9 - ALS Flashcards
You should do a head tilt chin lift for an initial airway manouvre. How do you perform this?
How do you use suction for a patient who is gurgling?
- Suction in pouch of cheek
- Never blind sweep
- May have to occlude hole to get suction to work. Don’t occlude until in mouth
How do you do an SBAR?
How should you manage a patient who is choking?
If patient unable to speak or has weakening cough call 2222 as this is severe airway obstruction
If you suspect your patient is having an ACS, what are some important questions to ask them in the history?
Always hunt for risk factors
Always look for signs of heart failure and heart murmurs on examination
What should you label an ECG with in a suspect ECG?
File in chronological order
What are some important parts of the A to E in a suspected ACS? (THINK INVESTIGATIONS)
Never give GTN if sys<100
What is the adult tachycardia algorithm and the management for each? (LEARN VERY WELL)
Always start by assessing adverse features as if any present straight to synchronised shock
May need to shock up to 3 times and have to sedate patient for this so reassure them
Where are the pads often placed in synchronised DC cardioversion?
How do you do synchronised DC cardioversion?
- Sedate and give pain relief to pt
- Syncronise defib by pressing sync button and check arrows above each QRS and LED flashes with each QRS
- Charge
- Press and HOLD shock button
- Re-syncronise after every shock
Why does DC cardioversion need to be syncronised?
What do you do post DC shock?
What is the treatment algorithm for bradycardia?
(LEARN VERY WELL)
Again always assess for adverse features as if present may go to transcutaneous pacing first
When are bradycardic patients at high risk of asystole despite having no adverse features, so should be treated as high risk?
What is percussion pacing?
How do you perform transcutaneous pacing?
- Always have monitoring (3 lead ECG) and defib pads
- Press the pacer button
- Select rate (auto is 60bpm)
- Select current (increase until QRS after every pacing spike and then buffer up 10)
- Check patient’s pulse for mechanical capture
What is the ALS algorithm?
Adrenaline if non-shockable straight away
Adrenaline after third shock with Amiodarone if shockable rhythm
Adrenaline every 3-5 minutes
When is adrenaline given in ALS and at what dose? (think about shockable/non-shockable)
When is amiodarone given in ALS and at what dose?
What safety checks should you do before adminstering a defib shock in ALS?
What do you do if the defib is charged but you do not need the shock?
When using the defib in manual mode for cardiac arrest what buttons do you need?
- Use arrows to select charge
- Charge
What is this and how do you manage it?
What is this and how do you manage it?
What is this and how do you manage it?
What is this and how do you manage it?
Why are the tachycardia and bradycardia algorithm important to follow?
These are peri-arrest rhythms
What are the contraindications and complications to IO access?
What are the sites for IO access?
What equipment is needed for IO access?
How do you decided what needle size to use for IO access?
How do you insert IO access?
What is the most common picture on an ABG in a patient in cardiac arrest?
What adjustments do you need to make in cardiac arrest if the patient is pregnant?
What adjustments do you have to make in cardiac arrest for patients who were in acute asthma?
What adjustments in a cardiac arrest do you need to make for a hypothermic patient?
What documentation is needed after every 2222 call?
DATIX and document event in patients notes
Who do you need with you for DC cardioversion and pacing?
- Anaethetist
- Cardiologist
How do you size an NPA?
Usually 6 or 7 in adults
Use diameter of patient’s little finger
Where should you bevel face when inserting an NPA?
Away from the nasal septum
Ensure you lubricate it
When using a BVM what is important to do?
Open up airway with a chin lift with your grip
What depth and rate of chest compressions in CPR?
1/3rd of the chest
100-120 BPM
How long can IO access stay in for?
24 hours. Do not reinsert in the same site within 48 hours
What should you do post ROSC?
- Definitive airway
- 12 lead ECG
- BP
- Control temperature
- Consider any drugs needed
ARRANGE TRANSFER TO ITU
What do you need to do before and after a rhythm check in CPR?
Come off of chest whilst analysing and then check for pulse whilst off chest
Which two rhythms do you need to check for a pulse as they could be compatible with life?
- VT
- PEA
What shock do you give in cardioversion UHL?
360J
What shock do you give in CPR?
200, 300, 360 J
Where do you need to be looking when defibrillating?
AT THE BED - don’t button hover
