maintain PaO2 >60mmHg or SPO2 >90% despite high-flow oxygen delivery system or noninvasive ventilation
Evidence of ventilatory failure with worsening respiratory acidosis despite optimal noninvasive support
Name 4 reversible causes of cardiac arrest
Hypovolemia
Hypoxia
Hypo/hyperkalemia
Hydrogen ions (acidosis)
Hypoglycemia
Hypothermia
Toxins
Tension Pneumothorax
Thrombosis (cardiac or pulmonary)