ALS Flashcards
Shockable rhythms
VF and pulseless VT
Non shockable rhythms
PEA and asystole
waveform capnography
Measures the amount of CO2 in exhaled air, which accesses ventilation. Normaly 35-45mmHG
If shockable rhythm what medicines should you give and how frequently
1mg Adrenaline every 3-5 mins
300mg amiodarone after 3 shocks
What are the main things you can do to help
High quality compressions, continuously if advanced airway (or 30:2 if not), minimise time not doing compressions, get IV/interosseous access, Adrenaline 3-5 mins, amiodarone after 3 shocks. identify and treat reversible causes
Reversible causes
4 Hs and 4 Ts
Hypoxia - ensure airway patent and ventilate with high flow oxygen (30-70L per min)
Hypovolemia - may be obvious (blood loss/diarrhoea/vomiting) or subtle (sepsis/anaphylaxis). Rapidly infuse IV fluids
Hypo/hyperkalaemia - normal = 3.6-5.2.
- Hypokalaemia = infusion of 10-40mmol potassium chloride per hr with 0.9% saline. max dose 240mmol. (hypomagnesmium too, infuse with saline. normal = 0.85-1.1mmol)
-Hyperkalaemia - Ca chloride followed by insulin/dextrose infusion.
Hypo/hyperthermia - measure temp. rewarming techniques - bear hugger, heat packs, blankets.
Thrombosis - coronary: Coronary angiography/percutaneous intervention
mechanical chest compressions to facilitate transfer/treatment
pulmonary: consider immediate fibrinolytic treatment (streptokinase?), thrombolytic treatment, heparin
tension pneumothorax - look for unilateral expansion of chest, shift of trachea, submit emphysema. pleural US or CXR. if incubated, check intubation of Right main bronchus. needle decompression or thoracostomy if ventilated.
tamponade - need Cardiac US. consider after penetrating chest trauma/after cardiac surgery, device implantation, or PCI. Needle pericardiocentesis/resuscitative thoracotomy.
toxins - review drug chart. unlikely unless deliberate overdose or suspicion of substance abuse.
After rOSC management
A-E
Aim for SPO2 94-98
12 lead ECG
Identify and treat cause
Targeted Temp management
Bloods to take/what to put through IV
500ml saline
Bloods - FBC, glucose, U&Es, VBG
SBARD
Situation - introduce self, say what has happened
Background - key medical aspects
Assessment
Recommendation
A-E assessment
Airway: Breath sounds/voice.
O2, suction, definitive airway
Breathing: Resp rate, Sats, chest movements, trachea position, Auscultate/percuss, O2. aim for 94-98%. (treat causes, e.g. chest drain for pneumothorax)
Circulation: Palor, HR, Cap refill, auscultate, BP, ECG monitoring. Gain IV access (fluids. take bloods: FBC, Glucose, VBG, U&Es, ?CRP, ?Cultures, ?Group and save)
Disability: ACVPU, GCS (limb movements, eye opening, verbal response), pupillary response, glucose (hypo if <4mmol),
Abdo exam - palpation, pain and organomegaly.
temperature
Exposure: expose skin, check back
Next steps:
Catheter, ABG, ITU input, Abx, troponin
What percent of patients have shockable vs non shockable rhythm, and which is more favourable
80% non shockable (PEA, Asystole). 15% survival to discharge
20% shockable (VF/pVT). 50% survival to discharge
why should you cardiac monitor
Arrest rhythms
syncope (unexplained, esp during exercise, structural heart disease, abnormal ecg eg prolonged QT)
chest pain
persistent arhythmia
shock/severe illness
electrolyte abnormalities
poisoning/overdose
during/after surgery
6 stage ecg approach
Any electrical activity?
What is the ventricular (QRS rate)
Is the QRS rhythm regular
is the QRS width normal
is atrial activity present? normal p waves? AF?, Atrial flutter?
How is atrial activity related to ventricular activity?
causes of PEA
Large Acute MI
Massive PE
Tension pneumothorax
Cardiac taponade
Acute, severe blood loss
T wave inversion can indicate
NSTEMI - get troponin to confirm
signs of a posterior MI
Reciprocal change in anterior (V2/3/4), ST segment depression.
and Inferior changes (I, II, III, AvF), ST elevation
ACS immediate treatment
Aprisin (300mg), O2, Morphine, Nitroglycerine
ideal urine output in ICU
> 0.5ml per kg per hr
normo capnia
Pa CO2 4.7-6 kpa
what rate should you rewarm someone
0.25 decrees per hour
describe temperature management
induce to 33 (32-36) (can be down by infusing 2l of cold crystalloid pollution before ICU), maintain for 24hrs, then rewarm
Main aspects of post-resus care
Airway/breathing (94-98)
Circulation.- fluids, Arterial BP monitoring (>100).
control temp - sedative to avoid shivering
treatment of NSTEMI or unstable angina
A-E
Antithrombotic (aspirin), Platelet inhibitor e.g clopidogrel/ticegrelor.
fadaparinux/LMWH
Nitrate
morphine
Oxygen
Myocardial protection; Beta blocker, coronary angiography/PPCI in most patients
Treatment of STEMI (or MI with new LBBB)
Most likely complete blockage
A-E
Emergency repercussion therapy
PPCI (primary percutaneous coronary intervention)
Fibrinolytic therapy if no access to PPCI. (higher risk of bleeding)
avoid delay!
