ALS Algorithm

Question 1

Heart rhythms in connection to cardiac arrest are of which two groups?

Answer 1

Shockable (VF and pVT)

Non-shockable (Asystole and PEA)

Question 2

What are the most important and primary treatments in the ALS algorithm?

Answer 2

High quality, uninterrupted compressions

Early defibrillation (when appropriate)

Question 3

Revise the ALS algorithm

Answer 3

Question 4

Revise the manual defibrillator sequence

Answer 4

Question 5

Revise the manual defibrillator sequence

Answer 5

Question 6

If compressions are paused, what timeframe are we aiming?

Answer 6

Less than 5 seconds

Question 7

What is the defibrillator joules? and what can it be increased to on second and subsequent shocks?

Answer 7

200J

360J

Question 8

If a patient has had no response to effective compressions and VT is displayed, then treat as?

Answer 8

pVT

Question 9

If during a rhythm check, a rhythm compatible to life is found, then do what?

Answer 9

Check for pulse, signs of life and end tidal CO2

Question 10

If there is doubt between asystole and extremely fine VF, what do you do?

Answer 10

Don’t attempt defibrillation as CPR may increase the amplitude of the VF into a shockable VF

Question 11

What is the chance of survival with asystole / PEA arrest if a reversible cause cannot be found?

Answer 11

Unlikely

Question 12

What do you do if during CPR VF is seen (and it was asystole / PEA)?|

Answer 12

Wait until charge and check

Question 13

What rate do you ventilate lungs during CPR?

Answer 13

10RR

Question 14

With a supraglottic airway is inserted, do you stop to ventilate?

Answer 14

No, continuous CPR is now possible

Question 15

How long can you pause CPR for passing a tube between the chords?

Answer 15

5 seconds

Question 16

What is the CPR rate?

Answer 16

100-120 compressions per minute

Question 17

Breathing efforts, movements and eye opening MAY indicate ROSC, how do you confirm?

Answer 17

Rhythm check and pulse check

Question 18

ALS requires what kind monitoring?

Answer 18

ECG via pads, paddles or electrodes, ETCO2, Blood sampling (AVOID finger prick and ABG)

Question 19

When is ETCO2 more reliable? What ventilation technologies?

Answer 19

Less with BVM but more reliable with SGA / ET

Question 20

What ETCO2 value may indicate ROSC?

Answer 20

Approaching normal values or normal values

Question 21

What is the role of ETCO2 in CPR

Answer 21

Tracheal placement
Monitoring ventilation
Monitoring quality of compressions

Question 22

If ROSC is suspected, should you give adrenaline (if algo requires)?

Answer 22

No

Question 23

What ETCO2 values are associated with poor prognosis?

Answer 23

Failure to get ETCO2 >20mmHg after 20 mins of CPR

Question 24

What are the IO sites?

Answer 24

Humerus head, proximal / distal tibia, distal femur / sternum

Common site: Proximal tibia (Flat bone 2-3cm from patella and 2cm medial)

Question 25

When not to do IO?

Answer 25

Previous attempt in the area, broken bone, prosthesis, failure to identify landmarks

Question 26

How to confirm IO placement?

Answer 26

Aspirate (absence of aspiration is not absolute sign of failure)

Question 27

IO site can be used for what?

Answer 27

Blood tests (but must be sent to lab with identification of it beings IO), DRUGS, FLUIDS, BLOOD PRODUCTS

Question 28

With CPR, work to identify and correct the 4 H and 4 Ts, which are?

Answer 28

Hypovolaemia Hypoxia Hyperkalamia, hypok+, hypoglycaemia, hypocalcemia, acideaemia Hypothermia Toxins Thrombus Tension pneumothorax Cardiac tamponade

Question 29

What to do about hypoxia?

Answer 29

100% FiO2, check tube placement (ETCO2, auscultation), look for pre-arrest hypoxia if possible

Question 30

What to do about hypovolaemia (which often causes PEA)?

