Advanced Life Support

Question 1

What are the new energy selection levels on defibs?

Answer 1

200 J first shock
300 J second shock
360 J third and above shock

Question 2

Where in the heart does VF and pVF occur?

Answer 2

The Ventricles

Question 3

When should you give amiodarone in cardiac arrest?

Answer 3

After 3 shocks

Question 4

How often should you give adrenaline in cardiac arrest?

Answer 4

Every 3-5 mins (when indicated)

Question 5

What does waveform capnography do?

Answer 5

> Confirms correct tube placement
Monitor ventilation rate
Monitor quality of CPR
Identify ROSC

Question 6

What is normal capnography range for CPR and what rate is it unlikely for a good outcome?

Answer 6

1.6-1.9

If its below 1.3 after 20 mins of ALS then its unlikely for a good outcome.

Question 7

When should you give adrenaline in a shockable rhythm?

Answer 7

1:10,000

After the third shock
Repeat after ever 3-5 mins

Question 8

When should you give amiodarone in a shockable rhythm?

Answer 8

After the third shock
Half dose (150mg) may be given after the 5th shock.

Question 9

When should adrenaline be given in a non shockable rhythm?

Answer 9

As soon as circulatory access is gained
Repeat every 3-5 mins

Question 10

When should amiodarone be given in a non shockable rhythm?

Answer 10

You shouldn’t.

Question 11

How does adrenaline work?

Answer 11

Stimulates adrenergic receptors - Sympathic nervous system.

Effects the alpha receptors causing constriction of arterioles, causing increase in coronary perfusion pressure (CPP)

Question 12

What does amiodarone do?

Answer 12

Its an anti arrythmic drug - to try and prevent reoccurrence of VF/pVT.

Increases the duration of action potential and refractory period in the myocardium

Improves response to Defib

Question 13

How much flush should you give prior to amiodarone?

Answer 13

At least 20ml

Question 14

What are the reversible causes of cardiac arrest?

Answer 14

Hypoxia
Hypothermia
Hypovolaemia
Hypothermia
Hyperkalaemia
Tamponade
Thrombosis
Tension pneumothorax
Toxins

Question 15

What is the pit crew model in cardiac arrest?

Answer 15

Airway clinician at the heads of patient
CPR clinician at side of patient
Team leader at the foot end of patient

Question 16

What is the algorithm for hypothermic cardiac arrest patients?

Answer 16

Start rewarming
Immediate transport
Consider LUCAS so can warm pt
Below 30c = no cardiac drugs
30-34c = double interval time for dosage
If VF, max three shocks until core temp above 30c

Question 17

What is Hypo/hyperkalaemia?

Answer 17

It is extreme high/low levels of potassium in the body.
Signs of fistula will show.

Question 18

What is thrombosis?

Answer 18

Clotting of blood anywhere in body
Such as MI or Pulmonary embolism

Question 19

What are the clinical signs of tension pneumothorax?

Answer 19

Decreased breath sounds
Tracheal deviation
Surgical emphysema
Hyper resonant on percussion

Question 20

How is tension pneumothorax treated?

Answer 20

Initial treatment with needle decompression
in 2nd intercostal space.
Then put in a chest drain (thoracotomy)

Question 21

What is surgical emphysema?

Answer 21

Look like bubble wrap on skin and is air trying to escape.

Question 22

What is tamponade?

Answer 22

Blunt or penetrating trauma to the chest, causing the heart to bleed into the pericardial sac.

Question 23

How long before CPR would it be futile to start?

Answer 23

If 15 mins had elapsed and the patient is in asystole for 30 seconds.

Only of 30 second asystole check if this check if completed.

Question 24

When should you stop resus?

Answer 24

Asystolic patient = >30 mins of persistent aystole

PEA patient = no clear guidance

VF/VT = Do not stop resus, transport to hospital.

Question 25

When should you transport the patient to hospital in cardiac arrest?

Answer 25

> 20 weeks pregnant
Airway problem
Persistant VF
Penetrating trauma
Anything treatable in hospital (PE, anaphylaxis)
Overdose
Electrolyte disturbance
Drowning/Hypothermia

Question 26

How often does VF reoccur after ROSC?

Answer 26

Reoccurs in 50% of patients within 2 mins of successful termination.

Question 27

What are common symptoms of Post Cardiac Arrest Syndrome?

Answer 27

Myclonus (random muscle spasms)
Comas
Seizures

Question 28

Where in the heart is the failure if there are distended neck veins?

Answer 28

Right ventricle.

Question 29

Where in the heart is the failure id there is pulmonary oedema?

Answer 29

Left ventricular failure.

Question 30

How long are pts generally deferred from hospital after a cardiac arrest?

Answer 30

Generally deferred until at least 72h after cardiac arrest.

Question 31

How do you transport a patient in cardiac arrest?

Answer 31

Laying supine
Head up to 30 degrees in the ambulance
If taking patient down stairs, feet first.
ATMIST pre alert to hospital.