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Advanced Life Support NZ > Advanced Life Support > Flashcards

Advanced Life Support Flashcards

1
Q

What is the Chain of Survival?

A
  1. Early Recognition
    - to prevent Cardiac Arrest
  2. Early CPR
    - to buy time
  3. Early Defibrillation
    - to restart the heart
  4. Post Resus Care
    - to restore quality of life
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2
Q

Infant

A

Under 1 year

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3
Q

Child

A

1-8 year old

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4
Q

Adult

A

9+ year old

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5
Q

BLS

A

CPR and use of AED

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6
Q

CPR

A

Chest compressions combined with rescue breathing

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7
Q

ALS

A

BLS with more advanced techniques.

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8
Q

Symptoms of Cardiac Arrest

A

Chest pain
SOB
Nausea and Vomitting
Dizziness

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9
Q

DRSABCD

A 
Danger
Responsive
Send for help
Open airway
Normal breathing
CPR
Defib
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10
Q

List 4 of Adult Compressions

A
  1. 30:2
  2. 100-120bpm
  3. 1/3 of front-back dimension = 5+cm
  4. Mid lower half of sternum at nipple line
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11
Q

2 results of chest compressions

A
  1. Produce CO2 by generalised ^intrathoracic pressure and direct pressure on the heart.
  2. Release of compressions allows blood flow back to heart
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12
Q
  1. Early Recognition and Call for Help
A
  1. Signs of collapse and impending cardiac arrest

2. 111 in response to chest pain, SOB or sudden collapse

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13
Q
  1. Early CPR
A
  1. ^2-3 times survival rate when CPR began by bystanders

2. Risk of NOT doing CPR on someone who NEEDS it, outweighs the the risk of doing CPR on someone who does NOT.

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14
Q
  1. Early Defib
A
  1. Common cause of CA is VF

2. AED and BLS ^survival

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15
Q

Interval between CA and Defib in Metropolitian Areas?

A

4mins or less

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16
Q

Interval between CA and Defib in Hospital?

A

3mins or less

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17
Q
  1. Post Resus Care
A

After ROSC

  1. Re-evaluate ABCDE
  2. ECG
  3. Treat precipitating causes
  4. Re-evaluate O2 and ventilation
  5. Targeted temperature management
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18
Q

List 3 of Child Compressions

A
  1. 2:15
  2. 100-120bpm
  3. Approx 5cm depth
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19
Q

How much does survival decrease every minute Defib is delayed?

A

10%

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20
Q

Where are Pads positioned for Adults?

A

Anterior-Lateral

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21
Q

If the person has a PPM or ICD, how far away do the Defib Pads need to be positioned?

A

8cm away from device

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22
Q

Where are Pads positioned for Paediatrics?

A

Paediatric Pads = Anterior-Lateral

Adult Pads = Anterior - Posterior

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23
Q

SEVERE CHOKING + Responsive

A

Ineffective Cough

  1. Send for help
  2. 5 BACK BLOWS
  3. 5 CHEST THRUSTS
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24
Q

SEVERE CHOKING + unresponsive

A

Ineffective Cough

  1. Send for help
  2. CPR
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25
Q

MILD CHOKING

A

Effective Cough

  1. Encourage coughing
  2. Continue to check
  3. Send for help
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26
Q

What is Anaphylaxis?

A

Serious allergic reaction that is rapid in onset and may cause death.

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27
Q

Anaphylaxis with UNKNOWN allergen.

A

ACUTE onset and SKIN/MUCOSAL of at least one:

  1. RESP compromise
  2. LOW BP
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28
Q

Anaphylaxis with LIKELY allergen.

A

2 or more in mins or hours

  1. SKIN/MUCOSAL
  2. RESP
  3. LOW BP
  4. GI symptoms
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29
Q

Anaphylaxis with KNOWN allergen

A
  1. LOW BP
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30
Q

What % of anaphylaxis has SKIN involvement?

A

90%

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31
Q

List 4 common allergens for anaphylaxis

A
  1. STINGS
  2. FOOD - shellfish, nuts, dairy
  3. MEDICATIONS - abx, NSAIDS
  4. OTHER - latex, chlorhex, contrast
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32
Q

Initial Treatment for signs and symptoms of anaphylaxis

A
  1. Remove trigger
  2. Send for help
  3. Assess ABCD
  4. Lie flat
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33
Q

List 3 complications of Anaphylaxis

A
  1. SHOCK
  2. UPPER AIRWAY OBS
  3. LOWER AIRWAY OBS
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34
Q

Difference between Upper Airway OBS and Lower Airway OBS (ADULTS)

A

UPPER AIRWAY = stridor and tongue/laryngeal swelling.

