ADVANCED LIFE SUPPORT

Question 1

How to correctly manage a ROSC?

Answer 1

Blood Pressure - Aim for a Systolic BP of 90-100mmHg, if below administer 250ml IV/IO bolus of 0.9% Saline (Sodium Chloride). Recheck and administer a Repeat Dose if Still unstable.
Symptomatic Bradycardia - Atropine. May need multiple doses as this is unlikely to work on first dose. Re-assess Obs After each Intervention.
Oxygen - Ventilate the Patient every 6 Seconds if they are making no Respiratory Effort.
Adrenaline

Question 2

What paramedic drug can cause a prolonged QTc?

Answer 2

Amiodarone and Ondansetron.

Question 3

What conditions are likely to lead to Ventricular Tachycardia (VT)?

Answer 3

Coronary Artery Disease, Myocardial Infarction, Cardiomyopathy, Myocarditis, Electrolyte Imbalance (Potassium, Calcium, Magnesium), Stimulants, Caffeine, and Alcohol.

Question 4

What conditions are likely to lead to Ventricular Fibrillation (VF)?

Answer 4

Heart Failure, Heart Valve Disease, Cardiomyopathy, Low Potassium, Medications, and Trauma.

Question 5

What conditions cause the 4 HS?

Answer 5

HYPOXIA - Asthma, COPD, Pneumonia, Smoke Inhalation, Choking

HYPOKALAEMIA/HYPERKALAEMIA - CKD, Alcohol Use, Diarrhoea, Sweating, Laxative Use, DKA

HYPOTHERMIA/HYPERTHERMIA - Exposure to Cold Environments, Falling into Cold Water

HYPOVOLAEMIA - Injury, Burns, Cuts, Wounds, Vomiting, Diarrhoea

Question 6

What conditions cause the 4 Ts?

Answer 6

TENSION PNEUMOTHORAX - Penetrating Injuries, Blunt Trauma, Lung Diseases, Spontaneous Pneumothorax

TAMPONADE - Infections, Trauma, Surgery, Cancers, Aortic Dissections

THROMBOSIS - Atherosclerosis, Immobility, Surgery, Pregnancy, Medications, Obesity

TOXINS - Illicit Drugs & Poisons

Question 7

What is cardiac tamponade and its causes?

Answer 7

Results from the presence of blood/fluid in the pericardial space, limiting filling of the ventricles, reducing stroke volume and cardiac output.

Causes: Trauma, Penetrating Injuries, Blunt Force Trauma, Infection of the Pericardium, Ventricular Wall Rupture following a Myocardial Infarction.

Question 8

What is a tension pneumothorax and its causes?

Answer 8

Collection of air in the pleural space between the lung and the chest wall, leading to haemodynamic compromise.

Causes: Mechanical Ventilation, Asthma, Penetrating Injuries to the Chest: Gunshot/stab wound.

Question 9

What is the management of bradycardia?

Answer 9

ABCDE Approach

O2 if sats below 94%

Obtain IV Access

Monitor Vitals/ECG

Atropine: Repeat to a max of 3mg

Atropine should not be given to treat bradycardia in suspected hypothermia.

Question 10

What are the main goals of orogastric tube insertion?

Answer 10

1. Aspiration Prevention: Reduces the risk of stomach contents entering the airway during ventilation by providing a route for gastric drainage.
2. Gastric Decompression: Prevents complications from a full stomach, such as decreased venous return.
3. Maintain Efficacy of Chest Compressions

Question 11

What are the contraindications of orogastric tube insertion?

Answer 11

1. Oesophageal Trauma
2. Excessive leak through the gastric channel
3. Oesophageal varices or evidence of upper gastrointestinal bleed
4. History of upper gastrointestinal surgery
5. Bleeding abnormalities
6. Not deeply unconscious, which may lead to coughing, retching, or laryngospasm.