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ALS Flashcards

1
Q

Around what time after collapse does defibrillation produce the highest survival rates

A

50-70%

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2
Q

What CPR rate is usually given in an adult

A

30:2

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3
Q

Name the four Hs

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypo.hyperthermia

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4
Q

Name the four Ts

A

Thrombosis
Tension Pneumothorax
Tamponade
Toxins

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5
Q

After ROSC, what should be done

A

12-lead ECG
O2 monitoring
A-E

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6
Q

Outline the SBARD criteria

A

S- situation
B- background
A - assessment (A-E0
R - recommendation
D - decisions

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7
Q

At what NEWS level do we do continuous obs monitoring

A

7

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8
Q

At what NEWS score are nurses supposed to escalate to the medical team

A

3 or above

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9
Q

When do you NEWS for resp

A

<5 or >36

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10
Q

When do you NEWS for pulse

A

> 140

<40

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11
Q

What is a late sign of airway obstruction

A

Cyanosis

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12
Q

Final line management of airway obstruction is NPA or OPAs fail

A

Tracheal intubation

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13
Q

How do we assess Breathing

A
  1. Observatiob
  2. RR
    3.Depth of breath
  3. O2 conc
  4. Breath sounds
  5. Palpate, percuss, ascultate
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14
Q

How do we assess Circulation

A
  1. Appearance
  2. Limb temp
  3. CRT
  4. Venous filling
  5. BP
  6. Auscultate
  7. Oliguria (urine output < 0.5ml/kg/hr).
  8. Large bore cannula (remember to take blood)
  9. 500ml warm crystalloid
  10. ECG (if pain)
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15
Q

Management of ACS

A

MONA

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16
Q

How do we assess disability

A

Drugs check
Pupils
GCS/AVPU
BGs

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17
Q

How do we assess exposure

A

Clinical history
Ceiling of care
Notes

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18
Q

What three factors result in ACS

A
  1. Acute thrombosis
  2. Contraction of smooth muscle cells
  3. Partial or complete obstruction of lumen
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19
Q

If there is a non-shockable rhythm on the algorithm, what is the immediate action

A

CPR

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20
Q

How long should CPR be done if pulmonary thrombosis is suspected

A

60-90 minutes

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21
Q

Management of a coronary thrombosis

A

PCI or coronary angiography

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22
Q

How do we diagnose tamponade

A

Cardiac ECHO

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23
Q

When shoudl tamponade be considered

A

After penetrating chest trauma or after cardiac surgery

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24
Q

Name two non shockable rhythms

A

Asystole and PEA

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25
Q

When are adrenaline and amiodarone indicated for VF or pVT

A

after the third shock

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26
Q

How many mls of fluid should drugs be flushed into circulation with

A

20mls

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27
Q

How much adrenaline and amiodarone is needed after the third shock

A

1mg adrenaline

300mg amiodarone

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28
Q

After the initial dose of adrenaline is given. How often should it be given there onwards

A

Every 3-5 minutes

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29
Q

How often should rescuers switch roles in chest compression

A

Every 2 minutes

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30
Q

What factor can influence the likelihood of successful resuscitation in VF/pVT

A

reduction of pre and post-shock pauses.

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31
Q

When should a pulse check be done in VF/pVT

A

Only when organised electrical activity compatible with a pulse is seen

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32
Q

When should intraosseous access be considered for cardiac arrests

A

If IV access has not been achieved within 2 minutes

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33
Q

When is external pacing indicated for asystole

A

p-wave asystole

not indicated for total asystole

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34
Q

What is the most common cause of adverse events in resuscitation

A

Lack of good non technical skills

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35
Q

Most common causes of cardiac arrest (2)

A

Hypotension and hypoxia

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36
Q

What is the most common cardiac arrest rhythm found in hospital arrests

A

PEA

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37
Q

When is an ECG indicated with syncope

A

Unexplained (during excercise)
Structural heart disease
Syncope and have an abnormal ECG (prolongued QT interval)

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38
Q

Outline the 6 stage approach to reading an ECG

A
  1. Is there any electrical activity
  2. What is the QRS rate
  3. Is QRS rhythm regular or irregular
  4. Is QRS narrow or broad
  5. Is atrial activity present
  6. Is atrial activity linked to ventricular.
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39
Q

What is torsades de pointes

A

Polymorphic VT

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40
Q

What is the prognosis of PEA

A

Poor

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41
Q

WHat can cause PEA

A

Blood loss
Tampoande
PE
Tension pneumothorax

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42
Q

Name the lateral leads

A

I, aVL, V6

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43
Q

Name the inferior leads

A

II, III, aVF

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44
Q

Name the anterior leads

A

V2-4

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45
Q

IN which leads is there normal deflection

A

aVR

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46
Q

In which v lead are t waves ngetaive

A

V1

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47
Q

in which lead, I, II or III can t waves be negative

A

III

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48
Q

What is the normal PR interval

A

0.2ms

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49
Q

What is the most common cause of death in patients who have had an out of hospital cardiac arrest