Answer 30

Causes: Haemorrhage (examine for evidence of this) - check wounds, drains -> fill the patient with fluid / bloods, stop the bleed Distributive shock (anaphylaxis / sepsis) - fluid replacement

Question 31

What to do about hyperkalaemia?

Answer 31

Give calcium chloride (stabilises cardiac cells in presence of high k+), sodium bic, 25g glucose and 10units short acting insulin

Question 32

What is severe hyperkalaemia?

Answer 32

>6.5mmol/L

Question 33

What are some causes of hypocalcaemia?

Answer 33

Shock, sepsis, pancreatitis, drug toxicity

Question 34

What to do about hypokalaemia? (<3.5mmol/L, severe is less than 2.5mmol/L)

Answer 34

5mmol IV K+; maybe 2g MgSo4 (helps with rapid correction)

Question 35

What should I suspect in drowning?

Answer 35

Hypothermia (use low reading thermometer)

Question 36

What is hyperthermia?

Answer 36

>40.6 (Think hot environments and malignant hyperthermia)

Question 37

Heat exhaustion vs heat stroke

Answer 37

Heat exhaustion causes nausea, vomiting, headache, malaise but has a core temperature below 40C Heat stroke is systemic inflammation with core >40C (altered mental state, organ dysfunction)

Question 38

In malignant hyperthermia (MDMA, meth, anaesthetics), what to give?

Answer 38

dantrolene

Question 39

How to cool patient in CPR?

Answer 39

Cooling mats, wrapped ice packs, intravascular cooling, IV fluids No drugs have been demonstrated as effective

Question 40

If ACS is suspected with thrombus, what may be performed with CPR?

Answer 40

PCI, routine fibrinolytic is not recommended.

Question 41

The most common thrombus is PE. What to give immediately?

Answer 41

This is when fibrinolytic is given immediately (at least 30 mins of CPR now needed up to 60-90mins)

Question 42

What are pre-arrest signs of tension pneumothorax? What sign in ventilated patient? Common causes?

Answer 42

Chest pain, respiratory distress, tachycardia, air hunger, fall SPo2, hypotension, altered consciousness In ventilated patients, high inspiratory pressures may indicate Causes: Trauma, thoracic surgery, pacing wires, asthma, COPD Ultrasound can help with diagnosis

Question 43

How is needle thoracocentesis performed?

Answer 43

14G long cannula (second intercostal space, midclavicular)

Question 44

What is cardiac tamponade?

Answer 44

Build up of pressure in pericardial space (early signs hypotension, distended neck veins)

Question 45

Pre-arrest signs in cardiac tamponade?

Answer 45

Tachypnoea, dyspnoea, low voltage QRS, Kussmaul's sign, pulsus paradoxus, Beck's triad: jugular venous distension, muffled heart sounds, low BP (often with narrow pulse pressure)

Question 46

In cardiac arrest, what are some common causes that raises suspicion for cardiac tamponade?

Answer 46

Chest trauma, after cardiac surgery

Question 47

What diagnostics can be helpful to confirm cardiac tamponade?

Answer 47

Echo

Question 48

What treatments are possible for tamponade?

Answer 48

re-sternotomy, pericardiocentesis (ultrasound guided), thoracotomy

Question 49

Antidote has been shown to work for toxins?

Answer 49

For cyanide toxicity (cardiac arrest, instability, acidosis, altered GCS), hydroxocobalamin (5mg up to 15mg) Nalaxone 100mcg titrates Sodium bicarbonate - TCAs

Question 50

When is it generally accepted that asystole without reversible cause is a good time to stop?

Answer 50

20 mins of CPR

Question 51

After stopping CPR, what is the means of diagnosing death?

Answer 51

Observe for 5 mins Confirm loss of cardiac function by lack of central pluse and lack of auscultation of pulse + maybe asystole on ECG / lack of pulse of arterial line or echo Any return of cardiac or respiratory activity should prompt another 5 mins of observation After 5 mins of cardiorespiratory arrest, absence of pupil response, corneal reflex, motor response to supra-orbital pressure should confirm.