What is the priority action if oxygenation cannot be achieved?
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Cutting the neck (performing a cricothyrotomy).
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What is the priority action if oxygenation cannot be achieved?
Cutting the neck (performing a cricothyrotomy).
What should be monitored to assess oxygenation during a CICO situation?
CO2 return by capnography and SpO2.
What should be done for hypoglycemia?
Check for and correct hypoglycemia.
What is the recommended compression rate during CPR?
100 - 120 compressions per minute.
What are the signs indicating a potential pulmonary embolism?
Sudden decrease in EtCO2, BP, or SpO2; sudden increase in central venous pressure; dyspnea, respiratory distress, or cough in an awake patient.
What is the first step in performing emergency front of neck access (eFONA)?
Expose and extend the neck, then perform a laryngeal handshake to identify the midline.
What should be done if ventilation is possible during anaphylaxis?
Administer albuterol 4-8 puffs MDI or 2.5 mg nebulized and sevoflurane titrated to 1 MAC.
What action should be taken if a stroke is suspected?
Call Stroke Code and obtain a STAT head CT scan.
What sequence of numbers is presented?
3, 15, 16, 5, 6, 7, 8, 9, 10, 11, 12, 13, 17, 18, 19, 20, 21, 22, 23, 24, 25, 2, 4, 14, 26, 27, 28, 29.
What could the numbers represent in a different context?
They could correspond to letters in the alphabet (A=1, B=2, etc.).
What is a sign of delayed emergence in a patient?
Less responsive than expected during emergence.
What is the treatment for hypoglycemia?
Administer Dextrose/D50 1 amp (25 g) and monitor glucose.
What is a key consideration when using a supraglottic airway (SGA/LMA)?
Optimize size and fit, and consider using a second-generation device.
What direction should the scalpel be rotated during eFONA?
Rotate the scalpel 90° with the blade toward the patient’s feet and pull toward you.
What should be done if there is no pulse?
Start CPR and assess for Asystole/PEA.
What should be done if laryngoscopy fails?
Consider alternative airway techniques or call for help.
What is the initial dose of Esmolol for rate control in SVT?
0.5 mg/kg IV over 1 minute.
What lab tests should be sent for a bradycardia patient?
ABG, Hgb, electrolytes, troponin.
What is the first action to take in a VFIB/VTACH crisis?
Inform the team.
What should be done first in a crisis during delayed emergence?
Inform the team and stop all medications.
What energy levels should be used for defibrillation?
120-200 J biphasic or 360 J monophasic.
What is the recommended initial dose of epinephrine for anaphylaxis?
10 - 100 mcg IV or 500 mcg IM if no IV access.
What is the post-arrest care if ROSC is achieved?
Arrange ICU care and consider cooling.
What is the recommended action for fluid management in anaphylaxis?
Give a rapid IV fluid bolus, which may require many liters.
What is the CPR rate recommended if there is no pulse during anaphylaxis?
100 - 120 compressions per minute.
What should be done if the patient has wide and irregular SVT?
Consult Cardiology STAT as it is likely polymorphic VT.
What diagnostic tools aid in differential diagnosis?
TEE/TTE and labs.
What is the initial treatment for hypoxemia?
Administer 100% O2 at 10-15 L/min.
What should be done if the patient is not anesthetized before cardioversion?
Consider sedation.
What are signs of high intracranial pressure (ICP)?
Widened pulse pressure, bradycardia, irregular respirations.
What should be considered for persistent bronchospasm?
H1 antagonist (diphenhydramine 25-50 mg IV), H2 antagonist (famotidine 20 mg IV), or corticosteroid (hydrocortisone 100 mg IV or methylprednisolone 125 mg IV).
What should be done for hyperthermia?
See Malignant Hyperthermia protocol.
What should be added to the patient's allergy list after anaphylaxis?
Consider adding allergens.
What is the goal tidal volume to avoid hyperinflation?
6 mL/kg.
What is the purpose of considering magnesium in SVT management?
For Torsades de Pointes.
What does the phrase 'This space is intentionally blank' imply?
It indicates that the page is left empty for a specific purpose.
What should be done to manage hypovolemia?
Give rapid IV fluid bolus and check Hgb.
What is the setting for a wide complex and irregular rhythm during cardioversion?
Unsync 200 J biphasic.
What is the first action to take in an anaphylaxis crisis?
Inform the team.
What medication should be administered after the second shock?
Epinephrine 1 mg IV every 3 - 5 minutes.
What is the initial management for thrombosis - pulmonary?
Consider TEE/TTE to evaluate right ventricular function and RVSP.
How long should a patient be monitored after anaphylaxis?
At least 6 hours; if severe, monitor in ICU for 12-24 hours.
What other conditions should be considered when evaluating a patient with suspected pulmonary embolism?
Anaphylaxis, bone cement implantation syndrome, bronchospasm, cardiac tamponade, cardiogenic shock, distributive shock, hypovolemia, myocardial ischemia, pneumothorax, and pulmonary edema.
What medications should be administered before performing eFONA?
