Advanced Life Support Flashcards
What are the new energy selection levels on defibs?
200 J first shock
300 J second shock
360 J third and above shock
Where in the heart does VF and pVF occur?
The Ventricles
When should you give amiodarone in cardiac arrest?
After 3 shocks
How often should you give adrenaline in cardiac arrest?
Every 3-5 mins (when indicated)
What does waveform capnography do?
> Confirms correct tube placement
Monitor ventilation rate
Monitor quality of CPR
Identify ROSC
What is normal capnography range for CPR and what rate is it unlikely for a good outcome?
1.6-1.9
If its below 1.3 after 20 mins of ALS then its unlikely for a good outcome.
When should you give adrenaline in a shockable rhythm?
1:10,000
After the third shock
Repeat after ever 3-5 mins
When should you give amiodarone in a shockable rhythm?
After the third shock
Half dose (150mg) may be given after the 5th shock.
When should adrenaline be given in a non shockable rhythm?
As soon as circulatory access is gained
Repeat every 3-5 mins
When should amiodarone be given in a non shockable rhythm?
You shouldn’t.
How does adrenaline work?
Stimulates adrenergic receptors - Sympathic nervous system.
Effects the alpha receptors causing constriction of arterioles, causing increase in coronary perfusion pressure (CPP)
What does amiodarone do?
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
How much flush should you give prior to amiodarone?
At least 20ml
What are the reversible causes of cardiac arrest?
Hypoxia
Hypothermia
Hypovolaemia
Hypothermia
Hyperkalaemia
Tamponade
Thrombosis
Tension pneumothorax
Toxins
What is the pit crew model in cardiac arrest?
Airway clinician at the heads of patient
CPR clinician at side of patient
Team leader at the foot end of patient
What is the algorithm for hypothermic cardiac arrest patients?
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
What is Hypo/hyperkalaemia?
It is extreme high/low levels of potassium in the body.
Signs of fistula will show.
What is thrombosis?
Clotting of blood anywhere in body
Such as MI or Pulmonary embolism
What are the clinical signs of tension pneumothorax?
Decreased breath sounds
Tracheal deviation
Surgical emphysema
Hyper resonant on percussion
How is tension pneumothorax treated?
Initial treatment with needle decompression
in 2nd intercostal space.
Then put in a chest drain (thoracotomy)
What is surgical emphysema?
Look like bubble wrap on skin and is air trying to escape.
What is tamponade?
Blunt or penetrating trauma to the chest, causing the heart to bleed into the pericardial sac.
How long before CPR would it be futile to start?
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.
When should you stop resus?
Asystolic patient = >30 mins of persistent aystole
PEA patient = no clear guidance
VF/VT = Do not stop resus, transport to hospital.
When should you transport the patient to hospital in cardiac arrest?
> 20 weeks pregnant
Airway problem
Persistant VF
Penetrating trauma
Anything treatable in hospital (PE, anaphylaxis)
Overdose
Electrolyte disturbance
Drowning/Hypothermia
How often does VF reoccur after ROSC?
Reoccurs in 50% of patients within 2 mins of successful termination.
What are common symptoms of Post Cardiac Arrest Syndrome?
Myclonus (random muscle spasms)
Comas
Seizures
Where in the heart is the failure if there are distended neck veins?
Right ventricle.
Where in the heart is the failure id there is pulmonary oedema?
Left ventricular failure.
How long are pts generally deferred from hospital after a cardiac arrest?
Generally deferred until at least 72h after cardiac arrest.
How do you transport a patient in cardiac arrest?
Laying supine
Head up to 30 degrees in the ambulance
If taking patient down stairs, feet first.
ATMIST pre alert to hospital.
