Procedure: Advanced life support and Defibrillation

Question 1

What is a defibrillator?

Answer 1

Device that provides an electric shock to heart to allow it to get out of a potentially fatal abnormal heart rhythm

Question 2

What are the 3 types of defibrillator?

Answer 2

AED

ICD

Hospital Defibrillator

Question 3

What is an AED?

Answer 3

Automatic External Defibrillator

Portal device found in community settings

Question 4

What is an ICD?

Answer 4

Implantable Cardioverter Defibrillator

Battery-powered device implanted under skin to monitor heart rate and deliver shock if needed

Question 5

What systematic approach should you follow when someone has a cardiac arrest?

Answer 5

S: Safety
S: Stimulate
S: Shout for help
A: Airway
B: Breathing
C: Circulation

Question 6

How do you check for safety, if someone is having a cardiac arrest?

Answer 6

Ensure that the area is safe to approach

Ensure that the patient is safe to approach, if they have head, neck, spinal injuries then its not suitable to move the patient

Question 7

How do you stimulate the patient in 3 ways if they are having a cardiac arrest?

Answer 7

Shake their shoulders

Talk to patient and ask if they can hear you

Trapezius squeeze test (TST)

Question 8

If someone is having cardiac arrest, how do you call help in 2 ways?

Answer 8

Call someone near to help with ALS

Press hospital bed emergency button

Question 9

How do you check airways in 2 ways in ALS, if a patient is having a cardiac arrest?

Answer 9

Open airway by putting one hand on patient’s forehead and two fingers with other hand under patient’s chin, then tilt patient head upwards

Look inside mouth to check if there are any obstructions

Question 10

How do you check breathing in ALS, if the patient is having a cardiac arrest?

Answer 10

Place your ear above their mouth to listen for breathing and look at patient’s chest for movement for maximum of 10 seconds

Question 11

How do you check circulation in ALS, if the patient is having a cardiac arrest?

Answer 11

Keep one hand below chin to keep airway open, use other to palpate carotid pulse

Question 12

How should you ask the helper to call the resuscitation team, and what else should you ask the helper to do?

Answer 12

Call 2222, state location and ‘adult cardiac arrest’. Say 2 times

Ask helper to bring resus trolley

Question 13

When should you ask the helper to call the resuscitation team, if the patient is having a cardiac arrest?

Answer 13

After going through SSSABC and finding a sign that patient needs advanced life support

Question 14

After completing SSSABC, what should you do next to help the cardiac arrest patient?

Answer 14

Start CPR whilst waiting for resus trolley to arrive

Question 15

When the helper arrives with the resus trolley, what should you now do?

Answer 15

Get helper to take over CPR by counting them in with 5 chest compressions: ‘take over in 5,4,3,2,1’

Get defib pads out and apply to patients chest

Question 16

How do you apply the defib pads on a patient?

Answer 16

1. Remove backing sheet on pads if they have one
2. Apply first pad on upper right side below collarbone
3. Apply second pad on left side below nipple and in line with armpit
4. If defibrillator comes with a sensor, ask helper to stop chest compressions then place sensor in middle of chest then ask helper to continue chest compressions

Question 17

How can you ensure that the defib pads will stick to a patients chest when applied?

Answer 17

Make sure that chest is dry (wipe sweat off with towel before applying pads) and make sure there is no hair (shave hair off with razor before applying pads)

Question 18

After you have applied the defib pads to a patient’s chest, what should you do?

Answer 18

Turn on the defibrillator by turning dial from ‘off’ to ‘monitor’

Question 19

After turning on the defibrillator, what should you immediately do to check the heart rhythm?

Answer 19

1. Say ‘stop chest compressions’
2. Look at the ECG on the defibrillator to see whether it is a shockable or non-shockable rhythm
3. Say ‘resume chest compressions, everyone else clear’ whilst defibrillator is charging, or just continue if there is non-shockable rhythm

Question 20

What are the 2 shockable rhythms and 2 non-shockable rhythms?

Answer 20

Shockable rhythms: Ventricular fibrillation, pulseless ventricular tachycardia

Non-shockable rhythms: Asystole, pulseless electrical activity

Question 21

If the patient has a shockable rhythm, how do you deliver the first shock?

Answer 21

1. Charge defibrillator up to 120 joules by pressing ‘charge’ button. When defib is charging, say ‘everyone stand clear except from chest compressions’
2. When defibrillator is charged, say ‘everyone clear, oxygen away’ and make sweeping arm motion to make sure no one is touching the patient or the bed
3. Press ‘shock’ button to deliver shock
4. Immediately say ‘resume chest compressions, oxygen back on’

Question 22

If the patient has a shockable rhythm, how soon after the first shock should you deliver the second shock?

