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VENT TRANSFER
CRASH CARD
GAS EXCHANGE problem → correction
O2SpO2 / PaO2 low↑ FiO2 then ↑ PEEP
CO2EtCO2 / pCO2 high↑ RR then ↑ volume
CO2EtCO2 / pCO2 low↓ RR
DOPES
  • Displaced tube
  • Obstructed / plugged
  • Pneumothorax
  • Equipment failure
  • Stacked breaths
DOTTS
  • Disconnect vent
  • O2 100% · bag by hand
  • Tube: suction + EtCO2
  • Tweak settings
  • Sounds equal
HIGH PRESSURE  kink · plug · biting · bronchospasm · PTX
LOW PRESSURE  disconnect · cuff leak · extubated
TIDAL VOLUME 6 mL/kg PBW · by height & gender
HTF mLM mL
5'0"275300
5'2"300330
5'4"330355
5'6"355385
5'8"385410
5'10"410440
6'0"440465
6'2"465495
6'4"495520
ARDSNET (ARMA)
  • TV 6 mL/kg PBW · range 4–8
  • Plat ≤30 · if >30: ↓TV 1 mL/kg → min 4
  • RR ≤35 · titrate to pH
  • pH 7.30–7.45 · ≥7.15 tolerated
  • PaO2 55–80 · SpO2 88–95
  • ΔP ≤15 (Amato, post-hoc)
PBW derives from height + gender, not weight. 8 mL/kg = table × 1.33.
⚠ STILL HYPOXIC — ESCALATE IN ORDER
1 sedate deeper → 2 paralyze → 3 ↑PEEP (Plat ≤30, ΔP ≤15) → 4 prone if able → 5 accept SpO2 88 / pH ≥7.15 → 6 ECMO call (P/F <80)
High PEEP derecruits in seconds — clamp the tube before ANY circuit break.
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
LAB VALUES
CRASH CARDCC-LV-01 · ACUTE CARE 01
BASIC METABOLIC PANEL adult reference
Na135–145
▲K3.5–5.0
Cl / CO₂98–106 / 23–29
BUN / Cr7–20 / 0.6–1.2
▲Glucose70–100 (fasting)
Calcium8.5–10.5
Mg / Phos1.7–2.2 / 2.5–4.5
EXTENDED CHEMISTRY
Anion gap8–12
Osmolality275–295 mOsm/kg
Ammonia lab-specific15–45 µg/dL
Lipase lab-specific10–140 U/L
ABG arterial · PaCO₂ / PaO₂ mm Hg
pH7.35–7.45
PaCO₂35–45
PaO₂80–100
HCO₃⁻22–26 mEq/L
SaO₂95–100 %
▲Lactate0.5–2.0 · >4 critical mmol/L
▲ amber = high-alert analyte — recap on back
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
ETT SIZING
CRASH CARDCC-ETT-01 · ACUTE CARE 02
PEDIATRIC ETT uncuffed-led · cuffed = −0.5 · depth at lip
AGElbkgUNCUFFCUFFDEPTH cm
Preterm2–51–2.52.5–3.0—6–8
Newborn7–113–53.0–3.5—9–10
6 mo1573.5–4.03.0–3.510.5–12
1 yr22104.0–4.53.5–4.012–13.5
2 yr26124.54.013.5
4 yr35165.04.515
6 yr44205.55.016.5
8 yr55256.05.518
10 yr70326.56.019.5
12 yr88407.06.521
14 yr110507.0–7.56.5–7.021
FORMULAS · 1–10 YR
  • Uncuffed (age÷4)+4
  • Cuffed (age÷4)+3.5
  • Depth 3 × tube ID cm
  • Neonate kg + 6 cm at lip
BLADE
  • Preterm Miller 0
  • NB–2 yr Miller 1
  • 2–8 yr Miller / Mac 2
  • 8 yr+ Mac 3 · Mac 4 lg
SUCTION CATH 2 × ETT ID in Fr · 4.0 tube → 8 Fr
GASTRIC / OG 2 × ETT ID in Fr · decompress after BVM
STYLET straight-to-cuff ~35° · tip never past Murphy eye
⚠ FAILED AIRWAY — MOVE, DON'T REPEAT
1 reposition + bougie → 2 size down 0.5 → 3 SGA / LMA → 4 2-person BVM + OPA/NPA → 5 surgical airway — mark cricothyroid early if predicted difficult
Max 2 attempts per operator — SpO2 recovery between every attempt.
