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ILS Course - A to E Training & Solutions Ltd > ALS Algorithm > Flashcards

ALS Algorithm Flashcards

1
Q

What is the advantage of using the ALS algorithm?

A
  1. Rx to be delievered expediently
  2. Without protracted discussion
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2
Q

Key actions to improve survival in cardiac arrest:

A
  1. Early, high quality, uninterrupted chest compressions
  2. Early defibrillation for shockable rhythms
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3
Q

What is the ALS algorithm?

A
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4
Q

Recognition of cardiac arrest - Step 1:

A
  1. HAZARDS - Ensure the environment is safe; approach the pt.
  2. HELLO - Check for a response - Shake the pt’s shoulders & ask loudly: “Hello, Are you alright?”
  3. HELP - If they do not respond shout for help/pull the emergency buzzer & proceed to Step 2.
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5
Q

Recognition of cardiac arrest - Step 2:

A
  1. Assess for breathing & signs of life (take ≤ 10s).
  2. Turn the pt. onto their back
  3. Open airway - head tilt & chin lift
  4. Determine if the pt. is breathing normally:
  5. LOOK - chest movement
  6. LISTEN - breath sounds
  7. FEEL - air on your cheek
  8. Assess for a carotid pulse simultaneously
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6
Q

Recognition of cardiac arrest - Step 3 - If help has arrived:

A
  1. Start CPR
  2. Instruct the helper to the call resuscitation team (2222 if in-hospital, 999 if out-of-hospital)
  3. Helper to get the resuscitation equipment
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7
Q

Recognition of cardiac arrest - Step 3 - If help has NOT arrived & you’re alone:

A
  1. Leave pt. to get help
  2. Get resus equipment
  3. Return ASAP to start CPR
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8
Q

Performing CPR - Step 1:

A
  1. Place the heel of 1 hand in the centre of the chest with the other hand on top.
  2. Interlock your fingers
  3. Keep your arms straight
  4. Position shoulders vertically above the pt’s chest
  5. Compress to a depth of 5-6 cm.
  6. Allow the chest to recoil after each compression.
  7. Repeat at a rate of 100-120 min-1.
  8. Continue with a ratio of 30 chest compressions to 2 breaths
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9
Q

When to change person doing compressions to avoid fatigue?

A
  1. Change every 2 min
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10
Q

How to do compressions when airway secured/advanced airway in place?

A
  1. Continuous compressions wihtout pausing during ventilations

Ventilate at 10 breaths/min

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11
Q

What is the role of waveform capnography during CPR?

A
  1. Ensuring correct ETT placement
  2. Monitoring ventilation rate & avoiding hyperventilation
  3. ID ROSC during CPR - increase in end-tidal CO2
  4. Prognosticate during CPR
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12
Q

Monitoring during CPR:

A
  1. Clinical signs - breathing, eye opening, movements
  2. Pulse checks
  3. Heart rhythm
  4. End-tidal CO2 with waveform capnography
  5. Bloods - avoid finger pricks
  6. Invasive cardiac monitoring
  7. Focused US/echo
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13
Q

What principles to remember during CPR?

A
  1. Good quality compressions
  2. ID & Rx reversible causes
  3. Secure airway
  4. IV access
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14
Q

Performing CPR - Step 2:

A
  1. Attach the defibrillator ASAP
  2. Apply the self-adhesive pads beneath the R clavicle and the L-MAL.
  3. Minimise interruptions to chest compressions.
  4. As soon as the defibrillator is attached, perform a rhythm check.
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15
Q

Rhythm assessment - How to perform Rhythm check with AED?

A
  1. Follow the prompts
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16
Q

Rhythm assessment - How to perform Rhythm check with manual defibrillator:

A
  1. Pause chest compressions
  2. Observe the rhythm on the defibrillator screen
  3. Determine if shockable or non-shockable
  4. Take no longer than 5 s to do this
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17
Q

What are the shockable rhythms?

A
  1. VF
  2. Pulseless VT
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18
Q

What are the non-shockable rhythms?

A
  1. PEA
  2. Asystole
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19
Q

Characteristics of VF:

A
  1. Bizarre, irregular waveform
  2. No recognisable QRS complexes
  3. Random frequency & amplitude
  4. Uncoordinated electrical activity

Exclude artefact - movement/electrical interference.

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20
Q

Characteristics of pulseless VT:

A
  1. Broad complex rhythm
  2. Rapid rate
  3. Constant QRS morphology

check for a pulse.

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21
Q

Characteristics of PEA:

A
  1. Clinical features of cardiac arrest
  2. ECG normally associated with a palpable pulse
22
Q

Conditions ass. w/ PEA:

A
  1. Hypovolaemia
  2. Tamponade
  3. Tension pneumothorax
  4. Massive PE
23
Q

Characteristics of Asystole:

A
  1. Absent QRS
  2. Atrial activity (P waves) may persist
  3. Rarely a straight-line trace

Completely straight line - monitoring lead disconnected

24
Q

Mx of shockable rhythms - AED:

A
  1. Follow the audio/visual instructions from the machine
25
Q

Mx of shockable rhythms - Manual defibrillator:

A
  1. Apply self-adhesive pads while doing compressions
  2. Pause compressions (< 5 sec) for rhythm check
  3. Resume compressions immediately
  4. Warn all rescuers to “stand clear” expect one doing compressions
  5. Remove O2 as appropriate
  6. Select the appropriate energy on the defibrillator
  7. Press the charge button
  8. Once charged - instruct the rescuer doing chest compressions to “stand clear”
  9. When all rescuers are clear, deliver the shock
  10. After the shock - Immediate CPR
  11. Do not pause to reassess the rhythm or feel for a pulse
  12. Continue CPR for another 2-min cycle
  13. Continue to repeat the 2-min CPR cycle - rhythm check - defibrillation sequence if VF/pVT persists
  14. Prepare ADR 1 mg IV & Amiodarone 300 mg IV to be given after 3rd shock
  15. Give further ADR 1 mg IV after alternate shocks (about every 3-5 min)
26
Q

What shock energy is needed?

