Advanced Life Support (ALS) Flashcards
What are the chances of surviving a cardiac arrest in the hospital?
In hospital, the chances of surviving to discharge are about 15-20%
What are the components of the Chain of Survival? (4)
What is the range of temperatures in Targeted temperature management?
- targeted temperature management (TTM) is now preferred to therapeutic hypothermia
- maintenance of a constant temperature between 33°C and 36°C for at least 24 hours
ALS algorithm
What else to do/consider during CPR? (4)
- give oxygen
- vascular access (IV or intraosseous)
- Adrenaline every 3-5 minutes
- Amiodarone after 3 shocks
Reversible causes of cardiac arrest
Hs:
- hypoxia
- hypothermia
- hypovolaemia
- hyper/hypokalaemia (metabolic)
Ts:
- tamponade (cardiac tamponade)
- tension pneumothorax
- thrombosis (pulmonary or cardiac)
- toxins
First (4) steps in assessment of a collapsed/unconscious person
- Check the patient for a response
- Open the airway with a head tilt or chin lift
- Look, listen and feel for normal breathing* at the same time as checking for a carotid pulse for a maximum of 10 seconds
- If there are no signs of life, i.e. no normal breathing or pulse, name an assistant to call the cardiac arrest team and start CPR
How does agonal breathing look like?
Slow, sighing respirations
How deep and at what rate the chest compressions should be performed?
- depressing the sternum by 5-6 cm
- at a rate of 100-120 compressions per minute
Before obtaining a definite airway, how the ventilation should be provided (2)?
- A bag-valve mask
OR
- A pocket mask
What to remember about when using a bag-valve-mask? (3)
- Ensure that it is attached to the oxygen outlet with a flow of 15 litres per minute and inflate the reservoir bag
- Administer two ventilations for every 30 compressions
- Be sure the chest is rising during the ventilations
When should we attach a defibrillator?
As soon as possible → to determine the underlying rhythm
What are shockable rhythms? (2)
The shockable rhythms are:
- Ventricular fibrillation (VF)
- Pulseless ventricular tachycardia (pVT)
What are non-shockable rhythms?
The non-shockable rhythms are:
- Pulseless electrical activity (PEA)
- Asystole
Describe this ECG
The ECG demonstrates a bizarre irregular waveform. No recognizable QRS complexes are present. The rhythm is random frequency and amplitude.
This rhythm is known as ventricular fibrillation (VF) and represents random uncoordinated ventricular electrical activity.
Describe that rhythm
What’s the management?
- The ECG shows a broad complex tachycardia with uniform QRS morphology
- In the setting of a patient in cardiac arrest, this rhythm should be assumed to be ventricular in origin and treated as ventricular tachycardia
- Both ventricular fibrillation and pulseless ventricular tachycardia should be treated by defibrillation.
Shockable rhythm defibliration algorithm
What is that?
Management
This is asystole.
There are no p waves and no QRS complexes. The rhythm is rarely a completely flat line. A completely flat line would suggest lead disconnection.
Management:
Follow the non-shockable side of the algorithm:
- Start or continue CPR
- Administer 1 mg IV adrenaline
- Check the leads are correctly attached during CPR
- Look for and treat potentially reversible causes of the arrest
Patient is confirmed to be in a cardiac arrest and this is his ECG
What’s the diagnosis?
- The patient is in PEA (Pulseless Electrical Activity)
- This occurs when clinical features of cardiac arrest are present with an ECG that is normally associated with an output
Management of a non-shockable rhythm
- Chest compressions immediately and 1 mg IV adrenaline is given
- Continue CPR for 2 minutes then pause briefly for a second rhythm check
if electrical activity compatible with a pulse is seen, check for a pulse and signs of life:
- If no pulse or no signs of life are present continue CPR immediately and recheck the rhythm after a further 2 minutes. Give adrenaline 1 mg IV every 3-5 minutes or on alternate 2 minute cycles
- If a pulse or signs of life are present, start post resuscitation care
- If VF or pVT at rhythm check, change to the shockable side of algorithm
- If in asystole, check the ECG for the presence of p waves, because the patient may respond to cardiac pacing when in ventricular standstill with continuing p waves
What’s End-tidal CO2 and waveform capnography are used for?
End-tidal CO2 and waveform capnography
This is useful for a number of reasons including:
- Ensuring correct tracheal tube placement
- Monitoring rate of ventilation
- Monitoring quality of CPR
- Identifying ROSC
- Making a prognosis, with caution
Treatment of cardiac tamponade
needle pericardiocentesis or resuscitative thoracotomy
Treatment of thrombosis
thrombolytic drug (given immediately if it’s a suspected cause of a cardiac arrest)
Treatment for tension pneumothorax
Decompress rapidly by needle thoracocentesis, and then insert a chest drain
Treatment of toxins as a cause of cardiac arrest
antidotes and/or supportive care
What to do first when there is a witnessed, shockable cardiac arrest while a patient is on a monitor?
Witnessed cardiac arrest while on a monitor - up to three successive shocks before CPR
