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Questions and Answers
When distinguishing between Brugada syndrome and benign early repolarization on an ECG, which finding is most indicative of Brugada syndrome?
When distinguishing between Brugada syndrome and benign early repolarization on an ECG, which finding is most indicative of Brugada syndrome?
- The presence of a right bundle branch block.
- Downsloping ST-segment elevation in leads V1-V3. (correct)
- A notched J-point in the precordial leads.
- ST elevation in leads V2-6 with upward concavity.
Which of the following statements is most accurate regarding the assessment of a patient for long QT syndrome?
Which of the following statements is most accurate regarding the assessment of a patient for long QT syndrome?
- The QT interval is measured from the start of the Q wave to the midpoint of the T wave, with normal QTc limits between 0.35 and 0.44 seconds.
- Electrolyte imbalances associated with prolonged QT intervals include hypokalemia, hypomagnesemia, and hypocalcemia. (correct)
- QT interval nomograms are the preferred method for diagnosing congenital long QT syndrome over QTc formulas.
- Bazett's equation automatically adjusts the measured QT interval for a heart rate of 80 bpm.
Which characteristic is least likely to be associated with a positive outcome in determining if a patient will survive an out-of-hospital cardiac arrest?
Which characteristic is least likely to be associated with a positive outcome in determining if a patient will survive an out-of-hospital cardiac arrest?
- The initial rhythm is 'coarse' ventricular fibrillation (VF).
- The arrest is due to asystole resulting from a short period of hypoxia.
- The arrest occurs away from the patient's home. (correct)
- The arrest involves bradyasystole treated with atropine, adrenaline, and a pacemaker.
Regarding the right coronary artery (RCA), which statement is most accurate?
Regarding the right coronary artery (RCA), which statement is most accurate?
What is the approximate survival rate when defibrillation is administered within 5 minutes of the onset of ventricular tachycardia (VT) arrest?
What is the approximate survival rate when defibrillation is administered within 5 minutes of the onset of ventricular tachycardia (VT) arrest?
When performing chest compressions, which technique is most appropriate according to current guidelines?
When performing chest compressions, which technique is most appropriate according to current guidelines?
In neonatal resuscitation, after initial steps, which action should be prioritized before commencing chest compressions?
In neonatal resuscitation, after initial steps, which action should be prioritized before commencing chest compressions?
What is the correct size and length for an endotracheal tube (ETT) for a neonate weighing 3 kg?
What is the correct size and length for an endotracheal tube (ETT) for a neonate weighing 3 kg?
Which of the following drug dosages is incorrect in neonatal resuscitation according to current guidelines?
Which of the following drug dosages is incorrect in neonatal resuscitation according to current guidelines?
When managing a conscious child who is choking on a foreign body, which approach is appropriate for attempting to dislodge the obstruction?
When managing a conscious child who is choking on a foreign body, which approach is appropriate for attempting to dislodge the obstruction?
Which formula is most accurate in estimating a child's weight?
Which formula is most accurate in estimating a child's weight?
During advanced pediatric life support, which medication dose is incorrect?
During advanced pediatric life support, which medication dose is incorrect?
In which situation is the described drug or intervention not typically recommended?
In which situation is the described drug or intervention not typically recommended?
Flashcards
Brugada vs. Early Repolarization
Brugada vs. Early Repolarization
Brugada has a notched J-point and ST elevation in V1-3 with a downsloping ST segment and a negative T wave.
Electrolyte Causes of Long QT
Electrolyte Causes of Long QT
Electrolyte imbalances that cause long QT include hypokalemia, hypomagnesemia, and hypocalcemia.
Unfavorable Out-of-Hospital Arrest Character
Unfavorable Out-of-Hospital Arrest Character
Survival is more likely if arrest is witnessed, early defibrillation, unwitnessed arrest suggests hypoxia of brief duration. Bradyasystolic arrest treated with atropine, adrenalin, and pacemaker would likely not survive.