A

Post-cardiac arrest brain injury

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50
Q

Name three factors that can cause post cardiac brain injury

A

Hypercapnia, hypoxia, hypoglycaemia, pyrexia

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51
Q

What is post cardiac arrest myocardial dysfunction

A

Reduced LV EF and CO

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52
Q

Management of post cardiac arrest myocardial dysfunction

A

Self resolves within 72 hours

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53
Q

Name the four forms of post-cardiac arrest syndrome

A

Post cardiac arrest brain injury
Post cardiac arrest myocardial dysfunction
Systemic ischaemia-reperfusion response
Persistence of the precipitating pathology

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54
Q

What is normocarbia

A

4.7-6

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55
Q

How do we monitor Co2

A

end tidal co2 + waveform capnography and ABG

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56
Q

What is an issue with intubation we need to keep an eye on when A-E

A

That the tracheal tube might only have gone into the right main bronchus - check that airway entry is present bilaterally

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57
Q

Why should a gastric tube be inserted following ROSC

A

Decompress the stomach following mouth-to-mouth or bag-mask ventilation

58
Q

List the GCS components

A

Motor:
Nil
Extension
Abnormal Flexion
Flexion
Localises
Obeys commands

59
Q

What investigations should be considered in the post resuscitation phase

A

ABG
FBC
ECG
ECHO

60
Q

Why is insulin given as part of post-resuscitation care on ITU

A

To keep glucose < 10.

61
Q

How is enteral nutrition given post-resuscitatio

A

NG Tube

62
Q

Most common side effect after ROAC

A

Pyrexia

63
Q

Why is pacing and defibrillator pads put on post-resus

A

Arrythmias are common after a cardiac arrest

64
Q

What drug is given post resuscitation

A

Inotropes to keep MAP high

65
Q

Whys is hypercapnia bad

A

Results in cerebral blood vessel dilatation and increased blood flow

66
Q

How long should fevers be prevented for before porgnosis becomes poor

A

For 72 hours

67
Q

Name three ways we get ACS

A
  • Atherosclerotic plaque rupture
  • Smooth muscle contraction
  • Thrombus formation
68
Q

Name three types of ACS

A

NSTEMI
STEMI
UNSTABLE Angina

Not stable angina

69
Q

Troponin levels in unstable angina

A

Normal

70
Q

ECG reading in unstable angina

A

Normal

71
Q

What ECG rading in an unstable angina shows a high risk of porgression to MIs

A

ST Depression

72
Q

What is the immediate treatment for all acute coronary syndromes

A

300mg Aspirin
GTN
Oxygen (if sats under 94%)
Morphine

73
Q

Antithrombotic management of unstable angina and NSTEMI

A

BATMAN

B - Base the decision about angiography/PCI
A - Aspirin 300mg
T - Ticagrelor
M - Morphine
A - Fondaparinux
N - Nitrates

74
Q

If someone with unstable angina and NSTEMIs at a high risk, what other triple combination therapy agent should be given for thrommbotic medication

A

glycoprotein IIb/IIIa inhibitor

75
Q

Management of STEMIs

A

Emergency reperfusion therapy: PCI (within 2 hours) or fibrinolytic therapy if no access to PPCI

76
Q

If thrombolysis fails, what is the next step

A

Transfer to hospital who offer PCIs

77
Q

Absolute contraindications to antifibrinolytic therapy

A

Haemorrhagic stroke
CVA within past 6 months
Neoplasm
INternal bleeding
Dissection
Major durgery
Bleeding disorder

78
Q

Long term management of a STEMI

A

AAAA

A- Atenolol
A - Aspirin 75mg
A - Atorvastatin (80mg)
A - AceI

79
Q

Three steps following ROSC

A

ECG
ECHO
A-E assessment

80
Q

Define tachycardia

A

Over 100BPM

81
Q

Management of adult tachycardia if life threatening features are seen

A

DC Shock 3 times

82
Q

If DC shock does not work the third time for someone with tachycardia, what should be done

A

Amiodarone 300mg IV over 10-20mins

Then repeat the shock

83
Q

If a patient with tachycardia has no life threatening features, what is the next investigation

A

ECG to check if QRS is narrow or not

84
Q

If QRS is narrow, but regular in someone with tachycardia, what should be done

A

Vagal manoeuvres

85
Q

If QRS is narrow but irregluar, what should bve done

A

AF. Rate control. Anticoagulation after 48 hours

86
Q

If QRS is broad but regular in someone who is tachycardic, what should be done

A

Possible VT: Amiodarone 300mg IV over 20-60mins

87
Q

If QRS is broad for someone with tachycardia but irreglar, what should be done

A

Possible torsades de pointes - give MG Sulphate

88
Q

If vagal manoeuvres do not work for narrow complex tachycardia (regular), what should be done