LOWER AIRWAY = wheeze

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35
Q

Difference between Upper Airway OBS and Lower Airway OBS (CHILD)

A

UPPER AIRWAY = Stridor + RESP distress

LOWER AIRWAY = Wheeze + RESP distress

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36
Q

Treatment for Anaphylaxis (Adults)

A
  1. 5mg IM Adrenaline
    (0. 5ml of 1,1000)

Upper putter thigh
Repeat in 5mins if no improvement

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37
Q

Following treatments for anaphylaxis (Adults)

A
  1. IVF 0.9% NaCl 1000ml, Hiflo O2, monitoring
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38
Q

Following treatments if no resolution of anaphylaxis (Adult)

A

Consider x3 dose of IM Adrenaline

0.5ml of 1:1000

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39
Q

Treatments for complications of anaphylaxis (Adults)

  1. Shock
  2. UAO
  3. LAO
A
  1. IVF or INOTROPES
  2. Neb Adrenaline
  3. Neb Salbutamol
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40
Q

Resolution of Anaphylaxis (Adult and child)

A
  1. Observe ABC

2. Antihistamine or Prednisone

41
Q

Treatment for Anaphylaxis (Child)

A

10mcg/kg IM Adrenaline
(0.01ml/kg of 1:1000)

Repeat in 3-5mins

If no improvement
0.9% NaCl 20ml/kg

42
Q

No resolution for anaphylaxis (Child)

  1. Shock
  2. UAO
  3. LAO
A
  1. IVF or Adrenaline INF
  2. Neb Adrenaline or Adrenaline INF
  3. Neb Salbutamol or Adrenaline INF
43
Q

List 5 things DURING CPR

A
  1. Airway adjuncts = LMA/ETT
  2. O2
  3. Waveform capnography
  4. IV/IO access
  5. Plan actions before interrupting CPR
44
Q

4 Hs and 4 Ts

A
  1. Hypoxia
  2. Hypovolaemia
  3. Hypo/perthermia
  4. Hypo/perkalaemia
  5. Tamponade
  6. Tension Pneumothorax
  7. Toxins
  8. Thrombosis - coronary/pulmonary
45
Q

ACLS DRUGS SHOCKABLE

A

1mg/10ml IV ADRENALINE after 2nd shock
(then every 2nd look/4mins)

300mg/6ml IV AMIODARONE BOLUS after 3rd shock

46
Q

ACLS DRUGS NONSHOCKABLE

A

1mg/10ml IV ADRENALINE IMMEDIATELY

Then every 2nd loop/4mins

47
Q

What is the rate for VENTILATION

A

6-10/min

48
Q

What is an LMA?

A

Laryngeal mask

49
Q

What is an ETT?

A

Endotracheal Tube

50
Q

Why is overventillation harmful?

A

Gas trapping

51
Q

What 4 things is WAVEFORM CAPNOGRAOHY used for?

A
  1. Assess Airway PATENCY
  2. Confirm intubation of TRACHEA
  3. Assess ADEQUACY of CO during CPR
  4. To detect ROSC
52
Q

What does Waveform Capnography measure?

A

End-Tidal CO2 (ETCO2)

53
Q

What is adequate CO of ETCO2?

A

30-40mmHg

54
Q

What is an alternate drug to use in CA after Amiodarone?

A

1mg/kg IV LIGNOCAINE

55
Q

Compression:Ventillation Ratio

Adult/Child

A

30: 2 (Adult)
2: 15 (Child)

56
Q

List 4 ways to Ventilate

A
  1. Bag via Mask
  2. LMA
  3. ETT
  4. Tracheostomy
57
Q

How many cycles of ventilation (Adult/Child)

A

5 in 2mins Adult

5 in 1min Child

58
Q

How many compressions/min (Adult)

A

75

59
Q

How many compressions/min? (Child)

A

75

60
Q

How many breaths/min (Adult)

A

5

61
Q

How many breaths/min (Child)

A

10

62
Q

Why is hyperventilation harmful?

A
  1. ^intrathoracic pressure
  2. Dec coronary and cerebral perfusion
  3. Dec ROSC and survival rate
63
Q

Why do you need to beware of Gas Trapping?

A

^intrathoracic pressure cause NO VENOUS RETURN = No CO

64
Q

What is the BAG MASK O2 flow rate?

A

10-15ml/min

65
Q

What is ETCO2 rate meaning ineffective CPR?

A

<10mmHg

66
Q

What does Adrenaline do?

A

Peripheral VASOCONSTRICTION
Increases coronary perfusion

ASYSTOLE = overcome cholonergic induced Brady
PEA = improve cardiac contractility
67
Q

What dose of Adrenaline for Child CA?

A

10mcg/kg of 1:10,000

0.1ml/kg 1:10,000

68
Q

What does of Amiodarone for Child CA?

A

5mg/kg

69
Q

How many Jouls to shock a child?

A

4J/kg

70
Q

What does a Precordial Thump do?

