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ALS Flashcards

1
Q

NSTEMI/unstable angina care caused by what?

A

Transient or non complete occlusion of coronary artery

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1
Q

Troponin reflects what?

A

Extent of cardiac muscle damage

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2
Q

in Ventricular fibrillation - amiodarone should be given after how many shocks?

A

3

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3
Q

what dose of amiodarone is given in shockable rhythms?

A

300mg

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4
Q

when is adrenaline given in shockable rhythms?

A

After 3rd shock

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5
Q

what dose of adrenaline is given in cardiac arrest?

A

1 in 10,000 1mg

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6
Q

if ventilation is effective should you intubate the patient?W

A

No- await ROSC

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7
Q

in what environment can the 3 shock 360J shock be used?

A

monitored arrest in cardiac lab

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7
Q

immeadiately after cardiac arrest there is what electrolyte abnormality?

A

Hyperkalaemia

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8
Q

non invasive cardiac output monitoring improves outcome - true or false

A

False

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9
Q

non invasive cardiac output monitoring guides treatment - true or false

A

True

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10
Q

immediately after cardiac arrest there is a period of cerebral hyperaemia - true or false

A

True

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11
Q

Cerebral hypo perfusion occurs after cardiac arrest for approximately how long?

A

24 hours

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12
Q

seizures or myoclonus occur in what percentage of patients after ROSC?

A

5-15%

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13
Q

how many patients remain comatose after ROSC?

A

10-40%

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14
Q

what is more common after ROSC - myoclonus or seizures?

A

seizures

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15
Q

ventricular fibrillation duration affects success of resuscitation attempt - true or false

A

True
Shorter duration to VT

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16
Q

defibrillation should be attempted during inspiration or expiration?

A

Expiration

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17
Q

ventilation movements affect success of defibrillation - true or false

A

True as this affects transthoracic impedance

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18
Q

Paddle polarity affects defibrillation success - True or false

A

False - although marked positive and negative each can be placed in either location at cardiac apex or right sternum

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19
Q

position of electrodes is fixed - Yes or no

A

No - acceptable positions include Antero-posterior, postern-lateral, bi-axillary

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20
Q

Transthoracic impedance is lowest in what phase of ventilation

A

Expiration

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21
Q

transthoracic impedance means what?

A

Electrical resistance

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22
Q

what is the first line route for drug administration in cardiac arrest?

A

IV

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23
Q

what is the second line route for drug administration in cardiac arrest?

A

IO

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24
Q

all drugs can be safely IO route in arrest situations - true or false

A

True

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25
Q

peak drug concentrations are higher when inserted via central venous line - true or false

A

True

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26
Q

why is peripheral line drugs administration preferred over central line administration in cardiac arrest?

A

quick to insert
does not interrupt CPR
(can be used if already in place)

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27
Q

what are some primary assessment methods of correct tracheal tube placements?

A
  • observation of chest expansion
  • auscultation to lung fields, axilla, epigastric,
  • Clinical signs - condensation in tube, chest rise
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28
Q

what are 2 of the secondary assessment methods of tracheal tube placement?

A
  • Oesophageal detector device
  • waveform capnography
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29
Q

what is the most sensitive and specific way to confirm tracheal tube position?

A

Waveform capnography

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30
Q

waveform capnography distinguishes between bronchial and tracheal tube placement - true or false

A

False

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31
Q

what is the time limit for tracheal intubation attempt to interrupt chest compressions?

A

<10 seconds

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32
Q

in oesophageal detector device the likelihood of tracheal placement is high if how much gas is withdrawn from the ETT into the bulb without resistance?

A

> 30ml gas

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33
Q

what drug can be used to treat tricyclic antidepressant overdose in resuscitation?

A

Sodium bicarbonate

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34
Q

sodium bicarbonate should be used at what dose?

A

8.4% 50mmol

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35
Q

when can sodium bicarbonate be used in rescucitation?

A

Life threatening hyperkalaemia
Cardiac arrest associated with hyperkalaemia
Tricyclic overdose

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36
Q

vagal manœuvres will terminate what percentage of episodes of paroxysmal SVT?

