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ALS > 01 > Flashcards

01 Flashcards

1
Q

True/False: shockable rhythms are more common than non-shockable rhythms

A

False: non-shockable rhythms are more common

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2
Q

PEA is a non-shockable rhythm

A

True, along with asystole

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3
Q

What is recommended for IO access in adults?

A

The three main insertion sites for IO access recommended for use in adults are the proximal humerus, proximal tibia and distal tibia.

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4
Q

What does placing a ring magnet over an ICD do?

A

A ring magnet placed over an ICD can deactivate its defibrillation function, but it does not disable the pacemaker function if the device has that capability.

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5
Q

What do we do in adult tachycardia if, after vasovagal manoeuvres, there is no response?

A

Give adenosine 6mg rapid IV bolus. If unsuccessful, give 12 mg. If unsuccessful, give 18mg. Monitor ECG continuously. If ineffective with adenosine,consider verapamil or beta-blocker. Lastly if still ineffective, synchronised DC shock up to 3 attempts.

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6
Q

Where would you see an anterior infarct on ECG? What causes it?

A

V1-V4
Left anterior descending artery

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7
Q

Where would you see an anterolateral infarct on ECG?

A

V1-V6 + leads I and aVL

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8
Q

Where would you see an inferior infarct on ECG? What causes it?

A

Leads II, III and aVF
Right coronary artery or the circumflex

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9
Q

Where would you see a lateral infarct on ECG? What causes it?

A

V5-V6 +- leads I and aVL
Lesion in the circumflex artery or diagonal branch of the LAD artery

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10
Q

What is the GRACE score used for?

A

a

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11
Q

How do we definitively manage ACS?

A

Primary PCI if available within…
Anti-thrombolytic therapy otherwise e.g. clopidogrel 600mg

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12
Q

When is fibrinolytic therapy contraindicated?

A

Previous haemorrhagic stroke
Recent ischaemic stroke
CNS damage or neoplasm
Major surgery/trauma in last 3w
Active internal bleeding

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13
Q

When is fibrinolysis deemed as failed? How do we manage it?

A

If STEMI has not improved by 50% in 60-90min post fibrinolytic therapy. Transfer for rescue PCI

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14
Q

How do we manage NSTEMI?

A

MONA
Fondaparinux 2.5mg OD
Aspirin 75mg OD
Angiography +- revascularisation

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15
Q

What anti-thrombotic therapy do we give after PCI/in high risk ACS?

A

Clopidogrel 75mg OD for at least one year

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16
Q

What are the 4 Hs

A

a

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17
Q

What are the 4 Ts

A

a

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18
Q

What energy is the first shock

A

120-150J

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19
Q

When do we give drugs in VF/pVT?

A

After third shock give adrenaline 1mg IV and amiodarone 300mg IV

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20
Q

When do we give adrenaline in VF/pVT?

A

Adrenaline 1mg IV after third shock
Then after alternate shocks

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21
Q

When do we give drugs in PEA/asystole?

A

Adrenaline 1mg IV as soon as IV access achieved. Then alternate 2min cycles CPR

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22
Q

How can we estimate the rate on an ECG

A

Count R to R wave in 6s (30 large squares), and multiply by ten

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23
Q

What is a normal QRS duration?

A

<0.12s (three small squares)

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24
Q

What is first degree heart block?

A

a

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25
Q

What is mobitz type 1 heart block?

A

a

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26
Q

What is mobitz type 2 heart block?

A

a

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27
Q

What is 2:1 and 3:1 heart block?

A

a

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28
Q

Define QT prolongation

A

A QTc of >0.45s in a man, or >0.47s in a woman

29
Q

How do we treat VT?

A

Amiodarone 300mg IV over 10-60min

30
Q

How do we manage regular narrow-complex tachycardia?

A

Vagal manoeuvres
If ineffective, adenosine 6mg rapid IV, then 12, then 18

If ineffective, then verapamil or beta blocker

If ineffective, then synchronic DC shock up to 3 attempts

31
Q

How d we manage irregular narrow complex tachycardia?

A

Likely atrial fibrillation:
Beta-blocker to control rate
COnsider digoxin or amiodarone if evidence of HF
Anticoagulate if duration > 48h

32
Q

How do we manage unstable adult tachycardia?

A

Synchronised DC shock up to 3 attempts

If unsuccessful: amiodarone 300mg IV over 10-20min
Repeat synchronised DC shock

33
Q

How do we manage adult bradycardia with life threatening signs?

A

Atropine 500mcg IV up to a maximum of 3mg

34
Q

Define hyperkalaemia

A

> 5,5mmol/L
Severe >6.5mmol/L

35
Q

How do we treat hyperkalaemia?

A

a

36
Q

What causes hyperkalaemia?

A

Renal failure
Drugs (ACEi, ARB, potassium sparing diuretics, NSAIDs, beta blockers, trimethoprim)
Tissue breakdown (e.g. rhabdomyolysis, tumour lysis, haemolysis)
Metabolic acidosis (e.g. DKA)
Endocrine disorders (e.g. Addison’s)
Diet

37
Q

How does hyperkalaemia present on ECG?

A

Tall tented T waves
Absent p waves

38
Q

How do we manage hyperkalaemia?

A

a

39
Q

How do we reverse benzo overdose?

A

Flumazenil (but not if comatose or hx of seizures)

40
Q

How do we treat TCA overdose?

