6. Advanced life support algorithm Flashcards
What percentage of initial monitored cardiac arrest rhythms do VF/pVT account for?
20%
How frequently does VF/pVT occur at some point in patients with initial recorded PEA/asystole?
25%
What defibillation energy should be chose for first shock?
120-150J
What is the adult ALS algorithm?
Will all patients have palpable pulses immediately after ROSC?
No, and 25% of patients with ROSC take more than 2 minutes to have palpable pulse
What drugs are used as standard in ALS algorithm?
- Adrenaline 1mg IV after 3rd shock and then after every other shock
- Amiodaron 300mg after total of 3 shocks and consider 150mg after 5 shocks
- Consider lidocaine 1mg/kg if amiodarone not available, but do not given once dose of amiodarone given
What is the protocol for witnessed/monitored cardiac arrests?
- 3 stacked shocks
- Start ALS algorithm if no ROSC as if only first shock has been given
- When giving adrenaline, treat the 3 shocks as the first shock
- When giving amiodarone, give immediately after the 3 shocks
At what rate should chest compressions and ventilation be delivered during CPR?
Chest compressions - 100-120/min
Ventilation - 10/min
What is the normal value of end-tidal CO2?
4.8 kPa (4.3 - 5.5 kPa)
In terms of end-tidal CO2 monitoring during CPR, what is considered a poor prognostic factor?
Failure to achieve end-tidal CO2 of >1.33 kPa after 20 mins of CPR
What are the common reversible causes of cardiac arrest?
4 Ts
1. Hypovolaemia
2. Hypoxia
3. Hyperkalaemia (and other metabolic disorders)
4. Hypothermia
4 Hs
1. Thrombosis (coronary or pulmonary)
2. Tension pneumothorax
3. Tamponade (cardiac)
4. Toxins
How is death diagnosed after stopping CPR?
- Observe patients for minimum of 5 minutes
- Absence of mechanical cardiac function (absence of central pulse, absence of heart sounds) along with:
* asystole on continuous ECG display
* absence of pulsatile flow on intra-arterial pressure monitoring
* absence of contractile activity on echocardiogram
