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ALS Flashcards

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1
Q

Outline the ALS algorithm

A
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2
Q

What drugs are given in shockable rhythms

A

Adrenaline 1mg IV every 3-5 mins
Amiodarone 300mg after 3rd shock, 150mg after 5th shock if shockable rhythms are seen

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3
Q

What are the 4Hs 4Ts

A

Hypoxia
Hypothermia
Hypovolaemia
Hypo/hypermetabolic

Thrombosis
Tamponade
Tension pneumo
Toxins

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4
Q

What drugs are given in non-shockable rhythms

A

Adrenaline 1mg IV as soon as IV access
Then every 3-5 mins

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5
Q

When can you give 3 successive shocks in VF/pVT?

A

Witnessed
Monitored on a manual defib
If unsuccessful commence typical ALS

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6
Q

What 5 things does waveform capnography assist with in ALS?

A

ET tube placement (alongside auscultation)
Ventilation rate
Chest compression quality
Identifying ROSC
Prognostication

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7
Q

How does a capnograph work?

A

Attach T piece to end of ET tubes / SGA device

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8
Q

What is the normal range for capnography
What etCO2 reading is associated with a poorer prognosis?

A

4.3-5.5kPa in a healthy patient
<1.33 kPa after 20 mins

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9
Q

What is needed alongside IV drug administration

A

20ml saline flush

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10
Q

What are the 3 main IO sites?

A

prox humerus
prox tibia
distal tibia

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11
Q

What are the 4 contraindications to IO access?

A

Trauma
Infection
Prosthesis
<48hr I/O access at that site inc failed attempts

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12
Q

How is IO access confirmed?

A

Blood on aspirate

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13
Q

How is death diagnosed in ALS

A

Following decision to stop ALS, wait 5 mins to confirm…
Absence of central pulse and heart sounds with
ONE of the following
a) asystole on ECG
b) no pulsatile flow on central arterial monitoring
c) absence of contractile activity on echo

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14
Q

How is USS used in ALS

A

Can help identify thrombosis or tamponade
Place probe just prior to ceasing of compressions to get a 10s analysis

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15
Q

How to clear airway in tracheostomy patient

A
  1. Check stoma/trache tube
  2. Change inner liner
  3. Pass suction catheter
  4. Remove and change trache tube

If trache tube removed can plug stoma and ventilate with mask or pass ET tube
OR
Place mask over stoma to ventilate

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16
Q

What is the choking pathway for ALS?

A

Mild (speaking, coughing)
Encourage coughing

Severe (cant speak, cough, not breathing)
Unconscious –> CPR
Conscious: 5 back blows –> 5 abdominal thrusts

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17
Q

What is the ‘hierarchy’ of airway aids

A

NP
OP
SGA
LMA
ET

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18
Q

What are the drawbacks of an i-gel (ET tube?

A

Gas leakage in poor lung compliance (COPD, oedema etc)
Some gas leak if uninterrupted compressions –> revert to 30:2 if inadequate
?Risk of aspiration

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19
Q

When should a tracheal intubation be used?

A

If a trained individual has a 95% chance of successful placement on 2 attempts

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20
Q

When should tracheal intubation be avoided

A

Acute epiglottitis
pharynx/larynx disease
Head injury

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21
Q

What do after tracheal tube placement

A

Confirm via auscultation and Capnography

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22
Q

What are the stages of ECG interpretation

A
  1. Electrical activity
  2. What is the ventricular rate
  3. Is the rhythm regular or irregular
  4. Is the QRS narrow or broad
  5. Is atrial activity present
  6. How is atrial activity related to ventricular activity
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23
Q

How to quickly calculate rate?

