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Junior Anaesthesia > Advanced Life Support > Flashcards

Advanced Life Support Flashcards

1
Q

Intubation attempt should not interrupt chest compressions for more than ________________

A

5 -10 seconds

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2
Q

Ventilation ( Breathing)

High flow O2 at _________L/min
Suction apparatus
Ventilation - Ambu (Self-inflating) bag
Once trachea has been intubated, ventilation should be independent of compression (Compression _______/min, ventilation ______/min)
Insp time is _______- enough for chest to rise
Avoid ______ventilation

A

10-15

100-120

10-12

1sec; hyper

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3
Q

Paediatric Airway & Breathing

Tracheal tubes- (cuffed or uncuffed?)

With cuffed tubes ensure correct ____ and minimum _______________

Sizeof TT–(Age(yrs)/4)+4 LMA – good alternative
After intubation, compression are uninterrupted at 100 - 120/min and ventilation according to child’s age.
Ventilate with (low or high?) concentration of O2

A

Uncuffed; size

cuff inflation pressure

High

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4
Q

Monitoring (for Circulation)
ECG - Rhythm recognition
1) ____________
2) ____________
3) ____________
4) ____________

 _______ are shockable
_______ are non-shockable

A

Ventricular fibrillation
Pulseless ventricular tachycardia
Asystole
Pulseless electrical activity

1 & 2 ; 3 & 4

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5
Q

Defibrillation

Passage of electrical current across heart to ____________ it

A

depolarise

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6
Q

Defibrillation

The aim is
 to __________ a critical mass of the heart muscle,
 terminate the ____________,
 allow __________________ to be re- established by the body’s natural pacemaker.

A

depolarize; arrhythmia

normal sinus rhythm

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7
Q

Defibrillation
Indicated for __________ rhythms

Chances of successful defibrillation decline at a rate of about ______% with each __________ of delay

A

shockable

10; minute

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8
Q

Defibrillator

Electrodes– below _________ and vertically in _________ line at level of ______ (clear of any ________________)

A

Rt clavicle

mid-axillary; V6

breast tissue

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9
Q

Defibrillators Used in Cardiac Arrest Situations

__________ Defibrillator.
______________________ Defibrillator (____).

A

Manual

Automated External; AED

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10
Q

Defibrillator

Dose - ______J (_______J for biphasic defibrillators)

Only ≈____% of current reaches heart

Safety - water, fluids, contact, O2

A

360; 150

4

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11
Q

Paediatric electrodes available – rarely indicated in paeds as most CA rhythms are __________

A

PEA

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12
Q

Automated external defibrillators

_________ cardiac rhythm

Semi-automatic – __________________ which is delivered by ___________

Fully automatic – _________ the shock

A

Analyse

indicates need for a shock ; operator

delivers

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13
Q

Paediatric Defibrillation

______ Monitoring
_______ is the most common rhythm

Consider and correct all reversible causes

Shockable rhythms are (common or rare?) and usually occur in ________ or ______

A

ECG; PEA

Rare; ICU or CCU

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14
Q

AED safe and successful in paeds >___ year(s)

A

1

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15
Q

Paeds defibrillation

One defibrillating shock for VF/VT of ___J/kg*

Attenuate energy to ____-_____J using paed pads

A

4

50 – 75

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16
Q

Paeds defibrillation location

Defib pads ______ cm for children Below _____________ and _________ line, ______-_______

Adult pads can be used in children > _____ years

A

8 – 12

right clavicle; mid-axillary

Antero-posterior

8

17
Q

DRUGS IN CARDIAC ARREST

Drug Delivery

__________
_____________

A

Intravenous
Intraosseous

18
Q

DRUGS IN CARDIAC ARREST

Drug Delivery
Intravenous - through _______ or __________

 avoid __________ injection

Intraosseous (tibia, humerus) –if IV route cannot be obtained within __________
 Can be employed for both adults &
Paeds
( _________ route: 2 -3 x IV dose no longer recommended)

A

peripheral or central vein

intra-cardiac; 2 minutes

Tracheal

19
Q

Adrenaline

 improves _________________ pressure
→ _______________

 ↑ _________________ which aids effective defibrillation

Defibrillation
converts heart to ________ rhythm

Anti-arrhythmic
___________ converted rhythm

A

Coronary perfusion pressure; myocardial O2

intensity of VF ; perfusing

stabilises

20
Q

Drugs in cardiac arrest

Adrenaline

__________
——————-

A

Defibrillation

Anti-arrhythmic

21
Q

Drugs in Adult Cardiac Arrest

Adrenaline
 ____mg after ______ shock.
 Repeat every _______ mins (every other loop)

