Advanced Life Support Flashcards by Iseoluwa Ojo

Intubation attempt should not interrupt chest compressions for more than ________________

5 -10 seconds

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Ventilation ( Breathing)

High flow O2 at _________L/min
Suction apparatus
Ventilation - Ambu (Self-inflating) bag
Once trachea has been intubated, ventilation should be independent of compression (Compression _______/min, ventilation ______/min)
Insp time is _______- enough for chest to rise
Avoid ______ventilation

10-15

100-120

10-12

1sec; hyper

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Paediatric Airway & Breathing

Tracheal tubes- (cuffed or uncuffed?)

With cuffed tubes ensure correct ____ and minimum _______________

Sizeof TT–(Age(yrs)/4)+4 LMA – good alternative
After intubation, compression are uninterrupted at 100 - 120/min and ventilation according to child’s age.
Ventilate with (low or high?) concentration of O2

Uncuffed; size

cuff inflation pressure

High

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Monitoring (for Circulation)
ECG - Rhythm recognition
1) ____________
2) ____________
3) ____________
4) ____________

 _______ are shockable
_______ are non-shockable

Ventricular fibrillation
Pulseless ventricular tachycardia
Asystole
Pulseless electrical activity

1 & 2 ; 3 & 4

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Defibrillation

Passage of electrical current across heart to ____________ it

depolarise

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Defibrillation

The aim is
 to __________ a critical mass of the heart muscle,
 terminate the ____________,
 allow __________________ to be re- established by the body’s natural pacemaker.

depolarize; arrhythmia

normal sinus rhythm

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Defibrillation
Indicated for __________ rhythms

Chances of successful defibrillation decline at a rate of about ______% with each __________ of delay

shockable

10; minute

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Defibrillator

Electrodes– below _________ and vertically in _________ line at level of ______ (clear of any ________________)

Rt clavicle

mid-axillary; V6

breast tissue

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Defibrillators Used in Cardiac Arrest Situations

__________ Defibrillator.
______________________ Defibrillator (____).

Manual

Automated External; AED

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Defibrillator

Dose - ______J (_______J for biphasic defibrillators)

Only ≈____% of current reaches heart

Safety - water, fluids, contact, O2

360; 150

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Paediatric electrodes available – rarely indicated in paeds as most CA rhythms are __________

PEA

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Automated external defibrillators

_________ cardiac rhythm

Semi-automatic – __________________ which is delivered by ___________

Fully automatic – _________ the shock

Analyse

indicates need for a shock ; operator

delivers

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Paediatric Defibrillation

______ Monitoring
_______ is the most common rhythm

Consider and correct all reversible causes

Shockable rhythms are (common or rare?) and usually occur in ________ or ______

ECG; PEA

Rare; ICU or CCU

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AED safe and successful in paeds >___ year(s)

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Paeds defibrillation

One defibrillating shock for VF/VT of ___J/kg*

Attenuate energy to ____-_____J using paed pads

50 – 75

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Paeds defibrillation location

Defib pads ______ cm for children Below _____________ and _________ line, ______-_______

Adult pads can be used in children > _____ years

8 – 12

right clavicle; mid-axillary

Antero-posterior

DRUGS IN CARDIAC ARREST

Drug Delivery

__________
_____________

Intravenous
Intraosseous

DRUGS IN CARDIAC ARREST

Drug Delivery
Intravenous - through _______ or __________

 avoid __________ injection

Intraosseous (tibia, humerus) –if IV route cannot be obtained within __________
 Can be employed for both adults &
Paeds
( _________ route: 2 -3 x IV dose no longer recommended)

peripheral or central vein

intra-cardiac; 2 minutes

Tracheal

Adrenaline

 improves _________________ pressure
→ _______________

 ↑ _________________ which aids effective defibrillation

Defibrillation
converts heart to ________ rhythm

Anti-arrhythmic
___________ converted rhythm

Coronary perfusion pressure; myocardial O2

intensity of VF ; perfusing

stabilises

Drugs in cardiac arrest

Adrenaline

__________
——————-

Defibrillation

Anti-arrhythmic

Drugs in Adult Cardiac Arrest

Adrenaline
 ____mg after ______ shock.
 Repeat every _______ mins (every other loop)

