Advanced life support Flashcards
How to do Chest compressions
- Centre of the chest
- Compress5-6cm
- Compress at a rate of 100-120
- Allow full recoil
- Firmsurface
What is the step wise approach to achieving an open airway for adequate oxygenations
positon (looking for signs of life) Manoeuver (Head tilt, chin lift) adjunct (OPA, NPA) supraglotic airway (IGEL) intubation ciricothyrioclotmy
What are the shockable rhythms
Ventricular Fibrillation
Pulseless Ventricular Tachycardia
What are the non shockable rhythms
Aystole
PEA
What drug should you give if PT is VF/VT?
• PersistentVF/pVT
• After 3rd shock
• Adrenaline 1mgin10ml-1:10,000
(Consider contra- indiciations)
How often can you give Adrenaline 1mgin10ml-1:10,000
Every 3 minutes
What are the contraindications of Adrenaline 1mgin10ml-1:10,000
Contra-indication– Hypothermic patients
How is Adrenline 1 mg in 10ml-1:10,000 given to pt
IV
IO
What should you give after admistering Adrenline 1 mg in 10ml-1:10,000
20ml flush
What are the benfits of adrenline?
- Smooth muscle relaxation in the airways
- Cause vasodilation of the coronary arteries
- Contraction smooth muscle in arterioles
- Increased peripheral resistance
What to adminster after the 3rd shock if it is still not successful
Amiodarone 300mg
What dose do you adminster of amiodrone after the 5th shcok
150mg in 5ml
what to adminster as soon as you have iv/io access un a non shockable rhythm?
Adreniline 1mg in 10ml– 1:10,000
Repeat every 3-5 minutes
What are the 4 h’s of reversiable causes
•Hypoxia •Hypothermia • Hypo/Hyper Kalaemia / Metobolic • Hypovolaemia
What is hypoxia ?
Low oxygen levels in the blood
How to reverse hypoxia in cardiac arrest
» Patent airway
» Adequately ventilated lungs
» Maximal possible inspired oxygen
What is hypovolaemia ?
Decreseas in blood volume due to severe haemorrhage
truma, gastrointestinal bleeding or rupture of an aoritc aneurysm
how to correct hypovolaemia in a cardiac arrest
» Stop the haemorrhage
» Fluid Therapy:
» <90 mmHg + impaired perfusion
» 250ml 0.9% NacL
Hyperkalaemia
elevated level of potassium - kidney failure
Hypokalaemia
low level of potassium
- vomiting, diarrhoea, dialysis
Hypocalcaemia
low calcium levels
- kidney failure
Hypoglycaemia
low blood sugar levels
what is HYPOTHERMIA
when the core body temperature is below 30 degress
what to do if your pt is hypothermic and in cardiac arrest
- Limit defibrillation attempts to three (delivered at maximum defibrillator output)
- Limit IV medications
what are the 4 t’s
- Tamponade
- Tension Pneumothorax
- Thrombosis
- Toxins
what is a THROMBOSIS
Blood clot
» Acute coronary syndrome or ischaemic heart disease - urgent coronary angiography
» Massive pulmonary embolism
- fibrinolytic treatment
what is a Tension pneumothorax
Tension pneumothorax is accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart.
how to reverse a Tension pneumothorax
Needle thoracentesis or thoracostomy
what is a cardiac tamponde
Fluid in the pericardium resulting in compression of the heart
Difficult to diagnose
Cardiac arrest after penetrating chest trauma is highly suggestive
what are the reasons someone could be in cardiac arrest due to toxins
» Accidental or deliberate ingestion of therapeutic or toxic substances
» History indicated
» Opioid overdos
how can you reverse cardiac arrest if its a opioid overdose
Naloxone
when would you not achive rosc on scene
if their is an untreatable reversable cause
or
need for medcial interventions
when would you not start cpr
• DNACPR • Finalstagesofterminalillness • 15minutessinceonset • NobystanderCPR • Asystolefor>30seconds • Asystolefor>20minutesdespiteALS • Exclusion: Pregnancy,Drowning, Hypothermia or Poisoning, • Decapitation • Massivecranialandcerebral deconstruction • Hemicortectomyorsimilarmassiveinjury • Decompositionandputrefaction • Incineration • Hypostasis • Rigormortis
if its a pediactric in cardiac arrest what do you do before starting cpr
5 rescue breaths, becuase they could be in respiratorty arrest
what is the rate of cpr for a peadiatrics
15:2