A

one quarter

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37
Q

Synchronised DC cardio version should be used in pulseless VT - true or false

A

FALSE
Follow ALS - unsynchronised shock

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38
Q

in tachycardia with adverse features with pulse what kind of shock is given?

A

Synchronised DC shock
120-150J biphasic shock increasing in increments

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39
Q

in regular narrow complex tachycardia without adverse features what is the standard management?

A

Vagal Manouvres
IV adenosine

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40
Q

What dose of adenosine is used in narrow complex tachycardia? (stable)

A

6mg –> 12mg –> 12mg
Then seek help

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41
Q

in a stable patient with regular broad complex tachycardia what dose of amiodarone is given?

A

300mg over 20-60 mins then 900mg over 24 hours

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42
Q

in unstable tachycardia after DC shock what drug is given?

A

Amiodarone
300mg over 10-20mins then 900mg over 24 h

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43
Q

in bradycardia glucagon may be used as a treatment in what circumstances?

A

If caused by beta blocker or calcium channel blocker

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44
Q

what is the first line drug used in bradycardia with adverse features?

A

Atropine 500mcg

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45
Q

if atropine is unsuccessful what further measures can be taken?

A

Atropine 500mcg to 3mg OR
Transcutaneous pacing OR
Isoprenaline infusion 5cm/min
Adrenaline 1-10mcg/min

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46
Q

Q waves in which leads are pathological?

A

Right sided leads V1-V3

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47
Q

posterior MI causes changes in which anterior leads?

A

Reciprocal changes in V1-V3 - ie. ST depression, dominant R wave,

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48
Q

new left bundle branch block is an indication of a STEMI - true or false

A

True

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49
Q

when are Q waves pathological?

A

> 40 ms (1 mm) wide
2 mm deep
25% of depth of QRS complex
Seen in leads V1-3

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50
Q

in transcutaneous pacing what capture voltage is used?

A

5-10amps

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51
Q

continued failure to achieve electrical capture may indicate what?

A

Non viable myocardium
OR
Condition that presents successful pacing

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52
Q

hyperkalaemia can prevent successful pacing - true or false

A

true

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53
Q

A QRS complex guarantees myocardial contractility

A

False

A QRS complex without a pulse - ie. PEA

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54
Q

12 lead ECG is the best form of monitoring in resuscitation - true or false

A

True but not always quickest emergency setting

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55
Q

a normal PR interval is what length?

A

0.12-0.2 seconds (3-5 small sq)

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56
Q

a normal QRS complex is what length?

A

<0.12seconds
(3 small sq)

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57
Q

hypoxia and hypovolaemia are commonly seen in PEA - true or false

A

True

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58
Q

PEA means what?

A

Evidence of ventricular activity on ECG without detectable cardiac output

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59
Q

Asystole means what?

A

Complete absence of demonstrable electrical and mechanical electrical activity

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60
Q

where there is no communication between atria and ventricles this is called what?

A

3rd degree AV block

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61
Q

PR interval elongates until QRS is dropped - refers to what type of heart block?

A

2nd degreee, Mobitz I

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62
Q

Normal PR interval where QRS is regularly missed is called what?

A

2nd degree heart block, Mobitz II

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63
Q

which is more dangerous- Mobitz I or II heart block?

A

Mobitz II - can lead to haemodynamic instability and 3rd degree heart block

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64
Q

what is 1st degree heart block?

A

PR interval >0.2x

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65
Q

Torsades de pointes is a form of what type of ventricular tachycardia?

A

Polymorphic VT

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66
Q

what are the ECG changes in AF?

A

No P waves
irregularly irregular rhythm
Fibrillatory waves

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67
Q

What ECG signs are present in bundle branch block?

A

Wide QRS >2seconds

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68
Q

‘William’ - W in V1 and M in V6 is a sign of what ECG abnormality?

A

LBBB

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69
Q

‘Marrow’ - M in V1 and W in V6 is a sign of what ECG abnormality?

A

RBBB

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70
Q

what ECG changes are caused by hyperkalaemia?