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
VASOACTIVE DRIPS
CRASH CARDCC-VD-01 · ACUTE CARE 03
INFUSIONS usual adult IV · titrate to effect
AGENTRECEPTORDOSEMIX
VASOPRESSORS
Norepinephrineα₁ > β₁0.01–0.5 µg/kg/min4 mg/250 = 16 µg/mL
Epinephrineβ₁β₂ > α₁0.01–0.5 µg/kg/min4 mg/250 = 16 µg/mL
VasopressinV₁0.03–0.04 U/min fixed20 U/100 = 0.2 U/mL
Phenylephrineα₁ pure0.5–6 µg/kg/min10 mg/250 = 40 µg/mL
INOTROPES
DopamineD→β₁→α₁2–20 µg/kg/min400 mg/250 = 1600
Dobutamineβ₁ > β₂2–20 µg/kg/min250 mg/250 = 1000
MilrinonePDE30.375–0.75 µg/kg/min20 mg/100 = 200
Amber agent = extravasation / high-alert. Dopamine effect is dose-dependent. Milrinone load & peripheral max rates omitted — facility-specific. Verify concentrations locally.
CHOOSE THE PRESSOR first-line by shock type
SEPTICNorepi+ vaso if refractory
CARDIOGENICNorepi ± dobutaminepressure first, then pump
ANAPHYLAXISEpidrip after IM dosing
NEUROGENICNorepi / phenylephrinewatch bradycardia
BRADYCARDICEpi / dopaminepace if refractory
LINE SAFETY
CENTRAL  preferred for all vasoactives · dedicated pump · labeled line
PERIPHERAL  bridge only · large vein · lowest dose · site check q1h
⚠ EXTRAVASATION
1 stop infusion → 2 aspirate via catheter → 3 phentolamine 5–10 mg SC in 10 mL NS around site → 4 new line · restart
Phentolamine reverses α agents — norepi · epi · phenyl · dopamine.
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
RSI · AIRWAY
CRASH CARDCC-RSI-01 · ACUTE CARE 04
PREPARE before the first attempt
Pre-oxygenate100% O₂ ≥3 min or 8 VC breaths
Apneic O₂NC 15 L/min — on through attempt
Positionear-to-sternal-notch · ramp if obese
Backupsuction on · bougie · SGA at hand
Pressorpush-dose epi drawn up before drugs
Planverbalise A→B→C · assign roles
INDUCTION → PARALYSIS IV · mg/kg
AGENTmg/kgONSETDURATIONHEMODYN.
INDUCTION
Etomidate0.330–60s3–10mneutral
Ketamine1–230–60s5–15m↑BP ↑HR
Propofol1.5–2.5<60s5–10m↓↓BP
Midazolam0.1–0.360–90s15–30m↓BP · slow
PARALYSIS
Succinylcholine1.545–60s6–10m↑K⁺
Rocuronium1.2 RSI45–60s30–60mneutral
ROC 1.2  intubating conditions ≈ sux speed · plan for 30–60 min down
NO ANALGESIA  etomidate / midazolam — pair with fentanyl
NO SUX — USE ROC
  • Hyperkalemia known / suspected
  • Burns / crush >72 h out
  • Denervation GBS · ALS · SCI
  • MH history personal / family
SHOCK / LOW BP
  • SI ≥1 → ketamine or etomidate
  • cut induction dose 25–50%
  • avoid propofol
  • push-dose epi 5–20 µg q2–5m
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
PEDIATRIC EMERGENCY
CRASH CARDCC-PED-01 · ACUTE CARE 05
WEIGHT & VITALS APLS wt (age+4)×2 kg · 1–10 y
AGE~KGHRRRSBP ≥
Neonate3.5100–18030–6060
Infant <1 y4–10100–16030–6070
Toddler 1–3 y10–1490–15024–4072–76
