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Flashcards in ALS Management Deck (44):
1

 

 

At what ratio would you do chest compressions to breaths in an adult?

 

 

30:2 at a depth of 5-6 cm; 2 per second

2

 

 

How long should you stop CPR to check for a rhythm/rescure breaths/electrical shocks?

 

 

5 seconds

3

 

 

How would you change your ratio of chest compressions to breaths once a definitive airway was in place?

 

 

Continuous compressions, venilating every 6 seconds/every 10 compressions

4

 

 

How often should you perform a rhythm check?

 

 

Every 2 minutes

5

 

 

If there is a pacemaker present in someone arresting, what would you want to make sure with regard to pad placement?

 

 

>8cm away from pacemaker

6

 

 

How would you approach chest compressions and ventilation if you were only using a Bag and mask?

 

 

30:2 compressions

7

 

 

How would you approach chest compressions and ventilation if a laryngeal mask/i-gel was in situe?

 

 

Continuous compressions with breaths every 6 seconds

8

 

 

What dose of adrenaline would you give in a cardiac arrest?

 

 

1mg IV (10 ml of 1:10000)

9

 

 

What would you want to do once IV access was established in an arrest situation?

 

  • Take bloods - VBG, FBC, U+E's, Mg2+, G&S
  • Give IV fluids

10

 

 

When would you give adrenaline if the rhythm was non-shockable?

 

 

Immediately after IV access established

11

 

 

When would you give IV adrenaline in a shockable rhythm?

 

 

After 3rd shock, then every 3-5 minutes

12

 

 

Why is IV adrenaline given in an arrest situation?

 

 

Causes peripheral vasoconstriction and so maximises cardiac blood flow

13

 

 

Once first dose of adrenaline had been given in a cardiac arrest, how often would you repeat giving the same dose?

 

 

Every 3-5 minutes, regardless of rhythm

14

 

 

When would you give amiodarone in a cardiac arrest situation?

If following rhythms, and after 3 shocks

  • pVT
  • VF

15

 

 

Why is amiodarone given in pVT/VF?

 

 

 

 

Stabilises the myocardium

16

 

 

What dose of amiodarone would you give someone in pVT/VF after 3 shocks?

 

 

300 mg IV

17

 

 

What are the 4 H's and 4 T's?

H's

  • Hypoxia
  • Hypovolaemia
  • Hypo/Hyperkalaemia
  • Hypothermia

T's

  • Thrombosis
  • Tension pneumothorax
  • Tamponade
  • Toxins

 

18

 

 

How would you assess hypoxia as a reversible cause of cardiac arrest?

 

 

  • Ventilation adequacy
  • Oxygen flow rate
  • ABG

19

 

 

How would you treat hypoxia as a cause of cardiac arrest?

 

 

15L/minute oxygen and good ventilation

20

 

 

How would you assess hypovolaemia as a cause of cardiac arrest?

 

  • History
  • Drains
  • Haemorrhage
  • Fluid collections

21

 

 

How would you manage hypovolaemia as a cause of cardiac arrest?

 

 

Fluid resus/blood products

22

 

 

How would you assess hyper/hypokalaemia as a cause of cardiac arrest?

 

  • ABG/VBG
  • Latest blood results

23

 

 

How would you treat hyperkalaemia asa  cause of cardaic arrest?

 

  • 10 ml 10% calcium chloride
  • 10 units Actrapid insulin in 50ml 50% dextrose

24

 

 

How would you treat hypokalaemia as a cause of cardiac arrest?

 

 

20 mmol KCL over 10 minutes

25

 

 

How would you assess hypothermia as a cause of cardiac arrest?

 

  • Temperature on NEWS chart
  • Warmth

26

 

 

How would you manage hypothermia in a patient in cardiac arrest?

 

 

Warm patient e.g. bear hugger, warm fluids etc.

27

 

 

What is the commonest reversible cause of cardiac arrest?

 

 

Thrombosis - PE/MI

28

 

 

How would you assess Thrombosis as a cause of cardiac arrest?

 

  • History
  • Risk factors
  • Legs (DVT)
  • Post-surgery

29

 

 

How would you manage a PE as the cause of a cardiac arrest?

 

 

Thrombolysis

30

 

 

How would you manage an MI as a cause of cardiac arrest?

 

 

Consult cardiology

31

 

 

How would you assess for tension pneumothorax in someone in cardiac arrest?

 

  • Tracheal deviation
  • Hyper-resonance
  • Decreased breath sounds

32

 

 

How would you manage tension pneumothorax in someone in cardiac arrest?

 

 

Cannula into 2nd intercostal space MC line

33

 

 

How would you assess for cardiac tamponade in someone in cardiac arrest?

 

  • Recent trauma/surgery
  • Ultrasound

34

 

 

How would you manage someone with cardiac tamponade as a cause of cardiac arrest?

 

 

Pericardiocentesis

35

 

 

How would you assess toxins as a cause of cardiac arrest?

 

  • History
  • Drug Chart
  • Gather info
  • Capillary glucose

36

 

 

How would you manage toxins as a cause of cardiac arrest?

 

 

Treat toxaemia e.g. naloxone for opioids

37

 

 

How would you manage someone with ROSC after cardiac arrest?

 

  • Full ABCDE
  • Controlled oxygenation (94-98%)
  • Consider therapeutic hypothermia (32-38oC) for 24 hours
  • Post-arrest investigations
  • Treat cause
  • Consider ITU transfer

38

 

 

What post-arrest investigations would you want to do?

 

  • CXR
  • 12-lead ECG
  • Full set of bloods
  • ECHO
  • ABG
  • Cap glucose
  • Cardiac Monitoring

39

 

 

What extra things would you consider doing in someone who had a cardiac arrest and was pregnant?

 

  • Manually shift uterus to left to prevent IVC obstruction
  • Prepare for emergency C-section

40

 

 

Where would you feel for a pulse in a child < 1 year?

 

 

Brachial pulse

41

 

 

Where would you feel for a pulse in a child > 1 year?

 

 

Carotid Pulse

42

 

 

What compression:ventilation ratio would you use for a child at birth?

 

 

3:1

43

 

 

What CPR regime would you use in a child/infant?

 

 

5 rescure breaths, then 15:2

44

 

 

What considerations would you take into account when managing an arrest due to an asthma attack?

 

  • Intubate early
  • Treat exacerbation
  • Consider tension pneumothorax
  • COnsider high shock energies - hyperexpanded chest