Advanced Life Support

Question 1

When to initiate ALS
Initial steps

Answer 1

Unresponsive, not breathing normally

Call resus team/LAS if in community
CPR 30:2 100BPM
Attach defib and monitor
Assess rhythm - stop CPR

Question 2

What are the shockable rhythms
-defib
-drugs

Answer 2

VF/pulseless VT
Continue CPR as defib charges
Remove O2 before shock
1 shock
Immediately restart 2mins CPR
Rhythm check - stop CPR

After 3rd shock
-Adrenaline 1mg => repeat every 3-5mins
-Amiodarone 300mg => 150mg after 5th shock

Question 3

What are the non shockable rhythms
-defib
-drugs

Answer 3

Pulseless electrical activity -
Asystole
Immediately restart 2mins CPR
Rhythm check - stop CPR

Adrenaline 1mg ASAP => repeat every 3-5mins

Question 4

When giving CPR, what else should be done at the same time

Answer 4

O2 bag mask
If patent airway cannot be maintained, can use adjuncts to help

Meds
1st line - IV
2nd line - IO

Address reversible causes of cardiac arrest
Hypoxia
Hypovolemia
High/low K, hypoglycemia, hypoCa, acidemia
Hypothermia

Thrombosis
TPX
Tamponade
Toxins

Question 5

What to do after ROSC

Answer 5

A-E
SaO2 94-98%
12 lead ECG
Core temp 36
Mean arterial pressure 65+
Identify and treat cause

Question 6

Management of cardiac arrest from hypothermia

Answer 6

Dry patients after retrieval from cold water
-cover extremities
-infuse warm fluids
-monitor core temperature

Core body temp U30deg
-limit defibrillation attempts to 3, and withhold amiodarone or adrenaline unless 30deg+

Core body temp 30-34deg
-double the interval between medicine doses (6-10mins)

Question 7

Management of cardiac arrest from tension pneumothorax

Answer 7

Hyperresonant percussion on affected side
Decrease in chest movement

Large bore cannula - 2nd ICS MCL on affected side
Hiss of air audible when cannula is placed
Secure cannula and insert chest drain at earliest opportunity - likely after ROSC
Ensure that cannula is not knocked out or kinked

Question 8

Management of cardiac arrest from thromboembolism

Answer 8

Massive PE = hypotension => thrombolysis
-resuscitation must continue 90mins after thrombolysis

Can carry out PCI whilst cardiac compressions continue but needs planning

Question 9

Causes of cardiac arrest from toxins

Answer 9

Anaphylaxis pre-arrest - IM adrenaline 500mcg + antihistamine + CS
During arrest - 1mg adrenaline

Opioids - naloxone
TCAs - sodium bicarbonate to manage acidosis
BZ - flumazenil but can cause seizures in BZ dependent patients

Question 10

Management of cardiac arrest from cardiac tamponade

Answer 10

Echocardiogram + pericardiocentesis

Question 11

Management of cardiac arrest in pregnancy

Answer 11

Manually displace uterus to left
Place hands 2-3cm higher than normal if 28wks+
If initial resus attempts unsuccessful => emergency CS
MAKE THIS DECISION WITHIN 5MINS OF CARDIAC ARREST
-can increase chances of ROSC and infant surviving

Question 12

Management of cardiac arrest post cardiac catheterisation or surgery

Answer 12

If VF/VT => 3 stacked DC shocks can be initially given

Question 13

What is post cardiac arrest syndrome?

Answer 13

Brain injury from hypoxia
Myocardial dysfunction
Systemic response to ischemia and reperfusion
Potential ongoing effects of the initial cause of cardiac arrest

=> MULTI ORGAN FAILURE