Advanced Life Support Flashcards
Intubation attempt should not interrupt chest compressions for more than ________________
5 -10 seconds
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
10-15
100-120
10-12
1sec; hyper
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
Uncuffed; size
cuff inflation pressure
High
Monitoring (for Circulation)
ECG - Rhythm recognition
1) ____________
2) ____________
3) ____________
4) ____________
_______ are shockable
_______ are non-shockable
Ventricular fibrillation
Pulseless ventricular tachycardia
Asystole
Pulseless electrical activity
1 & 2 ; 3 & 4
Defibrillation
Passage of electrical current across heart to ____________ it
depolarise
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.
depolarize; arrhythmia
normal sinus rhythm
Defibrillation
Indicated for __________ rhythms
Chances of successful defibrillation decline at a rate of about ______% with each __________ of delay
shockable
10; minute
Defibrillator
Electrodes– below _________ and vertically in _________ line at level of ______ (clear of any ________________)
Rt clavicle
mid-axillary; V6
breast tissue
Defibrillators Used in Cardiac Arrest Situations
__________ Defibrillator.
______________________ Defibrillator (____).
Manual
Automated External; AED
Defibrillator
Dose - ______J (_______J for biphasic defibrillators)
Only ≈____% of current reaches heart
Safety - water, fluids, contact, O2
360; 150
4
Paediatric electrodes available – rarely indicated in paeds as most CA rhythms are __________
PEA
Automated external defibrillators
_________ cardiac rhythm
Semi-automatic – __________________ which is delivered by ___________
Fully automatic – _________ the shock
Analyse
indicates need for a shock ; operator
delivers
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 ______
ECG; PEA
Rare; ICU or CCU
AED safe and successful in paeds >___ year(s)
1
Paeds defibrillation
One defibrillating shock for VF/VT of ___J/kg*
Attenuate energy to ____-_____J using paed pads
4
50 – 75
Paeds defibrillation location
Defib pads ______ cm for children Below _____________ and _________ line, ______-_______
Adult pads can be used in children > _____ years
8 – 12
right clavicle; mid-axillary
Antero-posterior
8
DRUGS IN CARDIAC ARREST
Drug Delivery
__________
_____________
Intravenous
Intraosseous
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)
peripheral or central vein
intra-cardiac; 2 minutes
Tracheal
Adrenaline
improves _________________ pressure
→ _______________
↑ _________________ which aids effective defibrillation
Defibrillation
converts heart to ________ rhythm
Anti-arrhythmic
___________ converted rhythm
Coronary perfusion pressure; myocardial O2
intensity of VF ; perfusing
stabilises
Drugs in cardiac arrest
Adrenaline
__________
——————-
Defibrillation
Anti-arrhythmic
Drugs in Adult Cardiac Arrest
Adrenaline
____mg after ______ shock.
Repeat every _______ mins (every other loop)
1; 2nd; 3 – 5
Drugs in adult cardiac arrest
Amiodarone
______ mg for refractory VF, PVT.
After ______ shock OR
Lignocaine ____mg/ kg boluses till ____mg/kg
300; 3rd
1; 3
Drugs in Adult cardiac arrest
NaHCO3-
used in _________ CA >____ mins
____mls of _____% solution
Ensure assisted vent with _____ & effective ______ and systemic perfusion before administration
Prolonged; 30
50; 8.4; O2; BLS
IVF
Avoid _________ containing fluids
Do not ______________ to give drugs
dextrose
interrupt compressions
Use waveform capnography to _________________ in CPR
To monitor the _________ of CPR
confirm correct tracheal tube placement
quality
Drugs in Paediatric Cardiac Arrest
Adrenaline ____ml/kg of ___:_____ (10mcg/kg)
Immediately ______ access is established or __________
Every ________ mins (every other loop)
0.1
1:10,000
venous; intraosseous
3 – 5
Drugs in Paediatric Cardiac Arrest
Atropine – for _______ unresponsive to ventilation and circulatory support.
- ___mcg/kg (max of ____mcg, minimum of ______mcg)
bradycardia
20; 600; 100
Drugs in Paediatric Cardiac Arrest
Amiodarone – ___mg/kg
5
Drugs in Paediatric Cardiac Arrest
Hypovolaemia
Boluses of ____ml/kg of _______ or ________
Hypoglycaemia
___-____g/kg of _______ if hypoglycaemia is diagnosed
Max conc of ______%.
20; crystalloid or colloid
0.5 – 1
glucose; 25
Reversible Causes (PALS) – 5H’s & 5T’s
5H’s
Hypoxia
Hypovolaemia
Hydrogen ion (acidosis)
Hyper/ hypoK ,
Hypothermia
Reversible Causes – 5H’s & 5T’s
5T’s
Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)
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
ICU or CCU
O2 therapy
normocapnia; hypothermia
32 - 36; 24 hrs ; hyperthermia
normoglycaemia
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
consent; DNR
Withholding CPR
•Do Not Attempt Resuscitation (DNAR orders)
Decision made by _________
•Advanced directives
Decision made by the ________
physicians
patient
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
O2, IVF
Advanced Directives
Includes _______ directives, __________
Statutorily defined legal document providing specific instructions regarding CPR
Ensure ________ competence
Consider decision by appropriate surrogates
written; living wills
mental
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.
anticipated terminal
Poor; Long; fatal trauma
Un-witnessed
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
20; BLS
30; defibrillation and drug therapy
20 minutes; drowning and hypothermia
asystole; DNAR
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
Return of spontaneous circulation
pre-arrest hypo
drug overdose.
mechanical Compression