A

Tall tented T waves
Prolonged PR
P wave flattening
VF

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71
Q

Hypocalcaemia causes what changes in an ECG?

A

Prolonged QTc interval

72
Q

Agonal breathing is an early sign of cardiac arrest and should start CPR - true or false

A

True

73
Q

A break in CPR should be made for ventilation prior to an advanced airway being inserted - true or false

A

True

74
Q

CPR should occur at what rate?

A

100-120 compressions per min

75
Q

adrenaline acts on what receptors?

A

Alpha and beta agonist

76
Q

adrenaline causes systemic vasocontriction - true or false

A

True (alpha effect)

77
Q

fast loading of amiodarone can cause hypertension or hypotension?

A

Hypotension

78
Q

amiodarone has a long or short half life?

A

Long half life

79
Q

how does amiodarone work?

A

Prolongs duration of action potential and refractory period in both atrial and ventricular tissue

80
Q

what ECG changes can amiodarone cause?

A
  • Slow sinus HR
  • Prolong PR interval
  • Widen QRS
  • Prolong QT interval
81
Q

through what mechanism is tricyclic overdose harmful to the myocardium?

A

Sodium channel blockage slowing of depolarisation of the cardiac action potential through the myocardium and conducting tissue.

82
Q

what ECG features are seen in tricyclic overdose?

A

Widened QRS
Prolonged QTc

83
Q

when should sodium bicarb be used in tricyclic overdose?

A
  • acidosis
  • QRS >120ms
  • arrhythmias
  • hypotension resistant to fluid resuscitation
84
Q

what fluid can be given in TCA overdose in arrhythmias?

A

Hypertonic saline - can reverse sodium blockage

85
Q

what concentration of oxygen is achieved if a bag mask reservoir system is attached to maximum oxygen flow?

A

85%

86
Q

how many people should be a part of optimal bag mask ventilation?

A

2 - hold seal

87
Q

does the patients expired air refill the reservoir bag in bag mask ventilation?

A

No - goes out via one way valve

88
Q

limb should be elevated for 10-20s after giving drugs peripherally - true or false

A

True

89
Q

amiodarone is highly irritant to peripheral veins - true or false

A

true

90
Q

atrial and ventricular systole produces what trace on ECG?

A

line with no deflections but with slight undulation of baseline

91
Q

heart’s electrical current flows toward its positive axis for which lead?

A

Lead II

92
Q

which lead is used most commonly to monitor ECG?

A

Lead II - hearts electrical current flows towards its positive axis

93
Q

initial assessment for signs of life in an unconscious patient should take how long?

A

10 seconds

94
Q

a cycle of CPR lasts how long?5-6

A

2 mins

95
Q

high quality chest compressions achieve a depth of what?

A

5-6cm

96
Q

you should allow the chest to recoil completely when performing high quality chest compressions - true or false

A

True

97
Q

lidocaine 1mg/kg may be given as an alternative to amiodarone in shockable rhythms- true or false

A

true

98
Q

Torsades de pointes may be treated with what drug?

A

Magnesium sulfate 2mg IV followed by maintenance infusion

99
Q

what is the standard recommended positioning of electrodes in cardiac arrest?

A

One electrode to right of upper sternum below clavicle and other electrode in mid axillary line in level with V6

100
Q

what is the survival to discharge rate of inhospital cardiac arrest?

A

24%

101
Q

what is the survival rate of out of hospital cardiac arrest?

A

10%

102
Q

what is the most common rhythm in cardiac arrest?

A

PEA

103
Q

simple airway manoeuvres such as head tilt, chin lift, and jaw thrust resolves airway obstruction most of the time - true or false

A

true

104
Q

what blood glucose should you aim for in critically unwell patients?

A

> 4mmol

105
Q

post arrest brain injury occurs in what percentage of out of hospital cardiac arrest that have survived to ITU?

A

68%

106
Q

Myocardial stunting ie reduction in LVEF occurs for how long after cardiac arrest?

A

72 hours

107
Q

which of decorticate or decerebrate posturing would earn 3 on the glasgow coma scale?

