Advanced Life Support

Question 1

When adrenaline is indicated in cardiac arrest?

Answer 1

Non shockable rhythm- straight away (as soon as cannula/IO access gained)
Shockable- after 3rd shock from defib

Question 2

Adrenaline dosage?

Answer 2

1mg in 10ml pre filled syringe
1 in 10,000

Question 3

Action of adrenaline in cardiac arrest?

Answer 3

Vasodilator, increase systemic circulation of blood to counteract hypoxia
Bronchodilator

Question 4

Repeat dose of adrenaline?

Answer 4

After 1st dose, every 3-5 mins (stop when ROSC achieved)
No max dose

Question 5

ALS algorithm for adults

Answer 5

D-GO/CAT-AVPU-A-B-C
Start CPR
Attach pads, rhythm assessment, shock/no shock (every 5 rounds)
Ventilations 30:2
Airway adjunct (I-GEL)
Drugs - Adrenaline/ amiodarone
4 Hs and Ts
ROSC (Reassess ABCDE)- stabilise for 10 mins on scene
Extrication
Pre alert to nearest ED under emergency conditions

Question 6

Paediatric ALS algorithm

Answer 6

1-18 year olds
D-GO/CAT- AVPU- A-B-C
Start CPR (5 rescue breaths, 15:2, one hand)
Different drug dosages/ joule shocks

Question 7

Trauma ALS algorithm

Answer 7

Prioritise trauma first (HOTT approach- e.g control cat haem with tourniquet/TXA)
D-GO/CAT- AVPU- A-B-C
Continue with DRABC

Question 8

HOTT reversible causes?

Answer 8

Hypovolaemia
Oxygen (hypoxia)
Temponade
Tension pneumothorax

Question 9

Hypovolaemia treatment

Answer 9

Tourniquet to stop bleeding
TXA
Traction splints/ pelvic binder (control internal bleeding)
Fluid

Question 10

Hypoxia treatment

Answer 10

15L 02 through trauma mask
Airway adjunct eg I-GEL
30:2 ventilations

Question 11

Tension pneumothorax treatment

Answer 11

Needle decompression of chest

Question 12

Cardiac tamponade treatment

Answer 12

Convey to hospital (can’t do anything else)

Question 13

Airway stepwise approach?

Answer 13

Work way up airway ladder:
Head tilt chin lift/ jaw thrust (use of blanket under neck to maintain)- repositioning
OPA/ NPA
I-GEL
Intubation
Surgical airways

Question 14

How to calculate joules to shock paeds?

Answer 14

4J/kg

Question 15

Adrenaline in ALS contraindications

Answer 15

Patients with temperatures under 30 degrees Celsius (adrenaline lowers temp)

Question 16

Amiodarone drug type?

Answer 16

Anti-arrhythmic

Question 17

When is amiodarone given?

Answer 17

After the 3rd shock and 5th shock
ONLY in shockable rhythms

Question 18

Action of amiodarone on the heart?

Answer 18

Prolongs conduction period of SA and AV nodes

Question 19

Doses of amiodarone?

Answer 19

300mg after 3rd shock (10ml- pre-filled syringe)
150mg after 5th shock (5ml- half a syringe)

Question 20

Dose interval of amiodarone in patients with temperatures below 35 degrees Celsius

Answer 20

Doubled
(Do not administer if temp below 30 degrees Celsius)

Question 21

Repeat dose of amiodarone?

Answer 21

NO MORE after 5th shock

Question 22

Dose of amiodarone in paediatrics?

Answer 22

Dose after 5th shock is NOT halved (so is 300mg like after the 3rd shock)

Question 23

Hypometabolic states (4Hs and Ts)

Answer 23

Hypokalaemia (peaked T waves on ECG)
Hypoglycaemia (BM, give IV glucose)

Question 24

Toxins (4Hs and Ts)

Answer 24

Track marks
Dilated pupils

Question 25

Signs of tension pneumothorax?

Answer 25

Deviated trachea Unilateral rise and fall of chest Resistance on BVM when ventilating Silent chest Hyper resonance

Question 26

Drugs to give for a ROSC?

Answer 26

Post ROSC adrenaline if systolic Bp is under 100 50-100 micrograms Repeat doses ever 3-5 mins if BP remains below 100

Question 27

TWELVE

Answer 27

Used to assess pt breathing/airway Tracheal deviation (T pneumo) Wounds/bleeding to neck Surgical Emphysema (crackling skin, Auscultate, look for swelling) Laryngeal crepitus Jugular venous distension (heart failure/cardiac tamponade/tension pneumothorax) Exposure

Question 28

FLAPS

Answer 28

Feel Look Auscultate Percuss Search