ALS algorithm

Question 1

What is the first monitored rhythm in 20% of cardiac arrests?

Answer 1

VF/pVT

Question 2

What is the dose of amiodarone?

Answer 2

300mg IV

Question 3

What is the dose of adrenaline in cardiac arrest?

Answer 3

1mg (10mL 1:10000) IV

Question 4

When should adrenaline be with-held?

Answer 4

When there are signs of ROSC

Question 5

What is an easy way to ensure adrenaline is given at the correct time in the shockable side of the algorithm?

Answer 5

Give after alternate shocks (starting after the third shock)

Question 6

When can the second dose of amiodarone be given in the shockable side of the algorithm?

Answer 6

After the 5th shock

Question 7

When should lidocaine be used?

Answer 7

Only if amiodarone is not available (dose 1mg kg)

Question 8

What should you check in shock refractory VF/pVT

Answer 8

position of pads

Question 9

What should you consider in shock refractory VF/pVT?

Answer 9

Changing the pad to AP

Question 10

When should pulse checks be carried out?

Answer 10

Only if there is a rhythm that could be compatible with a pulse
Only interrupt the chest compressions if if there are signs of ROSC

Question 11

When should stacked shocks be given?

Answer 11

Immediately after witnessed and monitored VF/pVT arrest

Question 12

If you use the stacked shocks method when should drugs be administered?

Answer 12

Amiodarone immediately after third stacked shocks, adrenaline after a further 2 shocks

Question 13

If P waves are detected on ECG during PEA arrest what should be done?

Answer 13

Ventricular standstill may be effectively treated by cardiac pacing

Question 14

When should adrenaline be given in PEA/asystole arrests?

Answer 14

Immediately after IV access is achieved then every 3-5 minutes (during alternate cycles of CPR)

Question 15

What should be used for ventilation in the absence of personnel skilled in tracheal intubation?

Answer 15

Bag-mask or SGA

Question 16

How much CO2 do we produce each day?

Answer 16

400L

Question 17

What does pCO2 mean

Answer 17

partial pressure of CO2

Question 18

What does paC02 mean?

Answer 18

partial pressure of CO2 in arterial blood

Question 19

What is the normal range of PaCO2?

Answer 19

4.7-6

Question 20

What is the end tidal CO2?

Answer 20

The partial pressure of CO2 at the end of an exhaled breath

Question 21

What does end tidal CO2 reflect?

Answer 21

Cardiac output and pulmonary blood flow as well as the ventilation minute volume

Question 22

What is the role of waveform capnography in CPR

Answer 22

ensuring ET tube placement in the trachea
monitoring ventilation rate
monitoring the quality of chest compressions
identifying rosc
prognosticatoin

Question 23

What may waveform capnography show if ROSC is achieved?

Answer 23

Increase in end-tidal CO2

Question 24

How do capnographs work?

Answer 24

Take a small sample of gas (50ml/min) and analyse it using absorption of infrared light

Question 25

What does the section AB represent in capnography?

Answer 25

baseline- indicates the end of inspiration

Question 26

What does the section BC represent in capnography?

Answer 26

start of expiration

Question 27

Why does the initial portion of BC have low CO2?

Answer 27

It has come from the anatomical dead space

Question 28

What does the section CD represent in capnography?

Answer 28

The alveolar plataeu- slight increase is because not all alveoli empty at the same rate

Question 29

What does the section DE represent in capnography?

Answer 29

As inspiration starts air containing no CO2 is mixed with the small amount of residual expired gas

Question 30

When is the end co2 at its maximal?

Answer 30

D- normally 4.8 in healthy patients

Question 31

What end CO2 value is associated with a poor outcome

Answer 31

Failure to achieve end tidal CO2 of 1.33 after 20 minutes of CPR is associated with a poor outcome

Question 32

What are clinical signs of life?

Answer 32

Waking, purposeful movement

Question 33

What are physiological signs of life?

Answer 33

sharp rise in end CO2

Question 34

What should be done if there is a combination of clinical and physiological signs of life?

Answer 34

Consider stopping chest compressions for rhythm analysis and if appropriate a pulse check

Question 35

What must any administration of drugs be followed by?

Answer 35

a 20mL flush and elevation of the extremity for 10-20 seconds

Question 36

What are the recommended sites for IO injection?

Answer 36

proximal humerus proximal tibia distal tibia

Question 37

What are the contraindications for IO

Answer 37

trauma, infection or a prosthesis at the target site, recent IO access (48hrs) in the same limb including a failed attempt, or a failure to identify the anatomical landmarks

Question 38

What are the complications of IO

Answer 38

extravasation into the soft tissues dislodgement of the needle compartment syndrome due to extravasation fracture or chipping of the bone during insertion pain related to the infusion of drugs/fluid fat emboli infection/osteomyelitis

Question 39

What are the 4Hs and 4Ts

Answer 39

Hypoxia Hypo/hyperthermia Hypovolaemia Hyper/hypo kalaemia Toxins Tamponade Tension Thrombosis

Question 40

PEA due to hypovolaemia is usually due to

Answer 40

Severe haemorrhage

Question 41

When should you suspect hypothermia?

Answer 41

In any drowning incident

Question 42

What is the commonest cause of thromboembolic or mechanical circulatory obstruction?

Answer 42

Massive PE

Question 43

What should be considered if the cause is felt tp be massive PE?

Answer 43

Fibrinolytic drugs

Question 44

If a fibrinolytic drug is given how long should CPR be continued?

Answer 44

For 60-90 minutes

Question 45

What are clinical signs of tamponade pre-arrest?

Answer 45

Distended neck veins and hypotension

Question 46

What should be considered if cardiac arrest occurs after chest stabbing?

Answer 46

Resuscitative thoracotomy

Question 47

What position is recommended for US?

Answer 47

Sub xiphoid

Question 48

What does ECPR require?

Answer 48

Vascular access circuit with a pump and an oxygenator

Question 49

It is generally accepted that asystole for more than __ minutes in the absence of ... is grounds for stopping resus attempts

Answer 49

20 minutes in the abscence of a reversible cause with ongoing ALS