A

1; 2nd; 3 – 5

22
Q

Drugs in adult cardiac arrest

Amiodarone
 ______ mg for refractory VF, PVT.
 After ______ shock OR
Lignocaine ____mg/ kg boluses till ____mg/kg

A

300; 3rd

1; 3

23
Q

Drugs in Adult cardiac arrest

NaHCO3-

 used in _________ CA >____ mins
 ____mls of _____% solution

Ensure assisted vent with _____ & effective ______ and systemic perfusion before administration

A

Prolonged; 30

50; 8.4; O2; BLS

24
Q

IVF
Avoid _________ containing fluids

Do not ______________ to give drugs

A

dextrose

interrupt compressions

25
Q

Use waveform capnography to _________________ in CPR

To monitor the _________ of CPR

A

confirm correct tracheal tube placement

quality

26
Q

Drugs in Paediatric Cardiac Arrest

Adrenaline ____ml/kg of ___:_____ (10mcg/kg)

Immediately ______ access is established or __________
Every ________ mins (every other loop)

A

0.1

1:10,000

venous; intraosseous

3 – 5

27
Q

Drugs in Paediatric Cardiac Arrest

Atropine – for _______ unresponsive to ventilation and circulatory support.
- ___mcg/kg (max of ____mcg, minimum of ______mcg)

A

bradycardia

20; 600; 100

28
Q

Drugs in Paediatric Cardiac Arrest

Amiodarone – ___mg/kg

A

5

29
Q

Drugs in Paediatric Cardiac Arrest

Hypovolaemia
Boluses of ____ml/kg of _______ or ________

Hypoglycaemia
___-____g/kg of _______ if hypoglycaemia is diagnosed
Max conc of ______%.

A

20; crystalloid or colloid

0.5 – 1

glucose; 25

30
Q

Reversible Causes (PALS) – 5H’s & 5T’s
 5H’s

A

Hypoxia
 Hypovolaemia
 Hydrogen ion (acidosis)
 Hyper/ hypoK ,
Hypothermia

31
Q

Reversible Causes – 5H’s & 5T’s

5T’s

A

 Tension pneumothorax
 Tamponade
 Toxins
 Thrombosis (pulmonary)
 Thrombosis (coronary)

32
Q

Post-Resuscitation care
Transfer to _______ or _______
Monitoring & _________
Ventilate to ————- if still unconscious
Preservation of cerebral and myocardial perfusion/function
Induced _________ (___-___) 0C for ______ Aggressive Rx of ________
Maintain _____________
Support haemodynamic function – fluids, noradrenaline, dobutamine

A

ICU or CCU

O2 therapy

normocapnia; hypothermia

32 - 36; 24 hrs ; hyperthermia

normoglycaemia

33
Q

The Unique nature of CPR – __________ is implied
The healthcare professional as a bystander
The duty of care
Respect _______ orders
Respect Advance Directives –mental competence
‘Good Samaritan’ laws

A

consent; DNR

34
Q

Withholding CPR

•Do Not Attempt Resuscitation (DNAR orders)
Decision made by _________

•Advanced directives
Decision made by the ________

A

physicians

patient

35
Q

Do Not Attempt Resuscitation

Respect DNR orders
Does not mean non-treatment – _____,___________ before devpt of cardiac arrest
Taken by most senior member of team.
Documentation which is reviewed daily
Should be communicated to all members of staff

A

O2, IVF

36
Q

Advanced Directives
Includes _______ directives, __________

Statutorily defined legal document providing specific instructions regarding CPR
Ensure ________ competence
Consider decision by appropriate surrogates

A

written; living wills

mental

37
Q

DNRs

It is essential to identify Patients for whom cardiopulmonary arrest is an ____________ event and in whom CPR is inappropriate

______ quality of life
_______ period before CPR
Obvious _____________
____________ death in presence of serious debilitating, chronic or terminal disease.

A

anticipated terminal

Poor; Long; fatal trauma

Un-witnessed

38
Q

Discontinuing CPR
Evidence of cardiac death,

 _____ mins ____ without deployment of
equipment or drugs
_____ mins of ________ and _______
 Asystole > _________ despite ALS except in _________ and _________
 Change of rhythm to ________ – signifies myocardial death
Presentation of valid _______ order

A

20; BLS

30; defibrillation and drug therapy

20 minutes; drowning and hypothermia

asystole; DNAR

39
Q

Prolonged CPR
Prolonged resuscitation efforts can be justified in the following situations:

__________________________________ of any duration during resuscitation.

 severe ________ ———-thermia.

Victims of ______________

May require a _________________ device

A

Return of spontaneous circulation

pre-arrest hypo

drug overdose.

mechanical Compression

Junior Anaesthesia (16 decks)

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