ALS Flashcards
(34 cards)
Shockable rhythms
VF and pulseless VT
Non shockable rhythms
PEA and asystole
waveform capnography
Measures the amount of CO2 in exhaled air, which accesses ventilation. Normaly 35-45mmHG
If shockable rhythm what medicines should you give and how frequently
1mg Adrenaline every 3-5 mins
300mg amiodarone after 3 shocks
What are the main things you can do to help
High quality compressions, continuously if advanced airway (or 30:2 if not), minimise time not doing compressions, get IV/interosseous access, Adrenaline 3-5 mins, amiodarone after 3 shocks. identify and treat reversible causes
Reversible causes
4 Hs and 4 Ts
Hypoxia - ensure airway patent and ventilate with high flow oxygen (30-70L per min)
Hypovolemia - may be obvious (blood loss/diarrhoea/vomiting) or subtle (sepsis/anaphylaxis). Rapidly infuse IV fluids
Hypo/hyperkalaemia - normal = 3.6-5.2.
- Hypokalaemia = infusion of 10-40mmol potassium chloride per hr with 0.9% saline. max dose 240mmol. (hypomagnesmium too, infuse with saline. normal = 0.85-1.1mmol)
-Hyperkalaemia - Ca chloride followed by insulin/dextrose infusion.
Hypo/hyperthermia - measure temp. rewarming techniques - bear hugger, heat packs, blankets.
Thrombosis - coronary: Coronary angiography/percutaneous intervention
mechanical chest compressions to facilitate transfer/treatment
pulmonary: consider immediate fibrinolytic treatment (streptokinase?), thrombolytic treatment, heparin
tension pneumothorax - look for unilateral expansion of chest, shift of trachea, submit emphysema. pleural US or CXR. if incubated, check intubation of Right main bronchus. needle decompression or thoracostomy if ventilated.
tamponade - need Cardiac US. consider after penetrating chest trauma/after cardiac surgery, device implantation, or PCI. Needle pericardiocentesis/resuscitative thoracotomy.
toxins - review drug chart. unlikely unless deliberate overdose or suspicion of substance abuse.
After rOSC management
A-E
Aim for SPO2 94-98
12 lead ECG
Identify and treat cause
Targeted Temp management
Bloods to take/what to put through IV
500ml saline
Bloods - FBC, glucose, U&Es, VBG
SBARD
Situation - introduce self, say what has happened
Background - key medical aspects
Assessment
Recommendation
A-E assessment
Airway: Breath sounds/voice.
O2, suction, definitive airway
Breathing: Resp rate, Sats, chest movements, trachea position, Auscultate/percuss, O2. aim for 94-98%. (treat causes, e.g. chest drain for pneumothorax)
Circulation: Palor, HR, Cap refill, auscultate, BP, ECG monitoring. Gain IV access (fluids. take bloods: FBC, Glucose, VBG, U&Es, ?CRP, ?Cultures, ?Group and save)
Disability: ACVPU, GCS (limb movements, eye opening, verbal response), pupillary response, glucose (hypo if <4mmol),
Abdo exam - palpation, pain and organomegaly.
temperature
Exposure: expose skin, check back
Next steps:
Catheter, ABG, ITU input, Abx, troponin
What percent of patients have shockable vs non shockable rhythm, and which is more favourable
80% non shockable (PEA, Asystole). 15% survival to discharge
20% shockable (VF/pVT). 50% survival to discharge
why should you cardiac monitor
Arrest rhythms
syncope (unexplained, esp during exercise, structural heart disease, abnormal ecg eg prolonged QT)
chest pain
persistent arhythmia
shock/severe illness
electrolyte abnormalities
poisoning/overdose
during/after surgery
6 stage ecg approach
Any electrical activity?
What is the ventricular (QRS rate)
Is the QRS rhythm regular
is the QRS width normal
is atrial activity present? normal p waves? AF?, Atrial flutter?
How is atrial activity related to ventricular activity?
causes of PEA
Large Acute MI
Massive PE
Tension pneumothorax
Cardiac taponade
Acute, severe blood loss
T wave inversion can indicate
NSTEMI - get troponin to confirm
signs of a posterior MI
Reciprocal change in anterior (V2/3/4), ST segment depression.
and Inferior changes (I, II, III, AvF), ST elevation
ACS immediate treatment
Aprisin (300mg), O2, Morphine, Nitroglycerine
ideal urine output in ICU
> 0.5ml per kg per hr
normo capnia
Pa CO2 4.7-6 kpa
what rate should you rewarm someone
0.25 decrees per hour
describe temperature management
induce to 33 (32-36) (can be down by infusing 2l of cold crystalloid pollution before ICU), maintain for 24hrs, then rewarm
Main aspects of post-resus care
Airway/breathing (94-98)
Circulation.- fluids, Arterial BP monitoring (>100).
control temp - sedative to avoid shivering
treatment of NSTEMI or unstable angina
A-E
Antithrombotic (aspirin), Platelet inhibitor e.g clopidogrel/ticegrelor.
fadaparinux/LMWH
Nitrate
morphine
Oxygen
Myocardial protection; Beta blocker, coronary angiography/PPCI in most patients
Treatment of STEMI (or MI with new LBBB)
Most likely complete blockage
A-E
Emergency repercussion therapy
PPCI (primary percutaneous coronary intervention)
Fibrinolytic therapy if no access to PPCI. (higher risk of bleeding)
avoid delay!
