Advanced Life Support

Question 1

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

Answer 1

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

Question 2

Which year did the new ALS guidelines come into practice?

Answer 2

2020/21 (AHA/ERC).

Question 3

List three key airway management techniques in ALS.

Answer 3

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

Question 4

What is the contraindication for using a nasopharyngeal airway?

Answer 4

Base of skull fracture.

Question 5

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

Answer 5

Endo-tracheal tube.

Question 6

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

Answer 6

No more than 5-10 seconds.

Question 7

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

Answer 7

High flow O2 at 10-15L/min.

Question 8

What device is used for manual ventilation in ALS?

Answer 8

Ambu (Self-inflating) bag.

Question 9

What should be avoided during ventilation to prevent complications?

Answer 9

Hyperventilation.

Question 10

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

Answer 10

(Age (yrs) / 4) + 4.

Question 11

What is the compression rate for paediatric patients after intubation?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Which rhythms are considered shockable in ALS?

Answer 13

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

Question 14

What is the purpose of defibrillation in ALS?

Answer 14

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

Question 15

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

Answer 15

150J for biphasic defibrillators.

Question 16

Where should defibrillator electrodes be placed on a patient?

Answer 16

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

Question 17

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

Answer 17

Manual Defibrillator and Automated External Defibrillator (AED).

Question 18

What percentage of current from defibrillation reaches the heart?

Answer 18

Approximately 4%.

Question 19

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

Answer 19

In children over 1 year of age.

Question 20

What is the defibrillation shock dose for paediatric patients?

Answer 20

4J/kg.

Question 21

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

Answer 21

Intravenous (IV) - peripheral or central vein.

Question 22

What is the indication for intraosseous access in ALS?

Answer 22

When IV access cannot be obtained within 2 minutes.

Question 23

Which drugs are commonly used in adult cardiac arrest management?

Answer 23

Adrenaline, Amiodarone, Lignocaine, NaHCO3.

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Amiodarone 300 mg after the 3rd shock.

Question 26

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

Answer 26

To avoid hyperglycaemia and potential complications.

Question 27

What is the role of adrenaline in cardiac arrest?

Answer 27

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

Question 28

How often should rhythm be assessed during defibrillation?

Answer 28

Every 2 minutes.

Question 29

What is the paediatric dose of adrenaline in cardiac arrest?

Answer 29

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

Question 30

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

Answer 30

Atropine.

Question 31

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

Answer 31

Boluses of 20 ml/kg of crystalloid or colloid.

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

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

Answer 35

32 - 36°C for 24 hours.

Question 36

What ethical principle implies consent for CPR?

Answer 36

Consent is implied.

Question 37

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

Answer 37

Ensure DNR orders are followed.

Question 38

What are Advanced Directives in the context of ALS?

Answer 38

Legal documents providing specific instructions regarding CPR.

Question 39

Who is responsible for making a DNAR decision?

Answer 39

The most senior member of the team.

Question 40

When is discontinuing CPR considered appropriate?

Answer 40

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

Question 41

Under what conditions is prolonged CPR justified?

Answer 41

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

Question 42

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

Answer 42

Greater than 20 minutes.

Question 43

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

Answer 43

Resuscitate.

Question 44

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

Answer 44

20 minutes.

Question 45

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

Answer 45

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