RCA and Bezold-Jarisch Reflex
RCA and Bezold-Jarisch Reflex
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Survival Rate with Defibrillation
Survival Rate with Defibrillation
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CPR and Pregnant Women
CPR and Pregnant Women
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CPR with Advanced Airway
CPR with Advanced Airway
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Newborn resuscitation
Newborn resuscitation
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Gastroschisis Immediate Tx
Gastroschisis Immediate Tx
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Pediatric Airway Differences
Pediatric Airway Differences
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Choking Child Management
Choking Child Management
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Child Weight Estimation Formula
Child Weight Estimation Formula
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Pediatric Defibrillation
Pediatric Defibrillation
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Pregnancy Physiology
Pregnancy Physiology
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Fetal Hemoglobin
Fetal Hemoglobin
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Study Notes
- Survival characteristics = young, witnessed collapse, early debfib, arrest occurs away from home, less comorbidities, or other easily correctable factors
Brugada vs Benign Early Repolarization
- Brugada is right precordial downsloping ST segment elevation V1-3 with a negative T wave often associated with a RBBB
- Early repolarization is ST elevation in V2-6 with an upward concavity a notched J wave and a positive T wave
Long QT Interval
- Bazett’s QTc=QT/√RR determines QTc at HR of 60
- QT interval measures from beginning of Q to end of T
- QT interval nomogram only used in acute poisoning because risk of torsades is better described by absolute rather than corrected QT
Out-of-Hospital Cardiac Arrest Survival
- Initial rhythm of VT or coarse VF has a 60% survival rate
- Initial rhythm of PEA has less than 5% survival, and bradysystolic has the worst odds of survival
Right Coronary Artery (RCA)
- Inferior infarcts are more often associated with Bezold-Jarisch reflex
- Proximal RCA supplies 55% of SA and distal RCA supplies 90% of AV
- Proximal occlusion can infarct both nodes
Survival Percentage from VT Arrest with Defibrillation Timing
- Within 2 minutes=90% survival
- Median of 5 minutes= 50%
- 10 minutes or greater=<10%
Chest Compression Techniques
- Strong recommendation but poor evidence for lower half of sternum during chest compressions
- Uterus displacement should only occur after commencement of CPR and do not do if it interferes with quality of CPR
- There is no upper limit as per ANZCOR guidelines BLS summary of changes December 2015
Airway Insertion in CPR
- There is equipoise between advanced airway and BVM
- Once intubated rate should be 10/min with no pause in CPR -> ANZCOR guidelines as of adult ALS summary of changes December 2015
Neonatal Resuscitation Sequence Before CPR
- In the absence of meconium tactile stimulation and warming should be done prior to resus
- PPV if HR <100 after 30 seconds
- If HR <60 after 30 seconds of PPV start CPR
- Term babies begin with air and titrate oxygen to sats if CPAP fails to oxygenate
- Tintinalli states repeated meconium suction prior to commencing resus but ANZCOR says only do this once GUIDELINE 13.4 JAN 2016
Neonatal Intubation Sizes
- Laryngoscope miller size 0 for <32 weeks <1.5kg otherwise size 0 to 1
- ETT size 2.5 for <1kg, 3 for 1-2kg, 3.5 for 2-3kg, 4 for > 3kg
- Length = 6 + kg
Incorrect Drug Doses in Neonatal Resuscitation
- Controversial – Tintinalli says to give bolus glucose but ANCOR guideline 13.9 jan 2016 states avoid bolus aim infusion 0.05 ml or 5 mg/kg/min
Immediate Treatment for Congenital Abnormality in Neonates
- Tracheoesophageal fistula = place in reverse trendelenburg
- Congenital diaphragmatic hernia is to avoid BVM as it will inflate GI contents
- Aim pCO2 30 to 35 mmHg to lower pulmonary vascular resistance
Differences Between Adult and Paediatric Airways
- A large occiput means there is no need for a pillow under head, instead put between shoulders
Choking Child
- Infants should not be placed prone, instead 5 back blows can be delivered if the child can maintain ventilation or vocalize, with coughing allowed to clear the airway
Estimation of Child's Dimensions
- APLS underestimates older children compared to Luscombe
- Broselow tape is height based, and parental estimation are often most accurate
Advanced Paediatric Life Support Drug Dosages
- Defib is 4J/kg as per ANZCOR guidelines 12.3 JAN 2016
- Adrenaline 10mcg/kg is 0.01ml/kg of 1:1,000 or 0.1ml/kg of 1:10,000)
Drugs & Situations Not Recommended
- Calcium only for hyperkalemia, hypocalcemia, and calcium-channel blocker overdose, MgSO4 as per ANZCOR guidelines 12.4 JAN 2016
Third Trimester Physiological Changes in Pregnant Women
- Cardiac output increases 30-45% above baseline
- A chronic resp alkalosis develops due to increased tidal volume and progesterone
- The uteroplacental mass requires 10% of blood volume at term
Maternal Hypoxia With Fetus
- Fetal Hb has a higher concentration per erythrocyte than maternal Hb
Intubating Pregnant Women
- Increased gastric emptying time and diminished lower oesophageal sphincter tone higher aspiration risk
- Airways issues produce greater chance of malampati class 3
Resuscitation in Pregnancy & Perimortem C-Section
- High risk of uterine atony and bleeding post c-section
- Perform perimortem c-section in <5 minutes
- Incision is vertical below xiphoid process to pubic symphysis, and performed on fetus of viable age which is now >22 weeks
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