Advanced Life Support

Question 1

Shockable rhythms

Answer 1

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

Question 2

Synchronised shock

Answer 2

Synchronous shock is only delivered when rhythms have synchronous activity/ there is synchrony in heart contraction
Using non synchronised DC cardioversion on a patient with a pulse can cause a cardiac arrest.
In synchronised DC shock the shock is delivered to avoid the repolarization phase ( ie the t wave) of the ventricles, as delivering a shock during repolarization risk transitioning into VF. The DC electrical discharge is syncrhonised with the R or S wave of the QRS complex.

Question 3

Non shockable rhythms

Answer 3

PEA and Asystole

Question 4

PEA and Asystole management

Answer 4

CPR
Adrenaline 1mg IV is given in the first cycle, and, should a non-shockable rhythm persist, every other cycle (i.e. cycles 1, 3, 5 etc.).

Question 5

Ventricular Fibrillation and Pulseless Ventricular Tachycardia management

Answer 5

CPR , shock
However if persistent, Amiodarone 300mg IV and Adrenaline 1mg IV (1:10,000) can be given after the third shock has been delivered.
Amiodarone is given as a one-off dose.
Adrenaline may be repeated every other cycle following a shock (i.e. cycles 3, 5, 7 etc.)

Question 6

4 Hs reversible causes

Answer 6

Hypoxia
Hypovolaemia
Hypothermia
Hypo/hyperkalaemia

Question 7

4 Ts reversible causes

Answer 7

Thrombosis
Tension Pneumothorax
Cardiac tamponde
Toxins