ALS Algorithm

Question 1

How do you confirm cardiac arrest?

Answer 1

Assess responsiveness
- sternal rub
Breathing
- cessation of breathing (agonal breathing not included)

Not central (carotid) pulse - can check it simultaneously (caution false positive)

Question 2

When do you start chest compressions?

Answer 2

Unresponsive

Abnormal breathing

Question 3

What is the standard energy setting for the defib?

Answer 3

200J

Question 4

What do you do for non-shockable?

Answer 4

Immediate adrenaline (1mg IV/IO)

Question 5

What are the shockable rhythms?

Answer 5

VF

Pulseless VT

Question 6

What are the 4H’s and 4T’s of reversible causes of cardio arrest?

Answer 6

Hypoxia
Hypovolaemia
Hypo/hyperthermia
Hyper/hypokalaemia, metabolic abnormality

Tension pneumo
Tamponade
Toxins
Thrombosis

Question 7

Management of hyperkalaemia?

Answer 7

Calcium chloride (or gluconate if chloride unavailable)
Bicarbonate
Insulin and dextrose
(in that order)

Question 8

Signs of tension pneumo?

Answer 8

Asymmetrical chest expansion
Absent breath sounds
Tracheal deviation
Hyperresonant percussion

Question 9

When do you think of tamponade?

Answer 9

Trauma
Post cardiac surgery
After some other procedure
Aortic dissection

Question 10

Management of PE?

Answer 10

Consider fibrinolytic therapy