A

count R-Rs in 30 large squares (6S), multiply by 10

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24
Q

How can you distinguish ECGs by type of irregular rhythms

A

Irregularly irregular, consistently: AF

Mostly regular, interrupted by irregularity: Ectopic.
If QRS broad could be ventricular or
supraventricular + BBB
Can occur up to 3 times successively; more than this is tachyarrhythmia

Cyclical variation:
Examine P and QRS relationship

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25
Which leads are good for assessing P wave activity
V1, II
26
How can P and QRS wave relationship determine rhythm?
Constant prolonged PR: 1st degree block Progressive lengthening then drop: 2.1 Intermittent pairing of P and QRS: 2.2 No association between P and QRS: Total heart block
27
What 3 factors determine successful defibrillation
1. Time from onset to shock 2. Continuous, uninterrupted chest compressions 3. Duration of stopping during ALS (every 5s halves the success rate of defibrillation)
28
What parts of the heart can pace rate and what is the general pacing these parts give?
SA node: 60-70 AV junctional region: 40-50 Distal purkinje-his fibres: 0-30
29
How is fist pacing performed
Raise fist to 20cm then hit L sternal praecordium Check QRS on monitor If no QRS, hit harder and augment site of landing If no regular pulse quickly ---> CPR
30
How to transcutaneous pace
Clear skin (shave and dry) Place electrodes conventionally or AP (if defib still needed) Select pacing rate ~60-90 Increase current until QRS spike followed by T wave - usually 50-100mA
31
What 3 ways can transvenous pacing fail
Increased voltage threshold Connection failure Lead displacement
32
Outline the tachyarrhythmia pathway
33
How is a regular broad complex tachycardia treated
Treat as VT 300mg amiodarone IV 10-60mins 900mg amiodarone IV 24 hr infusion post +/- synchronised DC if persistent
34
How is an IRregular broad complex tachycardia treated
Seek expert advice as could be AF + BBB / WPW / polymorphic VT If torsade des pointes: Give 2g MgSO4 over 10 min
35
What causes REGULAR narrow complex tachycardias
sinus SVT Atrial flutter
36
What is the treatment of regular narrow complex tachycardia
1. Vagal manouvres: carotid/valsalva 2. Adenosine 6mg 3. Increase to 12mg then 18mg if no transient relief of tachycardia
37
what drugs are alternative to adenosine?
Verapamil 2.5-5mg IV over 2 mins Metoprolol 2.5-15mg over 15 min given in 2.5mg bolus doses)
38
What do for rapid narrow complex tachys with no pulse
CPR
39
How to treat fast AF
Life threatening features: Cardiovert and LMWH No life threatening features Rate control with BBs or diltazem/amiodarone If <48 hrs: chemical cardioversion If >48 hours: Anticoagulate for 3 weeks then shock If WPW presents with pre-excited AF: expert help
40
Outline the bradycardia algorithm
41
How to treat hyperkalaemia
10ml 10% Ca gluconate 10 units insulin in 25 glucose IV --> Glucose 10% infusion at 50ml/hr if <7 glucose Remove potassium via binders (15-30g) Consider dialysis if refractory
42
How to treat hypokalemia?
IV potassium replacement (20mmol hr)
43
Which electrolyte derangement gives confusion, weakness, short QT, prolonged QRS, flat T wave?
Hypercalcaemia
44
What is the treatment of hypercalcaemia
Fluids furosemide hydrocortisone Pamidronate 30-90mg
45
How is hypocalcaemia treated
Ca chloride 10% 10-40ml IV 1-2g 50% MgSO4
46
How is hypermagnasaemia treated
Calcium chloride 10% 10ml
47
How is hypomagnasaemia treated
2g MgSO4 over 10-15 mins
48
How are opioids reversed
400ug IV / 800ug SC/IM / 2mg IN naloxone; lasts ~1hr Up to 10mg
49
How are benzos reversed?
flumenazil
50
How are TCAs reversed?
