ALS =- specific scenarios Flashcards

Question

Perioperative?

Answer 1

Overall survival is high Cmn causes: - Failure of ventilation, medication related, complications of central access, perioperative MI Types: - 41.7% were asystole - 35.4% VF/VT - PEA 11.5% Mx: - Asystole and VF are noted almost immediately- however PEA may not be as clear- ETCO2 will be a good clue - If surgery will not control consider early IR Alertations: - Can perform CPR with patient prone or cardiac massage - VT/VF attatch defib and can give precordial thump. - Brady: Stop surgery exacerbating this and give IV 0.5 mg atropine - give micro doses 0.5 mcg- 100 mcg IV rather then stat 1 mg.

Answer 2

Early emergency resternotomy is key - Other reversible causes adressed - 3 shocks given - Airway eastablished. ---> Within 5 mins - VF/asystole defib at highest amplitude - Start CPR - can use BP monitoring aim SBP>60 and DBP >25 resternotomy- use 20 J direct to heart via paddles Use adrenaline very cautiously

Answer 3

Primary resp impairement from immersion/submersion in a liquid medium. In immersion often hypothermic with open airway unless water splashes into mouth. Bradycardia from hypoxaemia occurs pre arrest. (can reverse with just O2). Try not to enter Water Submersion for <5-10 mins better outcome. >25 mins v.poor prognosis Review search and rescue at 30 and 60 mins

Answer 4

5 resucue breaths first. Supplement with O2 if available. Early Intubation Aim 94-98% confirm with ABG. Also PEEP 5-10 cm at least may need up to 15-20 Pulse is not always reliable- use ETCO2 and trace Rapid IV fluid and pressures --> Dehydration IV V.poor outcome if CPR >30 mins

Answer 5

Stage I: 35-32- Conscious shivering- mild Stage II: 32-28- Impaired conscious, No shivering: moderate Stage III: 24-28: Unconscious, vital present. Severe Stage IV: <24: no or minimal vitals. Arrest/no flow state Stage V: <11.8 death due to irreversible hypothermia Lower 1/3 of oesophagus- good temp for heart if airway present. 6% per degree reduction in metabolism Dilated pupils do not mean brain death and pulse//rythm can be supressed. Intermittent CPR can be of benefit.. Temp <28 then 5 mins CP with alternate 5 mins nil Temp <20 5 mins CPR then 5-10 mins without. 'No patient is dead, until warm and dead' Decreased sensitivity and action of insulin

Answer 6

_ Check for signs of life up to 1 min (central artery and assess cardaic rythm).- ETCO2 and US echo. - Hypothermia can increase stiffness of the chest wall necessitating mechanical CPR use. - Hypothermic metabolism and electical activity poor: --> Limited efficacy for drugs --> Hold adrenalin until >30 ---> >30 double intervals ---> as reaching normothermia return to normal --> VF persisting despite 3 shocks continue CPR until >30 - HOPE/ICE scores

Answer 7

Remove from cold environment- transfer to hospital Immobilise handle carefully apply O2 Remove wet clothing Beware of cooling post removal from the environmnet can suddenly arrest/drop GCS Extra Corpeal Life Support should be used in preference to CP bypass. - Non ECLS if cant reach hospital in 6 hrs - After ROSC use standard procedure

Answer 8

1. Classic non exertional 2. Exertional- high stress exercise in high temp/humidity- usually healthy young adults RF: Elderly, unaclamatised, Obseity, dehydration, alcohol, CVD, Hyperthyroid, Meds

Answer 9

1. Core temp >37.5 2. Neuro (confusion, seizures, coma) 3. Exposure to high temp or exercise

Answer 10

Cool enironment and lie flat Start cooling and transfer to Hx Colled to <39 Rapid coolling 0.2-0.3 degrees/min are achievable Best - COld water immersion or conductive cooling system Isotonic/hypertonic fluid If Na <130 can use 100ml 9% NaCl *3 May need high volume fluids to prevent hypotension

Answer 11

- Stop trigger immediately - Give Oxygen - Correct acidosis - Cool actively - Dantrolene can be used. relapse in 25% of people.

Answer 12

Community: (50% witnessed bystander or ambulance) 25% VF/VT, 25% asystole, 50% PEA (survive to home 9.7%- 30% ROSC) Hx: (survie to home 23.9%) - 18.1% VT/VF, 73% PEA/Asystole. Bystander CPR at 60% now

Answer 13

1. Early recognistion and call for help 2. Start CPR 3. Early Defib (within 3-5 min lead to 50-70% survival). Each minute delay decrease by 10-12% 4. Post resus care AED now used in 5% OOH arrest All are equally important

Answer 14

Poor communication skills are a factor in up to 80% of AI or near miss events

Answer 15

Witnessed, VF/ pVT MI related Immediate and succesful defib In 80% there is recognisable deterioration pre arrest

Answer 16

PEA- 14% survival vs 24% general

Answer 17

Sudden onset pain and marked hypotension with nil ECG changes

Answer 18

Education Monitorinf Recognition Calling for help Response

Answer 19

- ACS - HTN heart disease - Valve disease - Drugs - Inhertied (prolonged QTc) - Acidosis - Abnormal electorolyte - Hypothermia - Electrocution VF is likely to reccur if no reversal of underlying cause

Answer 20

Morphine 5-10 mg IV Oxygen if sats <94%- aim 94-98% GTN SL (unless hypotensive) Aspirin 300 mg ECG stat- then discuss with PCI lab.

Answer 21

Attend wtho 12 hrs of AMI and PCI not possible plus: - ST elevation >0.2 mm in adjacent leads or >0.1 mm in adjacent limb leads -Dominant R wvee and ST depression in V1-3 - New LBBB

Answer 22

1. High threshold: aim <1V usually 3-4 V initially- but if persistent may suggest not in contact with myocardium 2. Connection failure: - Bipolar one at tip and other 1 cm procimal/ Check connections immediately/ change connector. 3. Lead displacement. ?tamponade if sudden arrest and pulseless as migrates through RV. ICD displacement less likely after 4-6 weekscan be caused by trauma to left arm

Answer 23

1,. Time fro onse to shock- every 1 min increase mortality by 7-10% 2. Continuous uninteruted and high quality compression 3. Durration between stopping and delivering shock. (every 5s halves chance of success

Answer 24

HF rLVEF IHD Prolonged QT

Answer 25

Post arrest brain injury Post cardiac arrest myocardial dysfunction Systemic ischaemia/reperfusion response Persistant precipitating pathology Heart recovers in 3-4 days