Advanced Life Support

Question 1

CPR has been begun on a patient and the defibrillator attached. Which rhythms are shockable?

Answer 1

• VF
• Pulseless VT

Question 2

CPR has been begun on a patient and the defibrillator attached. Which rhythms are non-shockable?

Answer 2

• Asystole
• Pulseless electrical activity (PEA)

Question 3

CPR has been begun on a patient and the rhythm has been determined to be shockable. What are the appropriate pharmacological interventions and when should they be given?

Answer 3

• Adrenaline 1 mg after 2nd shock (after 2nd 2-min CPR cycle)
• Amiodarone 300 mg after 3rd shock

Question 4

CPR has been begun on a patient and the rhythm has been determined to be non-shockable. What are the appropriate pharmacological interventions and when should they be given?

Answer 4

• Adrenaline 1 mg stat
  
  • Then again every 2nd 2-min CPR cycle
• No amiodarone

Question 5

CPR has been begun on a patient and the CPR/defibrillation cycle is well established. You are looking for a cause of the arrest. What should you consider?

Answer 5

• HHHHTTTT
• Hypoxia
• Hypovolaemia
• Hyper(brady)/hypo(tachy)kalaemia, metabolic disorders
• Hypo/hyperthermia
• Tension pneumothorax
• Tamponade
• Toxins
• Thrombosis (pulmonary/coronary)

Question 6

What are important post-resuscitation requirements?

Answer 6

• Maintain SBP > 100 mmHg (adrenaline?)
• Maintain SaO2 > 94% in T1 resp failure
• Maintain SaO2 88-92% in T2 resp failure
• Ventilate to normocarbia
• BGLs between 4 and 10 mM
• Prophylactic anti-arrhythmic
• Temp control (32-34 for 24-72 hours) or to 36