A
  1. 1st shock - at least 150J
  2. Subsequent shocks - same or higher
27
Q

If electrical activity compatible with a pulse is seen during a rhythm check, or the AED advises no shock is required or check for signs of life - If no signs of life are present:

A
  1. Continue CPR
  2. Switch to the non-shockable side of the algorithm.
28
Q

If electrical activity compatible with a pulse is seen during a rhythm check, or the AED advises no shock is required or check for signs of life - If signs of life are present:

A
  1. Start post-resuscitation care.
29
Q

Mx of non-shockable rhythms - AED:

If the AED advises no shock is required?

A
  1. Follow its prompts
  2. Continue CPR.
30
Q

Mx of non-shockable rhythms - Manual Defibrillator:

If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life.

If no pulse and/or signs of life:

A
  1. Continue CPR
  2. Prepare ADR 1 mg IV/IO to be given as soon as access is achieved
  3. After 2-minutes of CPR, pause chest compressions briefly for rhythm check
31
Q

If an organised rhythm is seen during a 2 min period of CPR - What to do?

A
  1. DO NOT interrupt compressions to palpate pulse
  2. Only stop compressions to palpate pulse when signs of life
32
Q

If there is any doubt when doing pulse check - what to do?

A

1.Continue CPR

33
Q

Sites for IO access in adults?

A
  1. Proximal humerus
  2. Proximal tibia
  3. Distal tibia
34
Q

How to give drugs peripherally during CPR?

A
  1. Flush with 20 ml of fluid
  2. Elevate extremity for 10-20 sec
35
Q

Mx of non-shockable rhythms - Manual Defibrillator:

If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life.

If VF/pVT is seen at the rhythm check, or the AED advises to deliver a shock:

A
  1. Switch to the shockable side of algorithm
36
Q

Reversible causes of cardiac arrest - 4 Hs and 4 Ts

A

4Hs:
1. Hypoxia
2. Hypovolaemia
3. Hypothermia
4. HypoK/ hyperK/ hypoglycaemia/ hypoCa/ H ion excess (acidaemia)

4Ts:
1. Thrombosis - coronary / PE
2. Tamponade
3. Tension pneumothorax
4. Toxins

37
Q

Rx - Hypoxia:

A
  1. Ensure airway is patent
  2. Ventilate the lungs using a self-inflating bag;
  3. Give high-flow 100% O2
  4. Don’t hyperventilate - reduces the coronary perfusion pressure and can worsen the outcome
38
Q

Rx - Hypovolaemia:

A
  1. IVF
  2. Blood
39
Q

Rx - Hypo/HyperK:

A
  1. HyperK - give calcium chloride followed by insulin/dextrose infusion.
  2. HypoK - replace
40
Q

Rx - Hypothermia:

A
  1. Active re-warming techniques
  2. Cardiopulmonary bypass may be considered
41
Q

Rx - Coronary Thrombosis:

A
  1. PCI
  2. Thrombolysis
42
Q

What is the commonest cause of thromboembolic or mechanical circulatory obstruction?

A
  1. Massive PE
43
Q

Rx - Pulmonary Thrombosis:

A
  1. Fibrinolysis
44
Q

Rx - Tamponade:

A
  1. Needle pericardiocentesis or resuscitative thoracotomy
45
Q

Rx - Toxin OD (inpatients):

A
  1. R/V of the pt’s drug chart may be helpful
46
Q

Rx - Tension Pneumothorax:

A
  1. Early needle decompression (thoracocentesis)
  2. Followed by chest drain insertion is needed.
47
Q

Signs of ROSC:

A
  1. Clinical - breathing, eye opening, movements
  2. Monitoring - sudden increase end-tidal CO2 or arterial BP waveform
48
Q

What to do after Return of spontaneous circulation (ROSC)?

A
  1. Reasses pt. using ABCDE approach
  2. Aim for sats of 94-98%
  3. Aim for a normal PaCO2
  4. 12-lead ECG
  5. Rx any precipitating cause(s)
  6. Consider targeted temp Mx
49
Q

Who should be the one discussing stopping CPR?

A
  1. Team leader
50
Q

How to Dx death after unsuccessful resus attempt?

A
  1. Observe pt. for 5 min after stopping CPR
  2. Absent mechanical cardiac Fx - Absent central pulse / absent heart sounds
  3. Absent reflexes - pupillary / corneal/ motor response to supra-orbital pressure
  4. Supplementary features - Asystole on ECG/ absent flow on direct intra-arterial pressure monitor (A-line) / absent heart contractions on echo
51
Q

Post resus event tasks to do:

A
  1. Ongoing care of pt.
  2. Documentation of resus
  3. Communication w/ relatives
  4. Post-resus debriefing - immediate & delayed
  5. Restock equipment & drugs
  6. Audit forms

ILS Course - A to E Training & Solutions Ltd (12 decks)

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