1; 2nd; 3 – 5

Drugs in adult cardiac arrest

Amiodarone
 ______ mg for refractory VF, PVT.
 After ______ shock OR
Lignocaine ____mg/ kg boluses till ____mg/kg

300; 3rd

1; 3

Drugs in Adult cardiac arrest

NaHCO3-

 used in _________ CA >____ mins
 ____mls of _____% solution

Ensure assisted vent with _____ & effective ______ and systemic perfusion before administration

Prolonged; 30

50; 8.4; O2; BLS

IVF
Avoid _________ containing fluids

Do not ______________ to give drugs

dextrose

interrupt compressions

Use waveform capnography to _________________ in CPR To monitor the _________ of CPR

confirm correct tracheal tube placement quality

Drugs in Paediatric Cardiac Arrest Adrenaline ____ml/kg of ___:_____ (10mcg/kg) Immediately ______ access is established or __________ Every ________ mins (every other loop)

0.1 1:10,000 venous; intraosseous 3 – 5

Drugs in Paediatric Cardiac Arrest Atropine – for _______ unresponsive to ventilation and circulatory support. - ___mcg/kg (max of ____mcg, minimum of ______mcg)

bradycardia 20; 600; 100

Drugs in Paediatric Cardiac Arrest Amiodarone – ___mg/kg

Drugs in Paediatric Cardiac Arrest Hypovolaemia Boluses of ____ml/kg of _______ or ________ Hypoglycaemia ___-____g/kg of _______ if hypoglycaemia is diagnosed Max conc of ______%.

20; crystalloid or colloid 0.5 – 1 glucose; 25

Reversible Causes (PALS) – 5H’s & 5T’s  5H’s

Hypoxia  Hypovolaemia  Hydrogen ion (acidosis)  Hyper/ hypoK , Hypothermia

Reversible Causes – 5H’s & 5T’s 5T’s

 Tension pneumothorax  Tamponade  Toxins  Thrombosis (pulmonary)  Thrombosis (coronary)

Post-Resuscitation care Transfer to _______ or _______ Monitoring & _________ Ventilate to ————- if still unconscious Preservation of cerebral and myocardial perfusion/function Induced _________ (___-___) 0C for ______ Aggressive Rx of ________ Maintain _____________ Support haemodynamic function – fluids, noradrenaline, dobutamine

ICU or CCU O2 therapy normocapnia; hypothermia 32 - 36; 24 hrs ; hyperthermia normoglycaemia

The Unique nature of CPR – __________ is implied The healthcare professional as a bystander The duty of care Respect _______ orders Respect Advance Directives –mental competence ‘Good Samaritan’ laws

consent; DNR

Withholding CPR •Do Not Attempt Resuscitation (DNAR orders) Decision made by _________ •Advanced directives Decision made by the ________

physicians patient

Do Not Attempt Resuscitation Respect DNR orders Does not mean non-treatment – _____,___________ before devpt of cardiac arrest Taken by most senior member of team. Documentation which is reviewed daily Should be communicated to all members of staff

O2, IVF

Advanced Directives Includes _______ directives, __________ Statutorily defined legal document providing specific instructions regarding CPR Ensure ________ competence Consider decision by appropriate surrogates

written; living wills mental

DNRs It is essential to identify Patients for whom cardiopulmonary arrest is an ____________ event and in whom CPR is inappropriate ______ quality of life _______ period before CPR Obvious _____________ ____________ death in presence of serious debilitating, chronic or terminal disease.

anticipated terminal Poor; Long; fatal trauma Un-witnessed

Discontinuing CPR Evidence of cardiac death,  _____ mins ____ without deployment of equipment or drugs _____ mins of ________ and _______  Asystole > _________ despite ALS except in _________ and _________  Change of rhythm to ________ – signifies myocardial death Presentation of valid _______ order

20; BLS 30; defibrillation and drug therapy 20 minutes; drowning and hypothermia asystole; DNAR

Prolonged CPR Prolonged resuscitation efforts can be justified in the following situations: __________________________________ of any duration during resuscitation.  severe ________ ———-thermia. Victims of ______________ May require a _________________ device

Return of spontaneous circulation pre-arrest hypo drug overdose. mechanical Compression