Advanced life support (ALS/Cardiac arrest) [Complete]

Question 1

What is the survival rate (hospital discharge rate) of patients who have a cardiac arrest outside of hospital?

Answer 1

9%

Question 2

What is the survival rate (hospital discharge rate) of patients with cardiac arrest which happened in hospital?

Answer 2

24%

Question 3

What are the main causes of cardiac arrest?

Answer 3

4Hs and 4Ts

Hypoxia

Hypovolaemia

Hyper/hypokalaemia (and other electrolyte abnormalities)

Hypo/hyperthermia

Thromboembolism

Tamponade

Tension pneumothorax

Toxins

Question 4

What is the most common cause of cardiac arrest?

Answer 4

VF due to coronary artery disease

Question 5

What are considered shockable rhythms?

Answer 5

Pulseless ventricular tacchycardia

Ventricular fibrillation

Question 6

What is the management for patients with shockable rhythm?

Answer 6

1) DR ABDE

2) Call for help/cardiac arrest call [2222]

3) Compressions (30 + 2 rescue breaths) + secure airway

4) Defibrillation (Unsynchronised cardioversion 120-360J) ASAP

5) Resume CPR for 2 minutes followed by further shocks + rhythm checks

6) After third shock: IV 1mg adrenaline + 300mg amiodarone

7) 1mg adrenaline every 3-5 minutes + 150mg amiodarone every 5 shocks

Question 7

What should be done in the meantime whilst someone is doing compressions?

Answer 7

Secure airway

Give high-flow oxygen

Gain IV access (or intraosseous)

Treat reversible causes
* Hypovolaemia = IV fluids
* PE = thrombolysis
* Point of care ultrasound (POCUS) : Check for cardiac tamponade/pneumothorax

Question 8

What should initially be done to secure the airway before advanced airway placement?

Answer 8

Oropharyngeal/nasopharyngeal airway + bag valve mask for ventilation

Question 9

What advanced airway interventions can be performed during CPR?

Answer 9

Endotracheal intubation (provides secure airway)

Supraglottic airway (i-gel/laryngeal mask airway): If intubation not possible/difficult

Question 10

What is performed to confirm correct positioning of endotracheal tube?

Answer 10

Waveform capnography (measuring end-tidal carbon dioxide)

Question 11

What should be done before administering a shock?

Answer 11

Ensure no one is touching the patient

Remove oxygen (ventilatory equipment can stay intact)

Question 12

If IV access cannot be obtained, what alternative should be attempted?

Answer 12

Intraosseous (IO) acces

Question 13

What imaging can be used to determine whether cardiac tamponade/pneumothorax is an underlying cause of cardiac arrest?

Answer 13

Point of care ultrasound (POCUS)

Question 14

What are considered non-shockable rhythms?

Answer 14

Pulseless electrical activity

Asystole

Question 15

What is pulseless electrical activity?

Answer 15

Electrical activity that should produce a pulse, but doesn’t due to absent or insufficient cardiac output

Question 16

How are patients with non-shockable rhythms managed?

Answer 16

1) DR ABCDE

2) Call for help/cardiac arrest call [2222]

3) CPR (30:2)

4) IV/IO access + 1mg adrenaline ASAP

5) Give 1mg adrenaline every 3-5 minutes

6) Only perform defibrillation/ give amiodarone if rhythm changes to shockable

Question 17