A

Give Adenosine 6mg

then 12mg if unsuccessful

Then 18mg if unsuccessful

If ineffective:
Verapamil

89
Q

Normal PR interval

A

0.2s

90
Q

Treatment of first degree heart block

A

Nothing

91
Q

What is Mobitz type 2 heart block

A

Progressive elongation of PR interval until a p wave is dropped

92
Q

What is Mobitz type 2 heart block

A

where p waves drop randomly

93
Q

Management of Bradycardia

A

Atropine 500mcg IV

94
Q

What other drugs can be given for Bradycardia as second line

A

Atropine again
Isoprenaline
Adrenaline

95
Q

Long term management of bradycardia

A

Transvenous pacing

96
Q

What is the total amout of atropine that can be given for bradycardia

A

3mg IV

97
Q

If Atropine fails after 3ml IV, what should be done

A

Transcutaneous pacing

98
Q

What can be used as an alternate to CPR in severe bradycardia

A

Percussion Pacing

99
Q

Define bradycardia

A

<60 min

100
Q

How many mcg of adrenaline is given to an adult in anaphylaxis

A

500

101
Q

How many mcg of adrenaline is given to a child 6 - 12 years

A

300

102
Q

How many mcg of adrenaline is given to a child 6 months to 6 years

A

150 mcg

103
Q

What defines life threatening asthma

A

PEF < 33%
O2 < 92%
PaO2 < 8
Normal PaCo2

104
Q

Why is disconnecting the ventilator and checking for air tapping done in asthma

A

Relieves gas trapping in the lungs (hyperinflation can be seen in asthma)

105
Q

Signs of tricyclic antidepressants on ECG

A

Sinus tachycardia + wide QRS complexes

106
Q

How many amps does electrical capture occur with in transcutaneous pacing

A

50-100 mA

107
Q

How common is transcutaneous pacing successful in someone with hyperkalaemia

A

Not common

108
Q

Should prophylactic antibiotic therapy given routinely following drowning

A

No

109
Q

Why is there not immediate entry o water into the victim’s lungs when drowning

A

Initially laryngospasming and breath holding to prevent water entering the lungs

110
Q

Name three conditions in which calcium chloride 5ML 10% is indicated

A

Hyperkalaemia
Hypocalcaemia
Overdose from CCBs

111
Q

What is the first monitored rhythm in cardiac arrests

A

PEA and systole

112
Q

What is the rate of infusion of adrenaline in bradycardia

A

2-10 mcg mon-1

113
Q

What is the role of sodium bicarbonate in a cardiac arrest

A

Shifts oxygen dissociation curve to the left, inhibiting release of oxygen to the tissues

114
Q

What energy should be given in the first shock for VF

A

120J

115
Q

Cardiac arrest is secondary to hypercapnia in asthma: T or F

A

False - hypoxia

116
Q

What defines nes severe hyperkalaemia

A

> 6.5

117
Q

What calcium chloride amount is given in hyperkalaemia

A

10% 10mL IV

118
Q

In ITU what glucose level should be targeted

A

<10

119
Q

How common are seizures after ROS

A

30% incidence

120
Q

How many cardiac arrests result in ROSC

A

30%

121
Q

How many people survive to go home after ROSC is achieved

A

9.7%

122
Q

What is the most common cause of cardiac arrest (rhythm)

A

No shockable

123
Q

Bystander CPR rates in the UK

A

60%

124
Q

Name two situations in which chest compressions can be stopped

A

During defibrillation attempts and rhythm checks only

125
Q

Main causes of ventricular fibrillation

A

ACS
HTN
Valvular disease
Long QT syndrome

126
Q

Prior to PPCI, what triple anticoagulation therapy is given

A

Prasugrel
Clopidogrel 600mg
Ticagrelor

127
Q

What fibrinolytic therapy is given to patients with a STEMI

A

Aspirin 300mg + Ticagrelor 180mg

128
Q

What fibrinolytic therapy is given to patients with a bleeding risk

A

Aspirin 300mg
Clopidogrel 300mg

Or Aspirin alone

129
Q

4 indications for immediate PCI

A

St elevation > 0.2 in 2 adjacent chest leads
>0,1 mV in 2 or more adjacent limb leads
R waves or ST depression in V1-3
LBBB

130
Q

After fibrinolytic therapy is given, when should an ECG be performed

A

60-90 mins after therapy is given

131
Q

When is prasugrel contraindicated

A

> 75 years
<60kg

132
Q

What does of prasugrel is given

A

60mg loading dose and then 10mg daily

133
Q

When is an aldosterone antagonist needed in HF

A

EF < 40%

134
Q

How often should cardiac rhythm be assessed

A

Every 2 seconds

135
Q

When should adrenaline and amiodarone be given in pVT and VF

A

After the third shock

136
Q

How much amiodarone is given VF/pVT

A

300mg

137
Q

If 300mg amiodarone does not work in pVT/VF, how much should subsequent doses be

A

150mg after 5 defibrillator attempted.

138
Q

If amiodarone is not available for VT/pVT, what else can be given

A

Lidocaine

139
Q

Management of Systole and PEA

A

30:2 chest compressions

1mg Adrenaline as soon as access is given

Continue 30:2 chest compressions.

Recheck rhythm after 2 mins

140
Q
A

F1 (1 decks)

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