ACLS (arrhythmias see cardiology)

Question 1

How do you give adrenaline in asystole/PEA?

Answer 1

Give 1mg adrenaline when IVC inserted, then repeat every 3-5 minutes.

Question 2

Describe the ACLS cycle if a shockable rhythm present?

Answer 2

After assessing for danger, responsiveness, brief assessment of airway/breathing (up to 10s), pulse (up to 10s), start CPR
Arrange defibrillator, monitoring, O2
As soon as defibrillator available attach and shock if needed
2 minutes of CPR
Assess rhythm and shock if needed
Commence CPR - prepare adrenaline
Give adrenaline 1mg (i.e. after 2nd shock, and then every 3-5 minutes)
Commence CPR - prepare amiodarone
Assess rhythm and shock if needed
Give amiodarone 300mg IV/IO (i.e. after 3rd shock, and then consider an additional 150mg IV/IO once or lignocaine 1-1.5mg/kg first dose then 0.5-0.75mg/kg maximum 3 doses or 3mg/kg)

Question 3

What other drugs can you consider in shockable ACLS?

Answer 3

• magnesium 1-2 g IV/IO for torsades de pointes

- bicarbonate: hyperkalaemia, renal failure, TCA poisoning: 1mEq/kg

Question 4

What is the rate of respiration once a tube is placed?

Answer 4

8 to 10 breaths per minute

Question 5

6Hs and 4Ts?

Answer 5

hypoxia, hypovolaemia/hypotension, hypo/hyperkalaemia, hypo/hyperthermia (hydrogen ion/acidosis, hypo/hyperglycaemia)
toxins, tamponade, tension pneumothroax, thrombosis (coronary, PE)

Question 6

What J should you set the defibrillator to?

Answer 6

Manual biphasic 120-200J (if unknown then 200J); monophasic 360J

Question 7

What drug could you give after return of circulation?

Answer 7

Maintenance dose of amiodarone 1mg/kg

Question 8

Which drugs can you give through an ETT?

Answer 8

NAVEL - naloxone, atropine, ventolin/vasopressor, epinephrine (3mg mixed with 10mL saline), lignocaine

Question 9

What ECG changes would you see with:

• hypovolaemia
• hypoxia
• hypothermia
• hyperkalaemia
• hypokalaemia
• toxins
• tamponade
• tension pneumothorax
• cardiac thrombosis
• PE

Answer 9

• narrow complex tachycardia
• bradycardia
• low voltage complexes
• peaked t waves, then smaller p waves, QRS widens to sine
• flattened t waves with prominent u waves, QRS widens and QT prolongs to wide complex tachycardia
• variable but predominantly lengthening of QT
• narrow complex, rapid rate
• narrow complex, slow rate (hypoxia)
• ischaemic changes
• narrow complex, rapid rate

Question 10

What medical conditions could give acidosis?

Answer 10

diabetes, renal failure

Question 11

What medical conditions could give hyperkalaemia?

Answer 11

diabetes, renal failure

Question 12

What medical conditions could give hypokalaemia?

Answer 12

potassium wasting losses, diuretics

Question 13

Wide complex tachycardia during ACLS indicate a possible cause of..?
Narrow complex tachycardia during ACLS indicate a possible causes of..?
Wide complex bradycardia during ACLS indicate a possible cause of..?
Narrow complex bradycardia during ACLS indicate a possible causes of..?

Answer 13

Cardiac/ACS, electrolytes (K/Ca)
Hypovolaemia, tamponade, massive PE
Cardiac/ACS, electrolytes (K/Ca), drugs
Hypoxia, acidosis

Question 14

5 things to look at reversible causes?

Answer 14

Temperature
Glucose
Exclude dialysis
Rule out overdose
?ultrasound