A

Sodium bicarbonate

41
Q

How do we treat stimulant overdose?

A

Small doses of IV benzos

42
Q

How do we treat cocaine-induced coronary vasoconstriction?

A

GTN and phentolamine

43
Q

How do we treat local anaesthetic toxicity?

A

Intravenous 20% lipid emulsion
Bolus (1.5mg/kg/hr) followed by infusion (15mg/kg/hr)

44
Q

What tilt is ideal for CPR in pregnancy?

A

15-30 degrees

45
Q

What is mild hypothermia?

A

32-35 deg C

46
Q

What is moderate hypothermia?

A

32-38 deg C

47
Q

What is severe hypothermia?

A

24-28 degC

48
Q

What is malignant hyperthermia?

A

Hyperthermia secondary to administration of anaesthetic drugs

49
Q

T/F? The diaphgram is innervated by C5,6,7.

A

F
The innervation of the diaphragm is at the level of the third, fourth and fifth segment of the cervical cord.

50
Q

How fast is the kidneys response to bicarbonate changes?

A

The kidneys’ response to changes in bicarbonate levels is slow, taking several days. Unlike the respiratory system, which can respond rapidly, the kidneys require more time to adjust bicarbonate values.

51
Q

How does opioid overdose present?

A

Opioid poisoning can indeed lead to respiratory depression, pinpoint pupils, coma, and eventually respiratory arrest. Naloxone, an opioid antagonist, is effective in rapidly reversing these effects.

52
Q

Why is needle aspiration of a tamponade usually unreliable?

A

Needle aspiration of tamponade is often unreliable due to the presence of clotted blood in the pericardium, making it difficult to remove fluid effectively. Ultrasound guidance may not significantly improve the success of needle aspiration in these cases.

53
Q

Do you need to deactivate an ICD before an autopsy?

A

Yes

54
Q

Where do we place defibrillator electrodes?

A

To minimize the risk of damage, defibrillator electrodes should be positioned away from the pacemaker or ICD generator, ensuring a distance of greater than 8 cm. This maintains effective defibrillation while reducing the risk of harm to the implanted device or myocardium.

55
Q

What do ICDs work for?

A

ICDs deliver electrical shocks specifically for life-threatening tachyarrhythmias such as ventricular fibrillation or fast ventricular tachycardia.

56
Q

Defibrillation within 3-5mins can produce survival rates of up to…

A

Defibrillation within 3-5 minutes of collapse can produce survival rates as high as 50-70%

57
Q

How does hypothermia impact insulin sensitivity?

A

Hypothermia decreases insulin sensitivity and insulin secretion, leading to impaired glucose regulation and potential hyperglycemia. Insulin resistance is commonly observed during hypothermia, and treatment with insulin may be necessary to manage hyperglycemia.

58
Q

What is transthoracic impedance? How does it impact the success of defibrillation?

A

Transthoracic impedance, the electrical resistance of the chest, affects the flow of current during defibrillation.

59
Q

What do we use in chemical cardioversion for AF?

A

Propafenone and flecainide are drugs that can be used for chemical cardioversion in AF, but caution is advised in patients with certain conditions.

60
Q

How do we manage pts post-resus?

A

In adult post-resuscitation care, maintain constant temperature 32-36 degree C for ≥ 24h; prevent fever for at least 72h.

61
Q

What is used in the GRACE score?

A

GRACE Score is based on 8 variables: age, signs of heart failure, heart rate at presentation, blood pressure at presentation, serum creatinine concentration, ECG changes, troponin concentration, cardiac arrest at presentation.

62
Q

T/F: Early CPR is the first link in the Chain of Survival.

A

F: Early recognition of the deteriorating patient and prevention of cardiac arrest is the first link in the Chain of Survival. Followed by early CPR to buy time, early defibrillation to restart the heart , and post-resuscitation care to restore quality of life.

63
Q

How do we manage tachycardia with life threatening features?

A

As per Resuscitation Council UK, in an adult with tachycardia wit life threatening features, give synchronised DC shock up to 3 attempts. Sedation or anaesthesia if conscious. If unsuccessful, amiodarone 300mg IV over 10-20 mins. Repeat synchronised DC shock.

64
Q

NEWS of 0 should be routinely monitored every…

A

12 hours

65
Q

How much energy does an ICD release?

A

Upon detecting a shockable rhythm, an ICD will discharge approximately 40 J of energy through an internal pacing wire embedded in the right ventricle. Subcutaneous devices may deliver around 80 J. The number of shocks delivered may vary among individuals and devices.

66
Q

What does flumazenil work as?

A

Flumazenil acts as competitive antagonist of benzodiazepines. Reversal of benzodiazepine toxication with flumazenil can however cause significant toxicity (seizure, arrhythmia, hypotension and withdrawal syndrome) in patients with benzodiazepine dependence or co-ingestion of proconvulsants medications such as tricyclic antidepressants.

67
Q

What is the STOP-5 tool?

A

STOP-5 is a 5-minute debrief tool that can be utilized by resuscitation teams to facilitate a structured debriefing following the treatment of a patient.

68
Q

What are implantable event recorders used for?

A

Implantable event recorders are not typically used to record the heart’s rhythm during cardiac arrest. They are generally used to record the heart’s rhythm during specific events such as transient loss of consciousness.

69
Q
A

ALS (2 decks)

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