Preschool 3–6 y14–2080–14022–3476–82
School 6–12 y20–4070–12018–3082–90
Adolescent >12 y>4060–10012–2090
SBP floor 1–10 y = 70 + 2×age · a "normal" BP does not rule out shock
ARREST weight-based · IV/IO
Epi 0.1 mg/mL0.01 mg/kg = 0.1 mL/kg q3–5m · max 1 mg
Defibrillate2 J/kg → 4 J/kg · max 10 J/kg or adult dose
Cardioversion0.5–1 J/kg → 2 J/kg · synchronized
Amiodarone5 mg/kg · max 300 mg · may repeat ×2
Adenosine0.1 → 0.2 mg/kg rapid · max 6 → 12 mg
Compressions100–120/min · ⅓ AP depth · 15:2 two-rescuer
FLUIDS
  • Bolus 10–20 mL/kg isotonic
  • reassess after each bolus
  • Blood 10 mL/kg
  • Neonate/CHD 10 mL/kg
GLUCOSE rule of 50
  • D10 5 mL/kg · D25 2 mL/kg
  • D50 1 mL/kg (% × mL/kg = 50)
  • low: <60 child · <45 neonate
  • recheck 10–15 min after dose
⚠ NORMAL-LOOKING LOWS — HYPOTENSION IS LATE
Children compensate: tachycardia · cool/mottled skin · cap refill >2 s · narrow pulse pressure with SBP intact. Falling BP = decompensation — act before it.
Tachycardia out of proportion + poor perfusion = shock with a "normal" BP.
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
BURN ASSESSMENT
CRASH CARDCC-BRN-01 · ACUTE CARE 06
%TBSA — RULE OF NINES 2°/3° only · peds deltas amber
REGIONADULTPEDS
Head / neck918
Arm (each)99
Leg (each)1814
Trunk — anterior1818
Trunk — posterior1818
Perineum1–
PALM RULE  patient's palm including fingers ≈ 1% TBSA — scattered / irregular burns
DEPTH exam findings
SUPERFICIALepidermis · red, dry, blanches · painful · no blisters · not counted in TBSA
SUPERF. PARTIALpapillary dermis · wet, blisters, brisk blanch · very painful
DEEP PARTIALreticular dermis · mottled, sluggish / no blanch · ↓ pinprick sensation
FULLall layers · leathery, waxy, charred · no blanch · painless to touch
FLUID RESUSCITATION LR · count 2°/3° only
Parkland4 mL × kg × %TBSA · LR · total / 24 h
Modern start≈2 mL/kg/%TBSA · initial rate, then titrate
Peds+ D5 maintenance gtt · alongside resus fluid
⚠ HALF IN FIRST 8 h — FROM TIME OF BURN
0–8 h first half → 8–24 h second half — clock starts at the burn, not arrival
Subtract prehospital fluid already given from the first-half volume.
EXAMPLE 70 kg × 40% → 11.2 L / 24 h · ≈700 mL/h × 8 h · then titrate to UOP
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
TRAUMA / SHOCK
CRASH CARDCC-TRM-01 · ACUTE CARE 07
HEMORRHAGIC SHOCK I–IV classic cutoffs · 70 kg
CLASSLOSSHRSBPPPRRMENTAL
I<15%<100nlnl14–20sl. anxious
II15–30>100nl↓20–30anxious
III30–40>120↓↓30–40confused
IV>40%>140↓↓↓>35lethargic
Narrowing pulse pressure is the earliest vital-sign change — BP holds until class III.
HR masked by β-blockers · elderly · pacemaker · athletes — don't trust a normal rate.
