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ALS book Flashcards

(49 cards)

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1
Q

What rhythms are typical in cardiac arrest

A

50% is Asystole
25% is PEA
25% is shckable in VF or pulseless VT

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2
Q

Where do most cardiac arrests occur

A

At home/out of hospital

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3
Q

AT HOME - With those who have resus, how many get ROSC/make it out of hospital

A

30% ROSC

10% out of hospital

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4
Q

IN HOSPITAL - how many survive a cardiac arrest and get out of hospital?

A

25% get out of hospital

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5
Q

How many get out of hospital that have had VT/VF

A

50%

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6
Q

How many get out of hospital that have had a non-shockable rhythm?

A

15%

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7
Q

What is the chain of survival that contributes to successful outcome?

A

EARLY recognition
EARLY CPR
EARLY defibrillation - if done in 3-5minutes survival rates are 50-70%
Post-resus care

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8
Q

Describe the ALS algorithm

A

https://www.rcemlearning.co.uk/wp-content/uploads/modules/the-als-algorithm/new_als.png

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9
Q

What are the non-technical skills involved in ALS?

A

Situational swareness
Decision making
Team work
Task management

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10
Q

What are some communication methods used during handover

A 
SBAR
Situation
Background
Assessment
Response
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11
Q

How do we assess teams during an emergency

A

TEAM tool - team emergency assessment tool

Assesses:

  • Leadership
  • Teamwork
  • Task management
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12
Q

What makes survival more likely with cardiac arrest?

A

VF/VT
Causd by MI
Witnessed and monitored
Immediate defibrillation with success

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13
Q

What is PEA often caused by?

A

slow deterioration - hypoxia or hypovolaemia on wards

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14
Q

In how many patients is there a deterioration period before an arrest? (Lasting a few hours)

A

80%

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15
Q

What is the chain of prevention for cardiac arrest situations?

A

Education > monitoring > recognition of deterioration > call for help > response

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16
Q

What wound prompt an emergency call in ABCDE

A 
Airway compromise
Breaths <5 or >36
Pulse <40 or >140
Systolic <90
Decrease in GCS of >2
Repeated or prolonged seizures
Any other concerns
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17
Q

Causes of airway obstruction

A 
Angio-oedema
Something stuck
Epiglottitis
Trauma/ haematoma formation
Central nervous system depression
Blood
Vomit
Laryngospasm
Bronchospasm
Secretions
Blocked trachy
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18
Q

Treatment of airway compromise

A 
Head tilt chin lift/jaw thrust
Suction/ turn patient on side
airway adjuncts - NPA/OPA
I-gel/LMA
Intubation

OXYGEN
TREAT CAUSE

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19
Q

What is a respiratory arrest caused by

A

often multifactoral
Can be chest infection + chronic resp difficulty + muscle weakness + rib fractures - if blood is not oxygenated effectively there will ultimately be a cardiac arrest.

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20
Q

What are the catagories of causes of breathing disorders

Study These Flashcards
A

Decreased drive - CNS

Decreased effort - innervation
- damage to the spinal cord can reduce action of phrenic nerve if cervical injury or can reduce action of intercostal muscles with spinal cord damage too

Lung disorders - haemothorax, pneumothorax - tension causes reduction of venous return to the heart and a fall in cardiac output which can lead to cardiac arrest, ARDS, infection, pulmonary oedema, PE

21
Q

Causes o fVF

Study These Flashcards
A 
ACS
Acidosis
Valve problems
Toxins
Hypertension
Long QT
Electrolytes
Hypothermia
22
Q

What is the most common cause of sudden cardiac death? SCD

Study These Flashcards
A

Coronary artery disease

23
Q

How does syncope related to death in cardiac diseasE?

Study These Flashcards
A

In known cardiac disease, syncope is an independent RF for death

24
Q

What features of syncope make it more likely secondary to an arrhythmia?

Study These Flashcards
A 
From supine - lying facing upwards
No pre-syncopal symptoms
Associated with palpitations/chest pain
History of inherited cardiac disease
Occurring during or after exercise
Repeated unexplained episodes
25
If you have one episode of VF are you likely to have another?
Yes ! need preventative treatment - may need PCI or a defib
26
Is central cyanosis an early or late sign of airway obstruction?
LATE
27
How much oxygen to give with COPD patients
venturi at 24-28%
28
What to do if patients breathing is inadequate
use bag valve mask - may need NIV
29
What does a bounding central pulse indicate
sepsis
30
What can you tell from the pulse pressure
NARROW - 35-45mg - arterial vasoconstriction as in hypovolaemia or cardiogenic shock WIDE - arterial vasodilation - sepsis
31
What to do if blood glucose less than 4 in arrest
50ml 10% glucose and repeat every minute until patient regains consciousness. Max 250 ml given then recheck BM
32
WhT is causing ACS
Thrombosis within the vessel Contraction of smooth muscle Obstruction of lumen
33
What is unstable angina
On exertion with increasing frequency - crescendo angina - not provoked by exercise - unprovoked prolonged episode but without ecg change and trop rise
34
Ecg in unstable angina
Maybe ST depression | Maybe TWI
35
Dominant symptoms of MI in women diabetics renal disease elderly
SOB
36
Which arteries supply which part of the ecg
LAD - anterior Inferior - right coronary or circumflex Lateral - circumflex or diagonal branch of LAD Posterior - circumflex or right coronary Right side of heart - inferior or posterior with elevation in V1
37
If someone has a right sided infarct what Will the clinical picture be like?
High jugular venous pressure and fluid responsive hypotension WITHOUT pulmonary venous congestion
38
What about the territories in nstemi
Less related to site
39
Other conditions causing ischaemic and infarction signs
TBI PE - TWI in V1-4 due to dilated right ventricle Takasubos Brugada
40
Other causes of trop rise
``` Sepsis CKD acute or chronic heart failure Myocarditis PE dissection Arrhythmias ```
41
What does the GRACE score do
Risk stratification for admission and 6 months
42
Risk of bleeding in MI treatment?
Bad renal function Increasing age Bleeding complications Low body weight
43
ACS treatment
``` Aspirin 300mg Ticagrelor 180mg IV morphine Metoclopramide GTN - unless hypotension Oxygen if less than 94 ```
44
How quick does PPCI need to be done | What drug can be given IV or into the thrombus
Within 12h | Glycoprotein 2b/3a
45
Why PPCI vs fibrinolytic
Less risk of ICH
46
When can prasygrel not be given
Less than 60kg Elderly >75 History of bleeding or stroke
47
Absolute contraindications for fibrinolytic therapy
``` Previous haemorrhaging stroke Ischaemic stroke within 6 months Active bleeding Suspected dissection Bleeding disorder Major trauma/head injury/surgery within 3 months CNS damage or neoplasm ```
48
In how many patients does fibrinolytic therapy not work
20-30
49
How do you know fibrinolytic therapy has failed
Failure of more than 50% of stevo to resolve

ALS (1 decks)

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