Intermediate life support Flashcards

Question

recongising VF

Answer 1

VF can be caorse or fine. Electrical activity observed as "chaotic" with random frequency and amplitude and with no recognisable QRS complexes

Answer 2

1) VF is not compatible with life sop requires immediate initial 1st shock at **200 joules** 2) Carry on CPR in between shocks 3) Reassess the rhythm every 2 minutes. If patient remains in VF deliver a 2nd shcok at **300 joules** 4) After a further 2 minutes of CPR and if patient remains in VF deliver 3rd shock at **360** 5) All subsequent shcoks delivered at 360 joules 6) Immediately after 3rd shock give **1mg:10,000 adrenaline** IV and **300mg amiodarone IV**- both followed by a large flush

Answer 3

pulseless ventricular tachycardia

Answer 4

ventricular tachycardia is recogised by regular broad comples QRS generally greater than 180 bpm - can be compatible with life - **in cardiac arrest siutatio it is essential to check that the patien tdoes not have a pulse to confirm the rhythm is a pulseless ventiruclar tachycardia**

Answer 5

1) VT is not compatible with life sop requires immediate initial 1st shock at 200 joules 2) Carry on CPR in between shocks 3) Reassess the rhythm every 2 minutes. If patient remains in VF deliver a 2nd shock at 300 joules 4) After a further 2 minutes of CPR and if patient remains in VF deliver 3rd shock at 360 5) All subsequent shcoks delivered at 360 joules 6) Immediately after 3rd shock give 1mg:10,000 adrenaline IV and 300mg amiodarone IV- both followed by a large flush

Answer 6

200j 300j 360j ,360j, 360j........

Answer 7

For shockable rhythms - 300mg IV **Amiodarone** (only give once during cardiac arrest) - 1mg:10,000 IV **Adrenaline** (given every 3-5 minutes after initial dose for the duration of the cardiac arrest)

Answer 8

- Rapid A to E - IV access, bloods - ECG - IV fluid resus: IV 0.9 NaCL - Fixed rate insulin infusion (FRII) at 0.1 units/k/h - Potassium replacement if needed

Answer 9

- Bloods - IV access - Morphine - Oxygen - Nitrates - Aspirin

Answer 10

- >2cm -> aspirate via needle decompression - If no reduction insert chest drain

Answer 11

- A to E - Remove triggers e.g. stop any infusion - Lie patient flat o If pregnant- left lateral position - IM adrenaline in anterolateral aspect 1:1000 500 mg - Give high flow oxygen o Monitor: pulse oximetry, ECG, BP - If no response repeat adrenaline after 5 mins - IV fluid bolus (500ml over 15 mins) - If no improvement in breathing or circulation despite 2 doses of adrenaline -> commence CPR

Answer 12

- Encourage person top cough - If cough becomes ineffective give 5 back blows o Lean person forward o Between shoulder blades with heel of hand - If back blows ineffective give 5 abdominal thrusts - If chocking not relieved after 5 abdominal thrusts, continue alternating between 5 BB and % AR until relived - If person becomes unresponsive start CPR

Answer 13

- Support airway and breathing - Gain IV/IO access - Give benzodiazepine (buccal, IV or IO) - If 2 staggered benzos failure give either: o Phenytoin or levetiracetam - If the above fails -> thiopentol for rapid induction

Answer 14

**How to activate Major Haemorrhage Protocol** Phone 2222 and say “Major Haemorrhage, Children's Hospital” stating location of patient (i.e. ward / department). **Blood Bank will call the ward** Porter will go to the Blood Bank. **General response** - Control bleeding - Venous access - Avoid hypothermia - warm fluids - Take appropriate blood tests and send urgently to appropriate Laboratory **Immediate blood tests** - FBC - Crossmatch - Coagulation screen (including Fibrinogen) - Biochemistry (including Calcium - Blood gases (if appropriate). **Information required by Blood Bank** - Urgency of the situation - **Patient details:** - Conscious patient – forename, surname; DOB; gender; CHI number. - Unconscious/unidentified patient – minimum of gender and CHI number. - Whether cross match has been sent - Location of Patient - Contact number – need to establish clear lines of communication - Patient diagnosis -Nominate one person to liaise with Blood Bank **Blood component availability** Factor in time for samples to reach Blood Bank and any blood product to be delivered from Blood Bank. - Immediate – Group O Negative blood (4 units available in Paediatric theatres fridge) - 15 minutes – group specific blood (ABO + RhD grouping) - 35 minutes – fully cross-matched blood. - Platelets – Platelets supplies are limited so these may be delayed. - Fresh Frozen Plasma (FFP) and Cryoprecipitate – allow up to 20 minutes for thawing (plus delivery time)