Adult ALS Flashcards
What percentage of patients having an in hospital cardiac arrest survive to discharge?
Fewer than 20%
What are the 4 Hs and 4 Ts?
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia - metabolic
Hypothermia
Thrombosis - coronary/pulmonary
Tamponade - cardiac
Toxins
Tension pneumothorax
Defib shock dose?
360 J monophasic
150-200 J biphasic
Intubate or supraglottic airway in shockable rhythms?
ET 1st line, then supraglottic
Peripheral or central IV access?
Peripheral - quicker, easier and safer
Flush with 20ml saline etc.
Why is tracheal delivery no longer recommended?
Unpredictable plasma concentrations.
Optimal dose unknown.
On what evidence is adrenaline use based on?
Animal data
Short term human survival
(no placebo-controlled studies)
Amiodarone evidence?
Short term survival in refractory VF (after 3 shocks - 300mg, then 150 mg bolus followed by 900mg if refractory)
Sodium bicarbonate treatment?
Only if hyperkalaemia or TCA overdose (50mmol, repeat according to response)
What is asystole usually caused by?
Primary myocardial pathology (not excessive vagal tone - no routine atropine)
NB PEA/asystole - usually due to reversible causes.
When to use fibrinolytic therapy in cardiac arrest?
Proven or suspected PE
?Continue 60-90 minutes before terminating if given.
Is echocardiography of use in cardiac arrest?
Yes - sub-xiphoid probe
Most serious complication of attempted intubation?
Unrecognised oesophageal placement
Correct placement of ET tube - primary confirmation?
Bilateral chest expansion
Auscultate for breath sounds and for none at the epigastrium
Correct placement of ET tube - secondary confirmation
Exhaled CO2
Oesphageal detection device.
NB - none of these will differentiate between main bronchus and tracheal placement
Coronary and cerebral perfusion: even with best manual CPR?
30% of normal
Impedance threshold device (ITD)?
Valve that limits air entry into the lungs during chest recoil.
Why? For decreased intrathoracic pressure and therefore increased venous return to heart.
Not recommended due to lack of survival to discharge data
LUCAS?
Lund University Cardiac Arrest System
Gas-driven sternal compression device that incorporates suction cup
Autopulse?
Load-distributing band CPR
Adverse factors - to differentiate between stable and unstable arrhythmias
Shock - increased sympathetic activity, impaired consciousness and hypotension
Syncope
Heart failure - pulmonary oedema, raised JVP and hepatic enlargement
Myocardial ischaemia