bicarbonate if QRS widening
51
How is local anaesthetic reversed?
20% lipid emulsion 1.5ml/kg bolus followed by 1.5ml/kg /hr up to 12ml/kg dose Can give 3 bolus doses
52
How can asthma be classified into severe, life-threatening, near fatal?
Severe: PEFR 33-50%, RR >25, HR 110, incomplete sentences Life-threatening: PEFR <33%, exhaustion, Pao2 <8 Fatal: Rising CO2
53
How to treat asthma attack
Salbutamol 5mg every 15 min Ipratropium 500mcg 4-6 HOURLY Pred 40mg orally / hydro 100mg I 6 hrly MgSO4 IV 2g Aminophylline under senior instruction
54
Outline anaphylaxis algorithm
55
Outline refractory anaphylaxis algorithm
56
How to investigate anaphylaxis cause
Mast cell tryptase 1. At event 2. 1-2 hours post 3. at 24 hours
57
How to modify cardiac arrest management in pregnancy
Place in L lateral position / displace uterus to L if >20 weeks Prep for emergency C section if initial resuscitation efforts fail Early tracheal intubation to reduce aspiration risk
58
What pregnancy specific reversible causes are there?
Haemorrhage: Give TXA, oxytocin/PGs/uterine massage, uterine compression, surgical/IR control Drugs MI Pre-eclampsia/eclampsia: GIve MGSO4 Amniotic fluid embolism: Supportive
59
In traumatic cardioresp arrest, what constitutes damage control surgery
Permissive (radial pulse) hypotension (CI in brain injury) up to 60min TXA 1g IV, then 1g over 8 hours
60
How to relieve cardiac tamponade
resuscitative thoracotomy NOT aspiration
61
What is the most common arrest reason perioperatively
Airwat
62
What modifications are made for peri-op arrest
Supine chest compressions Adrenaline in 50-100mcg increments rather than bolus Stop surgery unless can prevent cause
63
What are the specific timings involved in drowning
<10 mins associated with better outcomes review rescue efforts at 30,60, 90 mins
64
What modifications to ALS are made in drowning patients
A/B: High flow, early intubation given increased pulm pressures, PEEP at 5-10cm H20 C/D: dont rely on pulse, hypovolaemia common once out of water
65
What are the post-resus care features of drowning
Ventilation strategies for ARDS ECMO for refractory arrest Pneumonia
66
What are the 5 stages of hypothermia
I: >32, conscious II: >28, reduced conscious III: >24, unconscious IV: <24, arrest V: <11.8, dead
67
How to measure hypothermia
Tympanic thermocoupled device Lower third oesophagus measurement
68
How to resuscitate hypothermia
<28: 5 mins on 5 mins off <20: 5 mins on 10 mins off Check vital signs over 1 min Can give drugs over double the time for temp 30-35 (eg 6-10 mins for adrenaline)
69
How to rewarm in hypothermia arrest
If >11.8 use heat packs, transfer to ECMO centre within 6 hours / warm on ward
70
How to treat hyperthermia
Cool and lay flat hypertonic saline if <130 (3 x 100ml)
71
How to treat malignant hyperthermia
Dantrolene
72
outline post-resuscitation care
73
Outline steps of ABG analysis
1. Clinical context 2. Hypoxaemic?: is PaO2 = FiO2-10 3. pH: <7.35 to 7.45 4. PaCO2 5. Compensation: The change in keeping with the pH is primary, the other will be compensatory 6. Other changes
74
When is sodium bicarbonate appropriate?
Hyperkalaemia TCA overdose
75
What implication does a DNACPR have on ICD function
CONSIDER removing the shock function
76
Is asystole a completely straight line?
No This indicates a removed lead
77
What dose of adrenaline is given in bradycardia?
2-10mg
78
What is the initial shock dose for vFIB
120J
79
What are the absolute contraindications to fibrinolytic therapy
Prev haemorrhage past 6 months <3 weeks major trauma/surgery <1 month history of GI bleeding Aortic dissection Bleeding disorders

ALS (1 decks)

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