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ALS1 Flashcards

1
Q

ALS1 - cardiac arrest - ddx to consider

A

4H and 4 T

  • hypothermia
  • hypokalaemia / hypoglycaemia / endocrine or electrolyte issue
  • hypoxia
  • hypovolaemia
  • Tension pneumothorax
  • tamponade
  • toxins
  • thrombosis - pulmonary/coronary
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2
Q

ALS1 - cardiac arrest - shockable rhythm - what drugs to administer and when

A
  • adrenaline 1mg after 2nd shock, then every 2nd loop

* amiodarone 300mg after 3 shocks

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3
Q

ALS1 - cardiac arrest - shockable rhythm - adrenaline - dosage, when to administer during algorithm

A

1mg per dose
first dose
- if shockable, after 2nd shock

repeat dose every 2nd loop

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4
Q

ALS1 - cardiac arrest - CPR - compressions: breath ratio

A

30 compression : 2 breaths

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5
Q

ALS1 - cardiac arrest - when to attach defibrillator

A

concurrent with CPR

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6
Q

ALS1 - percentage of in-hospital cardiac arrests that survive to discharge

A

20%

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7
Q

ALS1 - chain of prevention - elements of Early Warning Systems (7)

A 
respiration rate
oxygen saturation
supplemental O2 use
Temperature
systolic BP
heart rate
level of consciousness
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8
Q

ALS1 - airway obstruction - ddx to consider (11)

A

neuro
- CNS depression

physical objects

  • blood
  • vomitus
  • foreign body
  • bronchial secretions
  • blocked tracheostomy or laryngectomy

structural

  • direct trauma to face or throat
  • pharyngeal swelling
  • epiglottitis

spasm

  • laryngospasm
  • bronchospasm
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9
Q

ALS1 - target O2 saturations

A

94-98%

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10
Q

ALS1 - airway - positioning manœuvres to open the airway

A
  • nurse patient on the side
  • tilt head up
  • head tilt + chin lift
  • head tilt + jaw thrust
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11
Q

ALS1 - airway - signs & symptoms of partial airway obstruction (2)

A
  • efforts at breathing are noisy

- increased respiratory effort

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12
Q

ALS1 - airway - signs & symptoms of complete airway obstruction (4)

A
  • no movement of air at the mouth
  • strenuous respiratory movements if present
  • accessory respiratory muscle use ‘see-saw pattern’
  • central cyanosis
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13
Q

ALS1 - airway - s&s of complete airway obstruction - what is a ‘rocking horse’ or ‘see saw’ breathing pattern

A

at inspiration - chest draws in, abdomen expands
at expiration - chestt expands, abdomen draws in
(sounds like the abdomen is getting ventilated)

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14
Q

ALS1 - breathing issues - ddx (broad) (4)

A
  • inadequate respiratory drive (CNS depression)
  • inadequate respiratory effort (peripheral nervous system dysfunction)
  • acute on chronic lung disorders - exacerbation of COPD, asthma, PE etc
  • acute lung disease - pneumonia
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15
Q

ALS1 - breathing - how to assess (5)

A 
RATES
resp rate
auscultation of lungs
trachea position
effort of breathing
SaO2
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16
Q

ALS1 - tachypnea definition

A

RR > 25

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17
Q

ALS1 - breathing - best way to assess effectiveness of ventilation

A

PaCO2, measured via ABG

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18
Q

ALS1 - breathing - initial supplemental O2 management (non COPD)

A

15L per min O2 via high concentration reservoir mask, titrating fo 94-98%

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19
Q

ALS1 - circulation - ventricular fibrillation ddx (9)

A

cardiac

  • acute coronary syndrome
  • hypertensive heart disease
  • valve disease
  • inherited cardiac disease like long QT syndrome

endocrine/biochem

  • acidosis
  • abnormal electrolyte concentration

external

  • drugs like antiarrhythmics,TCA, digoxin
  • hypothermia
  • electrocution
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20
Q

ALS1 - breathing - signs of respiratory distress (4)

A
  • sweating
  • central cyanosis
  • use of accessory respiratory muscles
  • abdominal breathing
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21
Q

ALS1 - breathing - rattling airway noises suggest what dx

A

airway secretions

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22
Q

ALS1 - breathing - audible stridor or wheeze suggests what dx.

