(BH OSCE focused) ALS 5.4 Directives

Question 1

Explain the age categories for cardiac arrest.

Answer 1

24 - 8: kid joules, kid drugs
8-12: adult joules, kid drugs
over 12: adult joules and drugs

Question 2

Epi dosing for paediatric cardiac arrest for IV/IO

Answer 2

24 hrs to 12 years
1:10,000
0.1ml/kg (no max listed apparently)
min dose is 0.5ml
q 4 mins
no limit

Question 3

You can’t get access for a pediatric medical arrest, what would be your ETT epi dose?

Answer 3

24hrs to 12 yrs
1:1,000
0.1ml/kg
max 2ml
q 4 mins
apparently no limit on # doses

Question 4

Adult epi doses for cardiac arrest for IV/IO

Answer 4

1:10,000
1mg (10ml)
q 4 mins
no limit

Question 5

adult epi doses for cardiac arrest for ETT

Answer 5

2mg (does not state what concentration, but 1:1000 makes sense)
q 4 mins, no limit

Question 6

If you have a patient in cardiac arrest that you suspect was from anaphylaxis, what is the IM epi dose you can give?

Answer 6

must be at least 24 hours old
1:1,000
0.1ml/kg to max of 0.5ml
only 1 dose

Question 7

When is lidocaine indicated for a cardiac arrest?

Answer 7

for VT or VF in a patient at least 24 hours old

no where does it say the number of shocks or analysis required

Question 8

What are the conditions and contraindications for lidocaine for medical cardiac arrest

Answer 8

1. pt is at least 24hrs old
2. pt is in VF or pulseless VT
3. no allergy or sensitivity to lidocaine

Question 9

Dose for lidocaine for pediatric arrest? IV/IO

Answer 9

24hrs to 12 years
1mg/kg (no max or min)
q 4 mins
max 2 doses

Question 10

Lidocaine dose for adults for cardiac arrest? IV/IO

Answer 10

1.5mg/kg first dose
0.75mg/kg second dose
q 4 mins
only 2 doses

Question 11

When should a fluid bolus be considered in medical cardiac arrest? How much?

Answer 11

PEA OR suspected hypovolemia
20ml/kg for both peds and adults to max of 2L
reassess every 100ml for peds, and every 250mls for adults

Question 12

Who can be considered for a medical TOR? who is contraindicated?

Answer 12

1. at least 18 years old
2. no shocks delivered
3. arrest not witnessed by EMS
4. no ROSC after 20 mins resus

Do not TOR
- hypothermia
- pregnancy
- FBAO
- drug overdose (other than opioids)

Question 13

Who can have DSED or VCD for refractory VF or VT?

Answer 13

1. must be at least 18 years old
2. 3 consecutive shocks for VF or VT by Fire or paramedics
3. medical arrest of cardiac origin only

Question 14

How does running a trauma arrest differ from medical arrest.

Answer 14

No drugs given in trauma arrest. 1 analysis and transport or TOR. Fluid bolus and chest needle consideration.

Medical arrest uses drugs and at least 4 analysis prior to patch.

Question 15

List the steps of the ROSC checklist.

Answer 15

Slow everything down.
1. Note time of ROSC
2. Get full set of vitals and ensure monitoring equipment in place
3. Address airway (SGA/ETT, compliance, suction etc)
4. Address breathing (titrate O2 94-98%, ETCO2 30-40, breath every 6 seconds.
5. Address hemodynamic stability (fluid bolus if needed 10ml/kg, dopamine if needed, start second line)
6. Address possibility of STEMI (ECG 8-10 mins post ROSC)
7. Egress planning.