advanced cardiac life support Flashcards
Identify the ALS algorithm
- Start CPR
- Attach defib/monitor
- Assess rhythm
If shockable
- shock, then CPR
If non-shockable
- CPR for 2 mins
ROSC - post rests care
Identify the principles for chest compressions
- 30 compressions: 2 breaths
- Delivered over the lower half of the sternum at a depth of at least 5cm
- Heel of hand along the lower half of the sternum
- Rate: at least 100 per minute
Identify shockable rhythms
Ventricular fibrillation & Ventricular tachycardia
Identify characterising factors for VF
- bizarre irregular waveform and non-recognisable QRS complexes
- uncoordinated electrical activity
- coarse/fine
Identify characterising factors for VT
- broad complex rhythm
- rapid rate
- constant QRS morphology
Identify non-shockable rhythms
Asystole & pulseless electrical activity
Explain COACHED
A safe method for defibrillation
Compressions continue
Oxygen away
All others clear
Charging defibrillator
Hands off
Evaluating rhythm
Defibrillate or disarm
Identify the 4 H’s and 4 T’s
Hypoxia
Hypovolaemia
Hypo/hyperthermia
Hypo/hyperkalemia
Tamponade
Tension pneumothorx
Thrombosis
Toxins
Identify considerations for hypoxia
- pre-arrest Spo2 - dependent upon perfusion
- consider advanced airway and avoid hyperventilation (use capnography)
Identify causes and treatment of hypovolaemia
- internal/external haemorrhage
- wounds/surgical drains
- history of trauma
- sepsis
- anaphylaxis
- gastro
Treatment: control haemorrhage + replace blood, distributive shock: IV fluids
Identify considerations for hypo/hyperkalaemia
- diuretic use
- D & V
- kidney disease + hyperglycaemia
- drug chart and fluid I&O
Identify cause and treatment for hypothermia
Ill patients tend to have disrupted thermoregulation
Treatment: re-warming, IV fluids, consider cardiopulmonary bypass or ECMO
Identify cause and treatment for hyperthermia
Core temp is greater than 38 degrees celsius, and life threatening if over 41.5
Causes: drug toxicity, dehydration
Heat stroke aan resemble septic shock
Treatment: no quicker ran 0.5 Degrees celsius per hour - electrolyte and fluid replacement
Define tension pneumothorax and treatment
Air in intrapleural space
- Check position of tube, check for rise and fall of chest, decreased breath sounds, tracheal deviation
Treatment: needle decompression
Define tamponade and treatment
Blood or fluid in the pericardial space
Examination: anxiety, hypertension/tachypnoea, discomfort relieved when leaning forward
Treatment: needle pericardiocentesis, resuscitare thoracotamy
Nurses role is to identify, escalate and facilitate treatment
Define thrombosis and treatment
Clot in pulmonary vein often caused by DVT
Clinical characteristics: chest pain, SOB, hypoxia
Treatment: fibrinolytic - heparin, percutaneous infusion
In cardiac arrest, if fibrinolytic therapy given: min 30 mins CPR
Describe the MOA of adrenaline
CNS stimulation - increases CO and HR by causing vasoconstriction
- alpha and beta adrenergic effects
Identify when to administer adrenaline during ALS
VF/VT after initial counter shocks have failed (after 2nd shock loop)
Asystole and PEA in initial loop (then every 2nd loop)
Describe the MOA of amiodarone
- antiarrhythmic
- prolongs action potential and slows sinus rate
Identify when to administer amiodarone in ALS
- VF/pulseless VT (between 3rd and 4th shock)
- AF
Describe the MOA of lignocaine
anti-arrhythmic
Identify when to administer lignocaine in ALS
Ventricular arrhythmias
Not to be used in SVT
Describe the MOA of atropine
- anticholinergic
- parasympathetic agonist
- acts on conduction system of the heart and accelerates the transmission of electrical impulses through cardiac tissue
Identify when to administer atropine during ALS
- bradycardia
- asystole