A

Mechanical stimulation by producing a myocardial depolarisation to covert VT to SR.

71
Q

When should Precordial Thump only be used?

A

Person who is monitored, when a Defib is not immediately available and when the onset of VT is witnessed.

72
Q

How to do Precordial Thump?

A

Hold cleaned fist April 25-30cm above the sternum. Bring fist down sharply. Immediately start CPR after.

73
Q

Where does an Oropharyngeal airway sit?

A

Tip sits at the back of the pharynx keeping the tongue forward and airway open.

74
Q

How to measure OPAs?

A

Distance from persons earlobe to corner of the mouth from the mid-incisor to angle of the jaw.

Size 3,4 for Adults

75
Q

How to insert OPA?

A
  1. Open mouth
  2. Imager OPA upsidedown
  3. Once behind the tongue, rotate 180deg to final position.
76
Q

What is a CE grip?

A

Place thumbs over top of mask.
Place index fingers over the bottom of the mask.
Provide head tilt-chin lift with middle and ring fingers.
Ensure little finger is behind the angle of the jaw and provide jaw thrust with little finger and seal the mask to face.

77
Q

How to do alternate CE grip?

A

Place heels of both hands firmly into the sides of mask.
Place all four fingers behind the angle of the jaw.
Apply very firm jaw thrust with all four fingers to seal the mask to face.

78
Q

What is an LMA?

A

Has in inflatable cuff that sits above the vocal cords.

79
Q

What advantages of LMA?

A

Opens airway when OPAs are insufficient.
Maintains open airway without ongoing airway manoeuvres.
Insertion while compressions continue.
When ETT is difficult.
Stops aspiration.

80
Q

How do you insert an LMA?

A
  1. Test the cuff - with 30ml syringe.
  2. Lubricate back of cuff.
  3. Hold LMA with line facing towards you.
  4. Hold LMA like a pen and insert directly backwards following the HARD PALATE.
  5. Press LMA backwards and downwards around the corner until it goes no further.
  6. Inflate cuff with cuff size x 10.
81
Q

Does LMA protect against regurgitation?

A

No.

Aspiration is less common than with ORO or NASO

82
Q

Crisis Resource Management (CRM 15)

A
  1. Know Environment
  2. Anticipate and Plan
  3. Call for Help early
  4. Leadership and Followership
  5. Distribute Workload
  6. Mobilise available resources
  7. Communicate effectively
  8. Use all available information
  9. Fixation errors prevention and manage
  10. Double check
  11. Cognitive AIDS
  12. Re evaluate
  13. Teamwork
  14. Allocate attention wisely
  15. Set priorities dynamically
83
Q

What is CRM for?

A

Coordinate and utilise and apply all available resources to optimise patient safety and outcomes

84
Q
  1. Know environment
A

Equipment, resources and personnel.

Weekends, nights, how long.

Reduces stress.

85
Q
  1. Anticipate and plan
A

Plan for each possible difficulty and expect the unexpected.

Avoids surprises and reduces stress.

86
Q
  1. Call for help early
A

Knowing limitations.

Alone - dangerous and inappropriate

Shows safety respect and responsibility

87
Q
  1. Leadership
A

Take command, distribute tasks and collect all info.

Coordinating and planning using clear communication.

88
Q
  1. Followership
A

Listening to leader and doing what needed.

Assertive and ensure leader is aware of concerns

89
Q
  1. Distribute workload
A

Leader remain free of manual tasks.

Quality control from leader.

90
Q
  1. Mobilise all available resources.
A

Everyone and everything that can help.

Technology and people.

Skills and weaknesses are important resources.

91
Q
  1. Communicate effectively
A

Everyone on the same page.

Close the loop!!

92
Q
  1. Use all available information
A 
Complete picture:
Clinics impression
Vital signs
History 
Trends
93
Q
  1. Prevent and manage fixation errors.
A

Managing is getting a NEW view of situation not biased. Second opinion by someone NOT involved and don’t infect them.

Change perspective and step back to look at bigger picture.

94
Q
  1. Double check
A

Correlating what we already know from different sources.

Making sure what you remember you perceived is what you actually perceived.

95
Q
  1. Cognitive aids
A

Checklists and algorithms.

Look things up!

96
Q
  1. Re-evaluate
A

Don’t stick to initial decisions.

Things change in medicine and monitor trends!!

97
Q
  1. Teamwork
A

Respect members and weaknesses.

Team players should always think about what the other person will need next.

98
Q
  1. Allocate attention wisely
A

Not good at multitasking.

ABC sequence.

Don’t get fixated.

99
Q
  1. Set dynamic priorities.
A

Don’t stick to decisions.

After evaluation it may need new priorities and goals.

Ask for other views and opinions.

Advanced Life Support NZ (1 decks)

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