6 ALS Flashcards
(22 cards)
What are shockable rhythms?
Pulseless ventricular tachycardia /\/\/\/\/\/\/\/\/\
Ventricular fibrillaion VvVvVvVvvVvV
How are shockable rhythms treated?
Call for help
Check for signs of life for 10 seconds
Sall resus team 2222
Perform uninterrupted chest compressions while applying self adhesive defib/monitoring pads
Plan actions before pausing CPR for rhythms analysis and communicate to team
Stop chest compressions
Confirm rhythm/feel for pulse - VF/pVT from ECG
5 seconds max
REsume chest compressions
Warn all other team to stand clear and remove any oxygen delivery device
Select 150J for first shock
Safety check
Once defib is chaged and safety check complete, tell chest compressions to stand clear
When clear, give shock
Immediately restart 30:2 CPR
Continue for 2 minutes
Pause for rhythm check
If VF/pVT persists, deliver a 2nd shock and continue CPR for 2minutes
Rhythm check If VF/pVT persists, deliver a 3rd shock Resume chest compressions immediately Give 1mg IV adrenaline and 300mg IV amiodarone while 2 min CPR - withold adrenaline if ROS
Repeat 2min CPR - rhythm/pulse check - defibrillarion sequence if VF/pVT persists
Give further adrenaline 1mg IV after alternate shocks (every 3-5 minutes)
IF organised electrical activity compatible with cardiac output is seen, check for evidence of ROSC:
Signs of life, central pulse, end-tidal CO2
- If ROSC - post-resus care
- If no ROSC, continue CPR and non-shockable algorithm
IF asystole - continue CPR and non-shockable algorithm
Where should defib pds be attached?
One below right clavicle
One in V6 position midaxillary line
Why should chest compressions be resumed immediately after delivering a shock?
Rare for pulse to be palpable immediately after defib
Delay in trying to palpate a pulse will further compromise myocardium if perfusing rhythm has not been restored
If a perfusing rhythm has been restored, giving chest compressions does not increase change of VF recurring
In presence of post-shock asystole, chest compressions may induce VF
When is adrenaline given?
1mg IV In 2 min CPR period after third shock and alternative shocks afterwards
When is amiodarone given?
300mg IV after three defib attempts
If VF/pVT persists, a further dose of 150mg may be given after 5 defib attempts
(Lidocaine 1mg/kg can be used as alternative)
What evidence for ROSC when rhythm compatible?
Central pulse
Sudden increase in end-tidal CO2
Evidence of Cardiac output on monitoring
What are non-shockable rhythms and is survival likely?
Pulseless electrical activity - cardiac arrest in the presence of electrical activity normally associated with palpable pulse (except VT)
Asystole - absence of electrical activity -
Survival unlikely unless a reversible cause can be found and treated quickly
What is treatment for PEA/asystole?
CPR 30:2
Adrenaline 1mg IV/IO as soon as IV access
Continue 30:@ CPR until airway is secured, then continue chest compressions without pausing during ventilation
Recheck rhythm after 2 minutes
IF electrical activity compatible with a pulse - check for a pulse and signs of life
If a pulse/signs of life are present, start post resus care
If no pulse and no signs of life
- Continue CPR
- Recheck rhythm after 2 mins
- Give further adrenaline 1mg IV every 3-5 minutes (during alternate 2 min loops of CPR)
If VF/pVT, change to shockable algorithm
5 priorities?
Chest compressions Defib attempts REversible causes Airway IV access
What is waveform capnography? What is required?
Measurement of CO2 in expired air
End tidal CO2 reflects cardiac output and pulmonary blood flow (CO2 is transported by the venous system to the right heart and then to the lungs
Low end tidal values during CPR reflects the low cardiac output generated by chest compression
Usually requires a tracheal tube or a good seal with a supraglottic airway device
What is the role of waveform capnography in CPR?
Ensure tracheal tube placement in trachea
Monitor ventilation rate during CPR - avoid hyperventilation
Monitor the quality of chest compressions during CPR
Idenitfying ROSC - increase in end tidal CO2 during CPR - if ROC suspected during CPR, withold adrenaline and give if cardiac arrest confirmed at next rhythm check
Prognostication during CPR - low end tidal CO2 associated with lowe rROSC rates and increased mortality
What should you do if signs of life during CPR?
Regular respiratory effort, movement or readings compatible with ROSC (e.g. increase in end tidal CO2 or BP waveform)
Stop CPR briefly, check monitor
Rhythm compatible with pulse - check for a pulse
Pulse palpable - continue post-resuscitation care and/or treatment or peri-arrest arrhythmias
No pulse - continue CPR
What significance of vascular access in ALS?
Peripehral venous access
Drugs injected followed by flush of at least 20 ml of fluid and elevation of the extremity for 10-20 seconds to facilitate drug delirvery
What are the main sites for IO access? What should you do prior to delivery of drugs?
Proxima humerus
Proximal tibia
Distal tibia
Attempt to aspirate from the needle - presence of IO blood indicates correct placement
Flush needle to ensure patency and observe for leakage or extravasation
What are CI to IO access?
Complications?
Trauma Infection at target site Prosthesis Recent IO access in same limb, including failed attempt Failure to identify anatomical landmarks
Extravasation Dislodgement of needle Compartment syndrome Fracture or chipping of bone Pain
What are reversible causes of cardiac arrest?
Hypoxia
Hypovolaemia
Hyperkalaemia/Hypokalaemia/Hypoglycaemia/metabolic
Hypothermia
Thrombosis
Tension pneumothorax
Tamponade
Toxins
What are treatments for Hs?
Hypoxia - ventilate adquately with 100% O2 during CPR
IF ROSC adjust the inspired oxygen to target 94-98%
Hypovolaemia - PEA is due to severe haemorrhage
IV volume should be restored rapidly with fluid and blood coupled with urgent interventions to stop the haemorrhage
Hyperkalaemia/hypocalcaemia - IV calcium chloride
Suspect hypothermia in any drowning
Treatment for four Ts
Percutaneous coronary angiography and PCI during ongoing CPR - would require an automated mechanical chest compression device
Massive PE - consider fibrinolytic
Consider performing CPR for at least 60-90 minutes before temrination
Tension pneumothorax - decompress by thoracostomy or needle thoracocentesis
Insert chest drain
Tamponade
Resuscitative thoracotomy
How long asystole with absence of reversible cause before temrinating CPR?
20 minutes
How to diagnose death after unsuccessful resuscitation
Observe patient for 5 minutes
Absence of central pulse on palpation
Absence of heart sounds on auscultation
Asystole
Absence of pulsatile flow using direct intra arterial pressure monitoring
Absence of contractile activity using echocardiography
Any return of cardiac/respiraotyr activity during this 5 min should prompt further 5 min
After 5 min of continued cardiorespiratory arrest
Absence of pupillary response to light, corneal reflexes, motor response to supra-orbital pressure should be confirmed
What tasts after CPR event?
Ongoing patient care
Handover
Documentation of resuscitaiton attempt
Communication with relatives
Immediate post-event debriefing by team leader - immeidate issues and concerns
Ensuring equipment and drug trollies replenished
Complete audit forms
