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ALS Flashcards

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1
Q

What proportion of arrests are shockable vs non-shockable?

A

Shockable 1/4

Non-shockable 3/4

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2
Q

Approximately what percentage of arrests achieve ROSC?

A

25-30%

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3
Q

How often should adrenaline be given in CPR?

A

Every 3-5 mins

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4
Q

What are the reversible causes of arrest?

A 
Hypoxia
Hypovolaemia 
Hypo/hyperK
Hypothermia
Thrombosis
Tamponade
Toxins
Tension pneumothorax
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5
Q

After the 3rd shock, what drugs should be given?

A

1mg IV adrenaline

300g IV amiodarone

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6
Q

What is a sign that ROSC has occurred?

A

Increase in end tidal CO2

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7
Q

What rhythms are non-shockable?

A

PEA

Asystole

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8
Q

What percentage of in hospital arrest, non-shockable, survive to discharge?

A

10%

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9
Q

What percentage of in hospital, shockable, cardiac arrests survive to discharge?

A

40-50%

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10
Q

What is the speed of an ECG?

A

25mm/sec

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11
Q

Post-cardiac arrest syndrome includes:

A

Brain injury
Myocardial dysfunction
Systemic ischaemia/reperfusion response
Persistence of precipitating pathology

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12
Q

How many points can you score in each area of GCS?

A 
Eyes = 4
Verbal = 5
Motor = 6
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13
Q

What adverse features do you need to assess for in arrhythmia?

A

Shock
Syncope
MI
HF

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14
Q

If someone is tachycardic and shows adverse features, what is the management?

A

Cardio version up to 3 shocks

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15
Q

What are the 2 things we have to assess if someone is tachycardic with no adverse features?

A

QRS narrow or broad

Regular or irregular

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16
Q

If someone is tachycardic with a broad, regular QRS what rhythm is it and how do we treat?

A

VT

IV amiodarone 300mg

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17
Q

If someone is tachycardic with a broad, irregular QRS, what rhythm is it and what is the management?

A

Expert review needed
AF with BBB
Pre-excited AF

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18
Q

If someone is tachycardic with an irregular, narrow QRS, what is the likely rhythm and management?

A

AF

Control rate with beta blocker or diltiazem

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19
Q

If someone is tachycardic with a regular, narrow QRS, what is the management and potential rhythms?

A

Vagal manoeuvres
Adenosine 6mg IV
Continuous ECG

Re-entrant SVT
Atrial flutter

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20
Q

Carotid sinus massage/valsalva manoeuvre will terminate what proportion of SVTs?

A

1/4

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21
Q

What do we use for rate control in AF?

A

Beta blocker (1st line)
Diltiazem
Digoxin

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22
Q

What do we use for rhythm control in AF?

A

Flecainide

Amiodarone

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23
Q

Why do we need to synchronise shocks with the R wave?

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A

Otherwise can cause VF

24
Q

If someone has adverse features and is bradycardia, what is the management?

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A

IV atropine 500mcg

25
If someone has no adverse features and bradycardia, what do we need to assess next?
Risk of asystole - mobitz II - 3rd degree HB - ventricular pauses >3 secs
26
What is the management if someone is bradycardia with no adverse features and no risk of asystole?
Observe
27
What is the management if bradycardic with no adverse features but are at risk of asystole?
IV atropine 500mcg or TC pacing
28
What is the risk of giving CPR to an asthmatic?
Tension pneumothorax
29
What is the management of TCA poisoning?
Charcoal | Sodium bicarbonate 50mmol
30
What is the management of benzodiazepine overdose?
Flumazenil
31
When do we consider C section with an arrested CPR patient?
Gestation >20 weeks | After 5 mins of CPR with no ROSC
32
What is the difference with IV access in pregnant women?
Because of potential for IVC compression, IV access should be gained above the diaphragm where possible
33
What is the difference between submersion and immersion in near drowning?
Submersion - fully underneath the water | Immersion - head remains above the water but some aspiration of water may occur
34
What do you do in near drowning if the pulse is difficult to feel?
Need to check ECG and end tidal CO2
35
What are people with near drowning at risk of?
ARDS
36
Hypothermia is a core temperature less than...
35
37
The risk of hypothermia is increased by:
``` Alcohol Drugs Exhaustion Illness Injury Neglect ```
38
If someone is hypothermic, what do we do with regards to CPR drugs?
<30 degrees hold all drugs 30-35 degrees double the time interval between drugs >35 give drugs as normal
39
Why should electrodes be placed over bone?
To minimise artefact from muscles
40
What is the rate of adrenaline infusion if needed for bradycardia?
2-10mcg/min IV
41
What are the potassium levels that define hyperkalaemia and severe hyperkalaemia?
Hyper >5.5 | Severe >6.5
42
What do we do if there is a pacemaker?
Pads need to be 10-15cm away from pacemaker Or Anterior posterior position
43
Following ROSC, maintain glucose at what level?
4-10
44
Seizures occur in what proportion of patients who remain comatose following ROSC?
1/3
45
Causes of airway obstruction
``` CNS depression Blood Vomit Foreign body Direct trauma to face or throat Epiglottitis Pharyngeal swelling (infection,oedema) Laryngospasm Bronchospasm Bronchial secretions Blocked tracheostomy ```
46
Causes of VF
``` ACS Hypertensive heart disease Valve disease Drugs - eg. Antiarrhythmics, TCAs, digoxin Long QT Acidosis Abnormal electrolytes Hypothermia Electrocution ```
47
Absolute contraindications to fibrinolytic therapy post MI
Previous haemorrhagic stroke Ischaemic stroke in the past 6 months CNS damage or neoplasm Recent (3 weeks) major surgery, major head injury/trauma Active internal bleeding or GI bleeding in past month Known or suspected aortic dissection Known bleeding disorder
48
How do you size a nasopharyngeal airway?
Tip of the nose to tip of earlobe
49
How do you size an oropharyngeal airway?
From lips to the angle of mandible
50
What are the limitation of the LMA?
Presence of high airway resistance/poor lung compliance causes risk of significant leak around the cuff Continuous compressions cause leak around cuff Risk of aspiration of stomach contents
51
What are the normal positions for the defib pads?
Pectoral on right | Apical on left
52
Main causes of hyperkalaemia
``` Renal failure Drugs - ACEi, ARB, potassium sparing diuretic Tissue breakdown Metabolic acidosis Endocrine disorder Diet ```
53
ECG signs of hyperkalaemia
``` Prolonged PR interval Flattened/absent P wave Tall, tented T waves ST depression Widened QRS ```
54
What are the definitions of hypokalaemia and sever hypokalaemia?
Hypo <3.5 | Severe <2.5
55
Causes of hypokalaemia
``` GI losses Drugs - diuretics, laxatives, steroids Renal losses Endocrine disorders Metabolic alkalosis Poor diet ```
56
ECG features of hypokalaemia
U waves T wave flattening ST segment changes

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