Answer 22

1. After delivering first shock, resume CPR for 2 mins
2. After 2 min CPR cycle is completed, say ‘stop chest compressions’ and check monitor to see if heart rhythm is shockable or non-shockable
3. Say ‘resume chest compressions, everyone else stand clear’ whilst defibrillator is charging, or just continue if there is non-shockable rhythm

Question 23

If a patient has a shockable rhythm, how should you deliver the second shock?

Answer 23

1. Say ‘everyone except chest compressions stand clear’ then press ‘charge’ button to charge defib up to 150 joules
2. When defibrillator is charged, say ‘everyone clear, oxygen away’ and make sweeping arm motion to make sure no one is touching the patient or the bed
3. Press ‘shock’ button to deliver shock
4. Immediately say ‘resume chest compressions, oxygen back on’

Question 24

If the patient has a shockable rhythm, how long do you wait between delivering each shock?

Answer 24

After delivering a shock, complete 2 min CPR cycle

Then say ‘stop compressions’ and monitor ECG for rhythm

Then say ‘everyone clear except chest compressions’ and charge defib

Then say ‘everyone clear’ and deliver next shock

Question 25

If a patient has a shockable rhythm, how should you deliver the third shock?

Answer 25

1. Say 'everyone except chest compressions stand clear' then press 'charge' button to charge defib up to 200 joules 2. When defibrillator is charged, say 'everyone clear, oxygen away' and make sweeping arm motion to make sure no one is touching the patient or the bed 3. Press 'shock' button to deliver shock 4. Immediately say 'resume chest compressions, oxygen back on'

Question 26

If the patient has a shockable rhythm, what 2 drug should you give after you have delivered the third shock?

Answer 26

Vasopressor: Adrenaline 1 mg IV After this, give adrenaline 1 mg IV after every other shock (5th shock, 7th shock) Antiarrhythmic: Amiodarone 300 mg IV After this, give 150 mg amiodarone IV after 5th shock

Question 27

What does a ventricular fibrillation look like on an ECG, and is it shockable or non-shockable?

Answer 27

Irregular waves with different morphology and amplitude, no coordination. No identifiable P waves, QRS complexes or T waves Ventricles contract in a very rapid and uncoordinated manner. As a result, the heart doesn't pump blood to the rest of the body Shockable rhythm

Question 28

What does pulseless ventricular tachycardia look like on an ECG, and is it shockable or non-shockable?

Answer 28

Wide QRS complexes with regular rhythm over 100 bpm Coordinated, very rapid but ineffective ventricular contractions so there is no pulse due to failure to pump blood Shockable rhythm

Question 29

What does asystole look like on an ECG, and is it shockable or non-shockable?

Answer 29

Flatline Total cessation of electrical and mechanical cardiac activity Non-shockable: There's no rhythm to reset

Question 30

What does pulseless electrical activity look like on an ECG, and is it shockable or non-shockable?

Answer 30

Organised or semi-organised electrical activity Heart has a rhythm but causes unconsciousness and doesn't produce palpable pulses Non-shockable: Electrical activity in PEA is not an aberration that can be corrected by a shock, but rather a situation where the heart's electrical activity is simply not strong enough to generate a pulse

Question 31

How do you complete ALS in patients with pulseless electrical activity or asystole?

Answer 31

1. Start CPR again after confirming non-shockable rhythm on defib machine ECG, do 2 minute cycle 2. Give adrenaline 1 mg IV as soon as intravascular access is achieved with IV catheter 3. After 2 min CPR cycle, check rhythm on defib ECG and check for a pulse 4. If patient now has shockable rhythm then change to shockable rhythm algorithm, if patient still has non-shockable rhythm then continue CPR cycles and give adrenaline 1 mg IV every other cycle

Question 32

What are the reversible causes of cardiac arrest? (4 Hs and 4 Ts)

Answer 32

Hypoxia Hypovolemia Hypo/hyperkalemia Hypothermia Thrombosis: Pulmonary or cardiac (MI) Tamponade (cardiac) Toxins/tablets Tension pneumothorax

Question 33

How do you reverse hypoxia in cardiac arrest?

Answer 33

15L 100% oxygen non-rebreather mask Tracheal intubation or supraglottic airway with wave capnography

Question 34

How do you reverse hypovolemia in cardiac arrest?

Answer 34

500 ml IV saline Group and save for blood transfusion, if hypovolemia is due to blood loss

Question 35

How do you reverse hypo/hyperkalaemia in cardiac arrest?

Answer 35

Hypokalaemia: IV potassium chloride at rate of 20 mmol/hr Hyperkalaemia: IV calcium chloride 10% or calcium gluconate 10%, 10 units of short-acting insulin and 25g glucose IV, haemodialysis in severe hyperkalemia

Question 36

How do you reverse hypothermia in cardiac arrest?

Answer 36

Extracorporeal rewarming: ECMO or CPB Non-ECLS rewarming: Warmed IV saline, warm oxygen

Question 37

How do you reverse toxins in cardiac arrest?

Answer 37

Use TOXBASE to find reversal agent