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Anaesthesia > Advanced Life Support > Flashcards

Advanced Life Support Flashcards

1
Q

What is the primary aim of Advanced Life Support (ALS)?

A

To improve all aspects of Basic Life Support (BLS), stabilise circulation, and provide post-resuscitation care.

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2
Q

Which year did the new ALS guidelines come into practice?

A

2020/21 (AHA/ERC).

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3
Q

List three key airway management techniques in ALS.

A

Oropharyngeal airway, Laryngeal mask airway (LMA), Endo-tracheal tube.

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4
Q

What is the contraindication for using a nasopharyngeal airway?

A

Base of skull fracture.

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5
Q

What is the optimal method for airway management if skilled personnel are available?

A

Endo-tracheal tube.

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6
Q

What is the maximum duration chest compressions should be interrupted for intubation?

A

No more than 5-10 seconds.

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7
Q

What is the recommended flow rate of oxygen during ventilation in ALS?

A

High flow O2 at 10-15L/min.

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8
Q

What device is used for manual ventilation in ALS?

A

Ambu (Self-inflating) bag.

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9
Q

What should be avoided during ventilation to prevent complications?

A

Hyperventilation.

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10
Q

What is the calculation for the size of a tracheal tube for paediatric patients?

A

(Age (yrs) / 4) + 4.

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11
Q

What is the compression rate for paediatric patients after intubation?

A

100-120/min for compressions; ventilation rate according to age.

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12
Q

What type of rhythms are monitored on ECG for circulation assessment?

A

Ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity.

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13
Q

Which rhythms are considered shockable in ALS?

A

Ventricular fibrillation (VF) and pulseless ventricular tachycardia (PVT).

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14
Q

What is the purpose of defibrillation in ALS?

A

To depolarise a critical mass of the heart muscle, terminate arrhythmia, and re-establish normal sinus rhythm.

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15
Q

What is the energy dose for defibrillation in adults using a biphasic defibrillator?

A

150J for biphasic defibrillators.

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16
Q

Where should defibrillator electrodes be placed on a patient?

A

Below the right clavicle and vertically in the mid-axillary line at the level of V6.

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17
Q

What are the two types of defibrillators used in cardiac arrest situations?

A

Manual Defibrillator and Automated External Defibrillator (AED).

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18
Q

What percentage of current from defibrillation reaches the heart?

A

Approximately 4%.

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19
Q

At what age is AED considered safe and effective for paediatric patients?

A

In children over 1 year of age.

20
Q

What is the defibrillation shock dose for paediatric patients?

A

4J/kg.

21
Q

What is the standard drug delivery route in cardiac arrest management?

A

Intravenous (IV) - peripheral or central vein.

22
Q

What is the indication for intraosseous access in ALS?

A

When IV access cannot be obtained within 2 minutes.

23
Q

Which drugs are commonly used in adult cardiac arrest management?

A

Adrenaline, Amiodarone, Lignocaine, NaHCO3.

24
Q

What is the dose and frequency of adrenaline administration in adult ALS?

A

1 mg after the 2nd shock, repeat every 3–5 minutes.

25
Q

What drug is administered for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT)?

A

Amiodarone 300 mg after the 3rd shock.

26
Q

What is the primary reason for avoiding dextrose-containing fluids in cardiac arrest?

A

To avoid hyperglycaemia and potential complications.

27
Q

What is the role of adrenaline in cardiac arrest?

A

It improves coronary perfusion pressure and increases the intensity of VF.

28
Q

How often should rhythm be assessed during defibrillation?

A

Every 2 minutes.

29
Q

What is the paediatric dose of adrenaline in cardiac arrest?

A

0.1 ml/kg of 1:10,000 (10 mcg/kg).

30
Q

What drug is used for bradycardia unresponsive to ventilation and circulatory support in paediatric patients?

A

Atropine.

31
Q

What is the first-line treatment for hypovolemia in paediatric cardiac arrest?

A

Boluses of 20 ml/kg of crystalloid or colloid.

32
Q

What are the 5 H’s reversible causes of cardiac arrest?

A

Hypoxia, Hypovolaemia, Hydrogen ion (acidosis), Hyper/hypokalemia, Hypothermia.

33
Q

What are the 5 T’s reversible causes of cardiac arrest?

A

Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary), Thrombosis (coronary).

34
Q

What is the goal of post-resuscitation care in ALS?

A

To transfer to ICU/CCU, monitor and provide O2 therapy, and support cerebral and myocardial function.

35
Q

What temperature range is recommended for induced hypothermia in post-resuscitation care?

A

32 - 36°C for 24 hours.

36
Q

What ethical principle implies consent for CPR?

A

Consent is implied.

37
Q

What should be respected when a DNR (Do Not Resuscitate) order is in place?

A

Ensure DNR orders are followed.

38
Q

What are Advanced Directives in the context of ALS?

A

Legal documents providing specific instructions regarding CPR.

39
Q

Who is responsible for making a DNAR decision?

A

The most senior member of the team.

40
Q

When is discontinuing CPR considered appropriate?

A

Evidence of cardiac death, such as asystole > 20 minutes despite ALS.

41
Q

Under what conditions is prolonged CPR justified?

A

In severe pre-arrest hypothermia, drug overdose, or return of spontaneous circulation.

42
Q

What is the minimum amount of time for asystole before discontinuing ALS?

A

Greater than 20 minutes.

43
Q

What should be done if there is doubt regarding the appropriateness of resuscitation?

A

Resuscitate.

44
Q

What is the maximum duration for BLS without deploying equipment or drugs?

A

20 minutes.

45
Q

What is a ‘Good Samaritan’ law in the context of ALS?

A

Laws that provide legal protection for those who provide emergency care.

Anaesthesia (16 decks)

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