A

decorticate

108
Q

which of decorticate or decerebrate posturing would earn 3 on the glasgow coma scale?

A

decerebrate - brainstem damage

109
Q

what device can be inserted into the aorta via the femoral artery and are programmed to inflate during diastole. This increases the intra-aortic pressure during diastole, which ultimately increases coronary artery perfusion as this takes place almost exclusively during this stage of the cardiac cycle.

A

intra aortic balloon pump

110
Q

what urine output figure should you aim for after ROSC?

A

0.5ml/kg/hr

111
Q

seizures increase cerebral metabolism - true or false

A

true

112
Q

a period of mild hypothermia may improve neurological outcome after cardiac arrest - true or false

A

True

113
Q

hypercapnia causes cerebral blood vessel dilatation - true or false

A

True

114
Q

what effect does hypocapnia have on cerebral blood flow?

A

causes cerebral vasoconstriction and therefore decreases blood flow

115
Q

what temperature target should be aimed for after ROSC for 24 hrs?

A

32-36 degrees

116
Q

at what rate should rewarming take place?

A

0.25°C h-1 to reduce the incidence of electrolyte abnormalities and cardiovascular instability.

117
Q

hypothermia can cause what effects?

A

Shivering
arrhythmias
increased infection rates
electrolyte abnormalities and diuresis
hyperglycaemia
increase amylase concentration
slower clearance of sedative drugs

118
Q

prognostication after ROSC from cardiac arrest should occur at what point?

A

72hr

119
Q

myocardial contractility is impaired for how long afterr ROSC?

A

2-3 days

120
Q

should antiepileptics be used in the absence of seizures?

A

no

121
Q

most patients will be actively cooled post cardiac arrest - true or false

A

true

122
Q

how is mild hypotheramia typically initiated in patients post cardiac arrest?

A

2L ice cold crystalloid

123
Q

cooling should be delayed until the patient is on ITU - true or false

A

Falase

124
Q

how long is the normal QRS complex?

A

0.12s

125
Q

patients with continued atrial activity and ventricular standstill have a better outcome than no activity at all - true or false

A

true - may respond to ventricular pacing

126
Q

in atrial fibrillation there is no relationship between atrial and ventricular activity - true or false

A

true

127
Q

conduction through the AV node is relatively slow = true or false

A

true

128
Q

the AV node connects to what

A

bundle of his

129
Q

a negative T wave is normal in which leads

A

aVR, can be in V1, lead III

130
Q

pathological bradycardia is caused by what

A

malfunction of the SA node or from partial or complete failure of atrioventricular conduction.

131
Q

what is first degree AV block?

A

PR interval >0.2, can be normal

132
Q

what is Mobitz Type I AV block (also called Wenckebach AV block)

A

progressive prolongation after each successive P wave until a P wave occurs without a resulting QRS complex

133
Q

implanted devices that deliver pacing include

A
  • pacemakers implanted for the treatment of bradycardia
    (single or dual-chamber)
  • biventricular pacemakers (implanted for left ventricular failure)
  • ICDs (which have pacing capability).
134
Q

percussion pacing may be used in preference to CPR in what circumstances?

A

when bradycardia is so profound it causes cardiac arrest

135
Q

patients should be given analgesia and sedation for transcutaneous pacing - true or false

A

True

136
Q

skin changes alone can indicate anaphylaxis - true or false

A

false

137
Q

An infusion of IV lipid may be required if cardiac arrest occurs after an epidural infusion has been started and local anaesthetic toxicity is suspected- true or false

A

true

138
Q

cardiac arrest in pregnancy - early delivery should be considered if the fetes is how old?

A

> 20 weeks

139
Q

seizures are a complication of flumenazil - true or false

A

true

140
Q

gastric lavage is indicated in tricyclic overdose

A

FALSE - contraindicated

141
Q

cardiac arrest is a secondary event in drowning victims

A

true

142
Q

adrenaline provides short or long term benefits in cardiac arrest

A

short term

143
Q

what is the dose of adrenaline infusion that can be given in bradycardia?

A

2-10mcg/min IV

144
Q

what is the dose of isoprenaline that can be given in bradycardia?

