Advanced Life Support Flashcards
When adrenaline is indicated in cardiac arrest?
Non shockable rhythm- straight away (as soon as cannula/IO access gained)
Shockable- after 3rd shock from defib
Adrenaline dosage?
1mg in 10ml pre filled syringe
1 in 10,000
Action of adrenaline in cardiac arrest?
Vasodilator, increase systemic circulation of blood to counteract hypoxia
Bronchodilator
Repeat dose of adrenaline?
After 1st dose, every 3-5 mins (stop when ROSC achieved)
No max dose
ALS algorithm for adults
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
Paediatric ALS algorithm
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
Trauma ALS algorithm
Prioritise trauma first (HOTT approach- e.g control cat haem with tourniquet/TXA)
D-GO/CAT- AVPU- A-B-C
Continue with DRABC
HOTT reversible causes?
Hypovolaemia
Oxygen (hypoxia)
Temponade
Tension pneumothorax
Hypovolaemia treatment
Tourniquet to stop bleeding
TXA
Traction splints/ pelvic binder (control internal bleeding)
Fluid
Hypoxia treatment
15L 02 through trauma mask
Airway adjunct eg I-GEL
30:2 ventilations
Tension pneumothorax treatment
Needle decompression of chest
Cardiac tamponade treatment
Convey to hospital (can’t do anything else)
Airway stepwise approach?
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
How to calculate joules to shock paeds?
4J/kg
Adrenaline in ALS contraindications
Patients with temperatures under 30 degrees Celsius (adrenaline lowers temp)
Amiodarone drug type?
Anti-arrhythmic
When is amiodarone given?
After the 3rd shock and 5th shock
ONLY in shockable rhythms
Action of amiodarone on the heart?
Prolongs conduction period of SA and AV nodes
Doses of amiodarone?
300mg after 3rd shock (10ml- pre-filled syringe)
150mg after 5th shock (5ml- half a syringe)
Dose interval of amiodarone in patients with temperatures below 35 degrees Celsius
Doubled
(Do not administer if temp below 30 degrees Celsius)
Repeat dose of amiodarone?
NO MORE after 5th shock
Dose of amiodarone in paediatrics?
Dose after 5th shock is NOT halved (so is 300mg like after the 3rd shock)
Hypometabolic states (4Hs and Ts)
Hypokalaemia (peaked T waves on ECG)
Hypoglycaemia (BM, give IV glucose)
Toxins (4Hs and Ts)
Track marks
Dilated pupils
Signs of tension pneumothorax?
Deviated trachea
Unilateral rise and fall of chest
Resistance on BVM when ventilating
Silent chest
Hyper resonance
Drugs to give for a ROSC?
Post ROSC adrenaline if systolic Bp is under 100
50-100 micrograms
Repeat doses ever 3-5 mins if BP remains below 100
TWELVE
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
FLAPS
Feel
Look
Auscultate
Percuss
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