ACLS Flashcards
What are non-shockable rhythms?
- PEA
- Asystole
If your patient is in a non-shockable rhythm when do you administer adrenaline?
Straight away and then every second loop
What are the two shockable rhythms that present with cardiac arrest?
- VF
- VT
How does adrenaline help in cardiac arrest?
Helps maintain diastolic BP and hence coronary blood flow
How much energy should you use for a shock?
200 J
What is the chain of survival?
- Early recognition and call for help
- Early CPR
- Early Defibrillation
- Post resucitation care
What is involved in post-resusitation care?
- Re-evaluating ABCDE (disability, exposure)
- 12 lead ECG
- Treating precipitating causes
- Re-evaluating oxygenation and ventilation
- Use of targeted temperature management
What should the depth of chest compressions be?
One-third AP diameter
How should you treat choking?
- Encourage coughing if they are already coughing
- If not coughing but responsive 5 back blows then 5 chest thrusts
- If unresponsive CPR
What is the dose of adrenaline for anaphylaxis?
0.5mg IM
What is the dose of adrenaline for a child with anaphylaxis?
10mcg/kg (0.01mL/kg of 1:1000)
What does the ISBAR tool stand for?
- Identify yourself
- Situation
- Background
- Assessment
- Response
What is a recap tool that can be used?
- Stop
- Notify the team of the situation
- Assess
- Plan
- Prioritise
- Invite idease
What does the acronym PACER stand for?
Probe
Alert
Challenge
Emergency
React
What are the 4 H’s and T’s?
Hypoxia
Hypovolaemia
Hypothermia
Hypokalamia
Tension pneumothorax
Toxins
Thrombosis
Tamponade
During CPR what else should we be doing?
- Airway adjuncts
- Oxygen
- Waveform capnography
- IV/IO access
- Plan actions before interrupting compressions
If you are breathing for somone how many breaths per minute should you be doing?
6-10 a minute
When should amiodarone be given
Shockable rythm
Third defibrillation attempt
What should your target temperature be in post-resusitation care?
32-36 degrees
How many joules should you be shocking a child with?
4J/kg
How much amiodarone should you give a child?
5mg/kg
What % of oxygen should be used for those in cardiac arrest?
100%
What is the normal ETC02?
35-45mmHg
If the ETC02 is <10mmHg what does this imply?
The resuscitation is ineffective
When is amiodarone used in cardiac arrest?
- Refractory VF/VT
- When 3 loops of CPR followed by a shock have failed to restore a rhythm
What drug can be used instead of amiodarone?
Lignocaine 1mg/kg
What is the adult dose of amiodarone?
300mg IV
When should calcium be administered in a cardiac arrest?
- hyperkalaemia
- Hypermagnesaemia
- Calcium channel blocker overdose
- Profound hypocalcaemia (ie following massive blood transfusion)
What is the major acid base abnormality in cardiac arrest?
Respiratory acidosis
How can rewarming of an individual be most rapidly acheived?
cardiopulmonary bypass
What is malignant hyperthermia?
sensitivity of skeletal muscles to volatile anaesthetics and suxamethonium.
How do you treat malignant hyperthermia?
Dantrolene 2-5mg/kg
How can you treat hyperkalaemia?
- Calcium gluconate
- Insulin
- Salbutamol
- Bicarbonate
What are the classic signs of a tension pneumothorax?
- deviation of trachea away from tension
- Hyper-expanded chst
- Increased percussion note
How do you treat tension pneumothorax?
14G cannula into the second rib space mid-clavicular line
What is Beck’s triad?
- 3 clinical signs associated with cardiac tamponade:
- Hypotension
- Jugular vein distension
- Absent or distant heart sounds
What drug can you give in local anaesthetic toxicity?
Intralipid
What drug can you give in an opiate overdose?
Naloxone
What drug can you give in a panadol overdose?
N-acetyl cysteine
What are the priorities in the management of acute hypoxic brain injury?
- airway
- Breathing
- Circulatory control
- Temperature management
What happens with hypercapnia? (PCO2 >45mmhg)
Cerebral vasodilation
In post resusitation care what is targeted temperature management?
32-36 degrees
What are the 3 key abnormalities of asthma?
- Bronchoconstriction
- Airway inflammation
- Mucous plugging
What clinical features in an asthmatic make you suspect a near fatal asthma attack?
- PEF <33%
- 02 <92%
- Normal C02
- SIlent chest
- Cyanosis
- Bradycardia
- Arrhythmia
- Exhaustion
- Confusion
What management should you give to an asthmatic?
- Oxygen
- Salbutamol nebulised 5mg every 15 mins
- Hydrocortisone 200mg IV
- Nebulised anticholinergic ie ipratropium bronide 0.5mg q4-6h
- Magnesium sulphate 2g over 20 minutes
- IV salbutamol
When should peri-mortem caesarean be considered?
4 minutes of onset of cardiac arrest if ROSC has not returned
What is the survival rate of cardiac arrest in the OT?
30%
what are the two most important preventable causes of death following trauma?
- airway obstruction
- Blood loss
What is the sequence for trauma care?
- Primary survery
- Resuscitation
- Adjuncts to primary survery
- Secondary survey
- Definitive care
What are the priorities of the primary survey?
- Airway
- Breathing
- Circulation
- Disability (neurological status)
- Exposure (undress)
Should you be using c-spine collars in a pre-hospital setting?
No