SHOCK TYPE exam hallmark → first move
TYPEHALLMARKFIRST MOVE
HYPOVOLflat neck veins · cool · clammyblood · find bleed
CARDIOGJVD + rales · coolinotrope · no bolus
OBSTRUCTJVD + clear lungsdecompress / drain
DISTRIBwarm · wide pulse pressurepressor + fluids
TARGETS
PERMISSIVE HYPOTENSION
  • SBP 80–90 · palpable radial
  • only until surgical hemostasis
  • bolus to target, not to normal
  • reassess after every unit
TBI EXCEPTION
  • SBP 90–100 minimum
  • one hypotensive episode
  • doubles TBI mortality
  • GCS ≤8 → secure airway
SHOCK INDEX = HR ÷ SBP · >0.9 occult shock · >1.0 think blood + MTP
⚠ BLEEDING CONTROL — IN ORDER
1 direct pressure → 2 pack wound + pressure → 3 tourniquet high & tight — mark time → 4 junctional device / 2nd TQ above 1st
TQ not controlling → second tourniquet proximal, side by side.
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
ELECTROLYTES
CRASH CARDCC-LYT-01 · ACUTE CARE 08
REPLACEMENT DOSING adult IV · severity-tiered
K+ POTASSIUM3.5–5.0 mEq/L
3.0–3.4 · asymptomatic20–40 mEq PO/IV
<3.0 / symptomatic40–80 mEq IV · divided
Rate · peripheral≤10 mEq/h · monitor ≥10
central max per facility policy · 10 mEq ↑ K ~0.1 mEq/L
Mg2+ MAGNESIUM1.7–2.2 mg/dL
Repletion1–2 g IV over 30–60 min
TORSADES2 g IV over 1–2 min
PO₄ PHOSPHORUS2.5–4.5 mg/dL
Mild–mod0.08–0.16 mmol/kg IV
Severe <1.50.16–0.32 mmol/kg IV
Infuse over 4–6 h · K-phos if K low, else Na-phos
Ca2+ CALCIUMiCa 1.1–1.3 mmol/L
Gluconate1–2 g IV · peripheral OK
Chloride1 g = 3× elemental · CENTRAL
NEVER
  • K+ IV push — ever
  • CaCl periph — necrosis
  • Rapid Mg unless torsades
  • Ca + phos same line — precipitates
CO-REPLACEMENT
  • Mg first — K won't hold
  • K-phos counts toward K
  • Recheck before re-dose
  • PO route preferred if able
Mg BEFORE K
hypomagnesemia makes K repletion refractory — replete Mg first
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY
MARCH FIELD CARE
CRASH CARDCC-MFC-01 · FIELD OPS
M · MASSIVE HEMORRHAGE before anything else
TOURNIQUEThigh & tight · tighten until bleeding + distal pulse stop
TIMEwrite on TQ and casualty forehead
PACKwound packing + 3 min direct pressure
JUNCTIONALjunctional TQ / pack + pressure groin · axilla · neck
2ND TQside-by-side, proximal to first, if bleeding continues
A · AIRWAY
  • Position · chin lift / jaw thrust
  • unconscious → recovery position
  • NPA · tolerated semiconscious
  • Cric · surgical, if trained + failed above
  • burns / inhalation → airway early
R · RESPIRATION
  • Vented chest seal on open wounds
  • Needle decomp 10–14 ga · ≥3.25 in
  • 5th ICS AAL pref · 2nd ICS MCL
  • tension recurs — re-dart if needed
  • burp / replace clotted seal
C · CIRCULATION blood > crystalloid
SHOCK SIGN↓ mental status · weak / absent radial pulse
ACCESS18 ga IV · IO if ×2 fail or no time
TXA2 g IV/IO slow push · ≤3 h (was 1 g + 1 g)
FLUIDSwhole blood > components > crystalloid
BP TARGETpermissive: SBP 80–90 / radial pulse
TBI EXCEPT.keep SBP 100+ (newer trend 110+)
H · HYPOTHERMIA / HEAD
STRIPwet clothing off · insulate from ground
WRAPheat blanket + vapor shell + cap
FLUIDSwarm IV fluids when able
TBIavoid hypoxia SpO2 ≥90 · SBP 100+
RECHECKAVPU / pupils with every set of vitals
FIELD REFERENCE · NOT A PROTOCOLVERIFY LOCALLY

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CC-DECK-01 - COMPLETE SYSTEM

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Every card in the system - vent transfer, labs, ETT sizing, vasoactive drips, RSI, pediatric emergency, burns, trauma & shock, electrolytes, and MARCH field care. $150 of cards, one order, one badge reel of backup.

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