Give a paralytic and anesthetic.
What is the dosage for thrombolysis using rtPA alteplase?
10 mg IV followed by an infusion of 90 mg over 2 hours.
What equipment is needed for a cricothyrotomy?
Scalpel (e.g., #10 blade), bougie, and 6.0 ET tube.
What should be done for refractory unstable SVT?
Repeat synchronized shock with increased joules and consider amiodarone 150 mg IV slow over 10 minutes.
What should be administered if bronchospasm occurs?
Give a bronchodilator.
How long should the vertical midline skin incision be for eFONA?
8 cm.
What lab test should be sent after an anaphylactic reaction?
Peak serum tryptase 1-2 hours after reaction onset.
What should be done after inserting the bougie in eFONA?
Remove the scalpel and pass a 6.0 ET tube over the bougie.
What lab tests should be sent to evaluate the patient?
ABG plus electrolytes for hypercarbia, hyponatremia, hypernatremia, and hypercalcemia.
What should be monitored during the eFONA procedure?
Monitor vital signs and pulse.
What are the signs of Cement or Fat Embolism?
Petechial rash, confusion or irritability if awake.
What is the minimum depth for chest compressions?
≥ 5 cm.
How can hyperkalemia be treated?
Calcium chloride 1g IV, bicarbonate 1 amp IV, and insulin with D50.
What intravenous treatment can be given if unable to ventilate?
Epinephrine 5-10 mcg IV or ketamine 10-50 mg IV or magnesium sulfate 1-2 g IV.
What are the signs of tension pneumothorax?
Asymmetric breath sounds, distended neck veins, and deviated trachea.
How often should the IV dose of epinephrine be increased?
Every 2 minutes until clinical improvement.
What actions should be taken if stridor or hypoxemia is present?
Consider intubation.
What medication is used for narrow and regular SVT?
Adenosine, 6 mg IV push, followed by 12 mg IV if needed.
What is the tidal volume recommended for secure airway ventilation during CPR?
6 - 7 mL/kg.
When should a STAT Cardiovascular Surgery consult be considered?
For thrombectomy (open).
What is the heart rate threshold for bradycardia treatment?
Heart rate < 50 bpm.
What should be maintained during CPR regarding EtCO2?
Keep EtCO2 > 10 mmHg.
What should be done for suspected cardiac tamponade?
Consider TEE/TTE and perform pericardiocentesis.
What oxygen flow rate should be administered to a patient with suspected pulmonary embolism?
100% O2 at 10-15 L/min.
What is the recommended oxygen flow for airway management in bronchospasm?
100% O2 at 10 - 15 L/min.
What advanced interventions should be considered in cases of severe decompensation?
Consider ECMO or cardiopulmonary bypass.
What should be avoided when administering Adenosine?
In patients with WPW or asthma.
What lab tests should be considered in severe cases of bronchospasm?
ABG and serum tryptase.
What is the treatment for Amniotic Fluid Embolism?
Supportive treatment: airway, breathing, circulation; monitor fetus; consider urgent Cesarean section.
What should be done first in a bradycardia crisis?
Inform the team and identify a leader.
What is the recommended oxygen flow for airway management?
100% O2 at 10-15 L/min.
What is the maximum number of attempts allowed for oxygenation modalities?
Two attempts each.
What is preferred for laryngoscopy in difficult airway situations?
Video laryngoscopy.
What should be done to reverse residual neuromuscular paralysis?
Use sugammadex or neostigmine with glycopyrrolate.
What is the technique for accessing the trachea through the cricothyroid membrane?
Stab horizontally through the cricothyroid membrane and extend to the width of the trachea.
What is the treatment for hypocalcemia?
Calcium chloride 1 g IV.
What should be monitored when administering epinephrine?
Monitor for tachycardia and hypertension.
What is the recommended dose of Amiodarone for wide and regular SVT?
150 mg IV over 10 minutes.
What are the signs of Air or CO2 Embolism?
Air visible on TEE/TTE.
What is the significance of the numbers listed (3, 15, 16, etc.)?
They may represent a sequence or a coded message.
What should be considered for additional IV access in anaphylaxis treatment?
Consider arterial line placement.
What factors increase the risk of pulmonary embolism?
Long bone orthopedic surgery, pregnancy, cancer (especially renal tumor), high BMI, laparoscopic surgery, or surgical site above the level of the heart.
What should you do after making the vertical incision in eFONA?
Palpate the cricothyroid membrane.
What actions should be taken regarding circulation in a suspected pulmonary embolism case?
Turn off volatile anesthetic and vasodilating drips, give IV vasopressor bolus, and consider rapid fluid bolus.
What is the initial dose of naloxone for opioid reversal?
40 mcg IV, may double and repeat every 2 minutes up to 400 mcg.
What should be considered if there are risks for a difficult airway?
Make contingency plans and consider advanced airway equipment.
What additional medications can be considered for bronchospasm?
Ketamine 10 - 50 mg IV, magnesium sulfate 1 - 2 g IV, or hydrocortisone 100 mg IV.
