ADULT ALS Flashcards
(28 cards)
What is ALS?
ALS builds on BLS to increase liklihood of survival of cardiac arrest
it takes over from BLS once chest compressions have commenced and a defib is attached.
It focuses on more advanced airway management, adding in drugs for shockable and non-shockable rhythms and correcting reversible causes of cardiac arrest
what airway adjuncts may you use in ALS
oropharyngeal
nasopharyngeal
i-gel/LMA
endotracheal intubation
what defined roles are there in ALS
Team leader
Timer and scribe
Airway
CPR1/defib
CPR2
IV access/bloods/gases/Drugs
what rhythms are shockable rhythms
pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF)
what should the team leader do?
delegate tasks
ask people to say when theyve completed a task/cycle
coordiante tasks
go through reversible causes
in what circumstances should chest compressions be continuous
Chest compressions should be continuous once the airway is secured with endotracheal tube/ with an iGel
under what circumstances/for what things do you pause compressions for
ONLY stop CPR for rhythm checks, electrical shocks, and the 2 rescue breaths. Ask the person doing compressions to tell the airway person each time 30 compressions are complete.
what do you do with defib if pt has a pacemaker?
if a pacemaker is present, ensure pads are >8cm away from it (you can put the pads on AP if needed)
what are the cycles of ALS, when do they start?
a cycle = 2 minutes of CPR/rescue breaths
Cycle 1 starts when the defibrillator is connected.
Perform a rhythm check ± shock every 2 minutes
Management of a shockable rhythm
2 minute cycles of cpr followed by rhythm check
If the initial rhythm is shockable, provide one shock (at the recommended joules for your equipment)
resume cycles
After the third shock, give 300mg amiodarone and 1mg adrenaline IV/IO
Continue adrenaline every 3-5min
After the fifth shock, administer amiodarone 150mg
How to manage a non-shockable rhythm?
2 minute cycles of cpr followed by rhythm check
Give adrenaline 1mg IV/IO every 3 – 5 minutes
what is the dosing of adrenaline used in ALS
Adrenaline 1mg IV (10ml of 1:10,000)
what is the dosing of amiodarone used in ALS
Amiodarone 300mg IV after 3rd shock
Repeat 150mg IV after 5th shock if ongoing
when should adrenaline be used in ALS
Adrenaline 1mg IV (10ml of 1:10,000)
Shockable rhythm: give after 3rd shock (during CPR). Flush with 20ml saline.
Non-shockable rhythm: give as soon as IV access is established. Flush with 20ml saline.
Repeat adrenaline dose during every other CPR cycle thereafter (i.e. repeat every 3-5 minutes once given, regardless of rhythm)
when should amiodarone be used in ALS
Amiodarone 300mg IV: if shockable rhythm only. Give after 3rd shock (during CPR). Repeat 150mg IV after 5th shock if ongoing.
what are the reverisble cuases of cardiac arrest taht should be identified and worked through by the team leader
Hypoxia
Hypovolaemia
Hypokalaemia/hyperkalaemia
Hypothermia/hyperthermia
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins
How should the team leader assess and treat hypoxia
assess: ventilation adequacy, o2 flow rate, abg
treat: 15L/min O2, good ventilation, i-gel
How should the team leader assess and treat hypovolemia
assess: history, drains, haemorrhage, fluid collections (expose pt)
treat: fluid resuscitation, blood if haemorrhage, stop bleeding
how should the team leader assess and treat hypo/hyperkalaemia
ABG and latest blood results
if hyperkalaemic:
- Protect the heart: calcium chloride
- Shift K into cells: insulin and glucose, sodium bicarbonate
- Remove K from the body: consider dialysis for refractory hyperkalameic cardiac arrest
10 mL calcium chloride 10% IV by rapid bolus injection
10 units soluble insulin and 25 g glucose IV by rapid injection. Monitor blood glucose. Administer 10% glucose infusion guided by blood glucose to avoid hypoglycaemia.
50 mmol sodium bicarbonate (50 mL 8.4% solution) IV by rapid injection.
if hypokalaemic: 20mmol KCl over 10 mins
how should the team leader assess and treat hypo/hyperthermia
assess: pts temp on recent obs, warmth to touch
treat:
hypo = warm pt, extracorporeal CPR
hyper: cool pt, IV fluids
how does the team leader assess and treat tension pneumothorax
assess: tracheal deviation, unilateral hyper-resonance and decreased breath sounds
treat: insert cannula into second intercostal space mid clavicualr line
how should the team leader assess and treat cardiac tamponade
assess: recent chest trauma/surgery/pacemaker insertion/PCI
cardias USS if there is a risk
treat: pericardiocentesis
how should the team leader assess and treat toxins
assess: history, drug chart, capilalry glucose
treat: treat toxaemia eg naloxone for opiods
when is ECMO considered
Extracorporeal CPR using extracorporeal membrane oxygenation (ECMO) device may be considered where available for select patients to facilitate other definitive treatments, e.g. PCI, pulmonary thrombectomy for massive PE, rewarming for hypothermia