A

airway obstruction

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23
Q

ALS1 - pneumothorax - exam findings to look out for (4)

A

hyper resonance on percussion
reduced or absent airway sounds
tracheal deviation
chest wall crepitus / surgical emphysema

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24
Q

ALS1 - supplemental O2 in COPD

A
  • venturi 28% or 24% mask

target 88-92% SaO2

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25
ALS1 - patient is shocked - presumptive management in absence of cardiac cause
IV fluids - 500mL of 0.9% NaCl or Hartman's over 15 mins
26
ALS1 - signs of circulatory shock (2)
cool peripheries | tachycardia
27
ALS1 - circulation - things to assess (6)
- pulse rate - blood pressure - peripheral + central pulses - color of hands and fingers - temperature of hands - capillary refill time
28
ALS1 - circulation - low diastolic blood pressure ddx (2)
suggests arteriolar dilation - anaphylaxis - sepsis
29
ALS1 - circulation - what is pulse pressure, whats normal range
sysBP - diasBP (35-45)
30
ALS1 - circulation - high pulse pressure ddx (2)
cariogenic shock, hypovolaemia
31
ALS1 - circulation - how to measure capillary refill time - what does it assess
hold limb up to about cardiac height apply enough pressure to blanch skin for 5s remove pressure to see how long it takes to reperfuse assess peripheral perfusion
32
ALS1 - circulation - oliguria definition
< 0.5ml /kg per hour
33
ALS1 - patient is shocked - presumptive management if history of cardiac disease
IV fluids -250mL of 0.9% NaCl or Hartman's over 15 mins | listen to the chest for crackles
34
ALS1 - disability/drugs - things to assess
check drug chart examine pupils conscious state - AVPU blood glucose
35
ALS1 - hypoglycaemia - BSL < 4.0 - immediate management
50mL of 10% glucose IV stat, repeat doses if not going up
36
ALS1 - what is waveform capnography
non-invasive measurement of end-tidal CO2
37
ALS1 - how to do a head tilt + chin lift
1 hand on the forehead/scalp, to extend the neck | the other hand on the chin - 2 fingers in a gun position, closing the mouth
38
ALS1 - opening airway - option in ?cspine injury
jaw thrust + chin lift
39
ALS1 - correct hand position for CPR
middle of lower half of sternum
40
ALS1 target compressions per minute
100-120
41
ALS1 - ventilation - how long per forced inspiration
1 second
42
ALS1 target breaths per minute
10
43
ALS1 - how long is each 'loop' of the ALS1 algorithm
2 minutes
44
ALS1 - when to give 'stacked shocks'
- patient has monitored and witnessed cardiac arrest - was well oxygenated prior to arrest - you can give the first shock within 20 seconds - patient has VF or pulseless VT
45
ALS1 - 'stacked shocks' protocol
3 defibrillator attempts in succession in between each defibrillator, check for pulse and other signs of ROSC start CPR if 3rd shock unsuccessful
46
ALS1 algorithm - nonCPR things to establish while CPR is happening (4)
airway adjuncts oxygen IV/IO access waveform capnography
47
ALS1 algorithm - amiodarone - when to administer, what dose
shockable rhythm, 3 shocks have been done | give 300mg
48
ALS1 - defibrillator shock - joules range
200-360J
49
ALS1 - when to do a precordial thump
- monitored witnessed pVT/VF | - defibrillator not arrived yet
50
ALS1 - how to do a precordial thump
- make a fist - aim it at lower half of sternum - go from 20cm height down, and quickly remove - recommence CPR
51
ALS1 - insertion sites for intra osseous access (3)
proximal tibia, distal tibia | proximal humerus
52
ALS1 - role of waveform capnography in CPR
* check that tube is placed correctly * monitors ventilation rate * monitor quality of chest compressions during CPR (better CPR = better end-tidal CO2 value) * identifying ROSC during CPR * prognosticating during CPR
53
ALS1 - hyperkalaemia - immediate management
calcium chloride 10%, 10mL IV glucose 25g + 10 IU short acting insulin HCO3- 50mmol IV if severe acidosis
54
ALS1 - hyperkalaemia - why treat with calcium
stabilise cardiomyocyte resting membrane potential
55
ALS1 - what is pulsus paradoxus
abnormally large drop in BP mmHg on inspiration
56
ALS1 - beck's triad, what condition does it suggest
distended JVP muffled/distant heart sounds hypotension, with narrow pulse pressure suggests pericardial tamponade
57
ALS1 - choking - immediate actions
5 back blows then 5 chest thrusts alternate between the 2
58
ALS1 - how to size a guedel airway
mouthpiece to mouth, other piece to angle of jaw. should be just long enough
59
ALS1 - LMA sizing for adults
men - 5 | women - 4
60
ALS1 - LMA - inflating the bubble how much volume needed
size 5 = 40mL | size 4 = 30mL

GP exams (115 decks)

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