A

infusion 5mcg/min IV

145
Q

absence of pupillary light and corneal light reflexes at 72hrs post ROSC can aid prognostication - true or false

A

True

146
Q

post ROSC what PaCO2 should be aimed for?

A

normocapnia

147
Q

sodium bicarbonate facilitates release of oxygen to tissues - true or false

A

False - shifts O2 dissociation curve to left, inhibiting o2 release to tissues

148
Q

Primary PCI should be done within what time frame of call for help?

A

120min

149
Q

what initial shock energy should be used in shockable rhythms?

A

120J atleast, increase for subsequent shocks if needed

150
Q

what dose of magnesium sulphate can be given in asthma to aid bronchodilation?

A

2mg IV

151
Q

in anaphylaxis what dose of adrenaline is given?

A

0.5mg IM

152
Q

steroids are given early in anaphylaxis - true or false

A

False
*may be used if ongoing asthma like features

153
Q

what is considered severe hyperkaleamia

A

> 6.5

154
Q

Mobitz type I or type II is more likely to progress to asystole?

A

Type II

155
Q

in pts with an ICD where should the self adhesive pads be placed?

A

Atleast 10-15cm away from ICD or in anteroom-posterior position

156
Q

troponin may be increased in PE - true or false

A

true

157
Q

major surgery within how many weeks is an absolute contraindication to fibrinolytic therapy

A

3 weeks

158
Q

Hi-flow oxygen produces an inspired FIO2 of what percentage?

A

80%

159
Q

if a pt is receiving high flow O2 what would you expect there PaO2 to be?

A

60-70kPA

160
Q

following ROSC what should the pt blood glucose be maintained at ?

A

4-10mmol

161
Q

ventricular fibrillation can be associated with cardiac output - true or false?

A

False

162
Q

300 divided by the number of large squares between each R wave equates to what

A

heart rate

163
Q

what dose of glucose should be given in an insulin-glucose infusion for hyperkalaemia?

A

50ml 50% glucose with 10 units insulin

164
Q

what dose of insulin should be given in treatment of hyperkalaemia?

A

10 units with 50ml of 50% glucose/125ml 20% glucose

165
Q

what drug should be used for cardio protection in hyperkalaemia?

A

10ml 10% calcium chloride IV or 30ml 10% calcium gluconate IV

166
Q

dialysis in hyperkalaemia in what situation?

A

Hyperkalaemia resistant ti medical treatment
end stage renal disease
Oluguric AKI
Marked tissue breakdown

167
Q

what electrolyte abnormality causes U waves?

A

Hypokalaemia

168
Q

what are the ECG features of hypokalaemia?

A

U waves
T wave flattening
ST segment changes

169
Q

what ECG changes are seen in hypercalcaemia?

A

Short QT interval
Prolonged QRS interval
Flat T waves
AV block

170
Q

what ECG changes are seen in hypocalcaemia?

A

Prolonged QT interval
T wave inversion
Heart block

171
Q

low magnesium causes what ECG changes?

A

Prolonged PR and QT intervals
ST segment depression
T wave inversion
Flattened P waves
Increase QRS
Torsades de pointes

172
Q

hypermagnesaemia causes what?

A

Prolonged PR and QT intervals
T wave peaking
AV block

173
Q

activated charcoal can be used within what time period of poisoning?

A

1 hr

174
Q

routine use of gastric lavage is recommended in poisoning - true or false

A

False

175
Q

Flumenazil is associated with severe toxicity - true or false

A

True - seizure, arrhythmia, hypotension

176
Q

mydriasis, fever, dry skin, delirium, tachycardia, ileus and urianry retention are examples of what?

A

Anticholingergic effects

177
Q

the hypothermic heart may be unresponsive to cardio-active drugs - true or false

A

True (and also electrical pacing and attempted defibrillation)

178
Q

atropine is a parasympathetic antagonist that blocks the action of acetylcholine - true or false

A

true

179
Q

Bilaterally absent N20 SEEP wave indicated a poor outcome post ROSC - true or false

A

true

180
Q
A

ALS (1 decks)

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