What supportive treatments are necessary for Air or CO2 Embolism?
Airway, breathing, circulation.
What is the recommended pacing rate for a bradycardia patient?
Set pacer rate to at least 80 bpm.
What does the phrase 'This space is intentionally blank' imply?
It indicates that the page is left empty for a specific purpose.
What indicates that a patient is unstable?
SBP < 75 mmHg, sudden SBP decrease, acute ischemia, chest pain, acute heart failure, or altered mental status.
What should be done if SpO2 is critically low?
Go to the red box protocol.
What is the priority between defibrillation and intubation?
Defibrillation is the higher priority.
What should be done if angioedema occurs during anaphylaxis?
Consider early intubation.
What should be obtained to assist in the diagnosis of SVT?
A 12-lead ECG or a print rhythm strip.
Who should be informed during an emergency cricothyrotomy?
Announce the emergency cric / front of neck access to the team.
What advanced interventions may be considered for severe bronchospasm?
ECMO or cardiopulmonary bypass.
What should be done to optimize conditions before attempting intubation?
Ensure paralysis, anesthetic depth, and optimize positioning.
What medication should be continued if hypotension occurs during anaphylaxis?
Continue epinephrine infusion.
What vital signs should be checked and corrected?
Hypoxemia, hypercarbia, hypothermia, or hypotension.
What should be done if there is no pulse in a patient suspected of having a pulmonary embolism?
Start CPR, check rhythm, and follow the appropriate algorithm.
What should be done if hypomagnesemia or torsades is suspected?
Administer magnesium 1 - 2 g IV.
What should be done if the patient is hypotensive during anaphylaxis?
Turn off volatile anesthetics and vasodilating drips, and consider an amnestic agent.
What should be confirmed after inflating the cuff and ventilating in eFONA?
Confirm CO2 and check breath sounds.
What should be monitored to check for signs of return of spontaneous circulation (ROSC)?
Sustained increased EtCO2, spontaneous arterial waveform, rhythm change.
What should be monitored after administering Adenosine?
The EKG.
What is the initial synchronized cardioversion setting for a narrow complex and regular rhythm?
Sync 50-100 J biphasic.
When should pulse checks be performed?
Only if there are signs of ROSC.
What is the first action to take in a crisis situation involving a suspected pulmonary embolism?
Inform the team and identify a leader.
What are the signs of bronchospasm?
Inability to ventilate, high peak inspiratory pressure, wheezing, absent breath sounds if severe, increased expiratory time, increased EtCO2, upsloping EtCO2 waveform, decreased tidal volumes, hypotension if air-trapping.
What should be checked during a neurological exam?
Pupil changes, motor asymmetry, and gag reflex.
What is the first step in managing stable SVT?
Consult STAT Expert for rhythm diagnosis and medication selection.
What conditions should be ruled out during anaphylaxis treatment?
Anesthetic overdose, aspiration, distributive or obstructive shock, embolism, hemorrhage, hypotension, myocardial infarction, pneumothorax, and sepsis.
What should be done if there are residual mental status abnormalities?
Monitor the patient in ICU with neurologic follow-up.
What is the initial treatment for Pulmonary Thromboembolism?
Discuss feasibility and safety of urgent thrombolysis vs. thrombectomy with the surgical team.
What should be done if hypotension is observed during bronchospasm?
Briefly disconnect the circuit if air-trapping is suspected.
What should be evaluated in the right heart if instability or decreased RV function is suspected?
Use medication and diuresis to maintain sinus rhythm, normal RV volume status, RV contractility, and decrease RV afterload.
What should be done to stop allergens during anaphylaxis?
Remove allergens such as antibiotics, muscle relaxants, and latex.
What should be checked to confirm airway placement?
Check CO2 waveform and auscultate lungs.
What are the risk factors for Pulmonary Thromboembolism?
Chronic illness, neoplasm, immobility, missed anticoagulation.
What medications are recommended for severe bronchospasm?
Epinephrine 5 - 10 mcg IV every 3 - 5 min or 200 mcg subcutaneously, with possible addition of glycopyrrolate 0.2 - 0.4 mg IV.
What rare causes should be considered in delayed emergence?
High spinal, serotonin syndrome, malignant hyperthermia, myxedema coma, seizure, thyroid storm, hepatic/uremic encephalopathy.
What is the infusion rate for Esmolol after the initial dose?
50 - 300 mcg/kg/min.
What are the signs of Amniotic Fluid Embolism?
Altered mental status, hypotension, hypoxemia, seizures, coagulopathy in a peripartum patient.
What oxygen flow rate should be administered to a bradycardia patient?
100% O2 at 10 - 15 L/min.
What is the initial action if there is no pulse in a bradycardia patient?
Start CPR.
What is the first action to take in a crisis situation?
Inform the team.
What medication is first considered for bradycardia?
Atropine 0.5 - 1 mg IV every 3 minutes.
What should be done if atropine is ineffective?
Administer epinephrine 5 - 10 mcg IV.
What should be obtained to assess ischemia in a bradycardia patient?
12-lead ECG.
