ALS Flashcards
(182 cards)
1
Q
NSTEMI/unstable angina care caused by what?
A
Transient or non complete occlusion of coronary artery
1
Q
Troponin reflects what?
A
Extent of cardiac muscle damage
2
Q
in Ventricular fibrillation - amiodarone should be given after how many shocks?
A
3
3
Q
what dose of amiodarone is given in shockable rhythms?
A
300mg
4
Q
when is adrenaline given in shockable rhythms?
A
After 3rd shock
5
Q
what dose of adrenaline is given in cardiac arrest?
A
1 in 10,000 1mg
6
Q
if ventilation is effective should you intubate the patient?W
A
No- await ROSC
7
Q
in what environment can the 3 shock 360J shock be used?
A
monitored arrest in cardiac lab
7
Q
immeadiately after cardiac arrest there is what electrolyte abnormality?
A
Hyperkalaemia
8
Q
non invasive cardiac output monitoring improves outcome - true or false
A
False
9
Q
non invasive cardiac output monitoring guides treatment - true or false
A
True
10
Q
immediately after cardiac arrest there is a period of cerebral hyperaemia - true or false
A
True
11
Q
Cerebral hypo perfusion occurs after cardiac arrest for approximately how long?
A
24 hours
12
Q
seizures or myoclonus occur in what percentage of patients after ROSC?
A
5-15%
13
Q
how many patients remain comatose after ROSC?
A
10-40%
14
Q
what is more common after ROSC - myoclonus or seizures?
A
seizures
15
Q
ventricular fibrillation duration affects success of resuscitation attempt - true or false
A
True
Shorter duration to VT
16
Q
defibrillation should be attempted during inspiration or expiration?
A
Expiration
17
Q
ventilation movements affect success of defibrillation - true or false
A
True as this affects transthoracic impedance
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
19
Q
position of electrodes is fixed - Yes or no
A
No - acceptable positions include Antero-posterior, postern-lateral, bi-axillary
20
Q
Transthoracic impedance is lowest in what phase of ventilation
A
Expiration
21
Q
transthoracic impedance means what?
A
Electrical resistance
22
Q
what is the first line route for drug administration in cardiac arrest?
A
IV
23
what is the second line route for drug administration in cardiac arrest?
IO
24
all drugs can be safely IO route in arrest situations - true or false
True
25
peak drug concentrations are higher when inserted via central venous line - true or false
True
26
why is peripheral line drugs administration preferred over central line administration in cardiac arrest?
quick to insert
does not interrupt CPR
(can be used if already in place)
27
what are some primary assessment methods of correct tracheal tube placements?
- observation of chest expansion
- auscultation to lung fields, axilla, epigastric,
- Clinical signs - condensation in tube, chest rise
28
what are 2 of the secondary assessment methods of tracheal tube placement?
- Oesophageal detector device
- waveform capnography
29
what is the most sensitive and specific way to confirm tracheal tube position?
Waveform capnography
30
waveform capnography distinguishes between bronchial and tracheal tube placement - true or false
False
31
what is the time limit for tracheal intubation attempt to interrupt chest compressions?
<10 seconds
32
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?
>30ml gas
33
what drug can be used to treat tricyclic antidepressant overdose in resuscitation?
Sodium bicarbonate
34
sodium bicarbonate should be used at what dose?
8.4% 50mmol
35
when can sodium bicarbonate be used in rescucitation?
Life threatening hyperkalaemia
Cardiac arrest associated with hyperkalaemia
Tricyclic overdose
36
vagal manœuvres will terminate what percentage of episodes of paroxysmal SVT?
one quarter
37
Synchronised DC cardio version should be used in pulseless VT - true or false
FALSE
Follow ALS - unsynchronised shock
38
in tachycardia with adverse features with pulse what kind of shock is given?
Synchronised DC shock
120-150J biphasic shock increasing in increments
39
in regular narrow complex tachycardia without adverse features what is the standard management?
Vagal Manouvres
IV adenosine
40
What dose of adenosine is used in narrow complex tachycardia? (stable)
6mg --> 12mg --> 12mg
Then seek help
41
in a stable patient with regular broad complex tachycardia what dose of amiodarone is given?
300mg over 20-60 mins then 900mg over 24 hours
42
in unstable tachycardia after DC shock what drug is given?
Amiodarone
300mg over 10-20mins then 900mg over 24 h
43
in bradycardia glucagon may be used as a treatment in what circumstances?
If caused by beta blocker or calcium channel blocker
44
what is the first line drug used in bradycardia with adverse features?
Atropine 500mcg
45
if atropine is unsuccessful what further measures can be taken?
Atropine 500mcg to 3mg OR
Transcutaneous pacing OR
Isoprenaline infusion 5cm/min
Adrenaline 1-10mcg/min
46
Q waves in which leads are pathological?
Right sided leads V1-V3
47
posterior MI causes changes in which anterior leads?
Reciprocal changes in V1-V3 - ie. ST depression, dominant R wave,
48
new left bundle branch block is an indication of a STEMI - true or false
True
49
when are Q waves pathological?
> 40 ms (1 mm) wide
> 2 mm deep
> 25% of depth of QRS complex
Seen in leads V1-3
50
in transcutaneous pacing what capture voltage is used?
5-10amps
51
continued failure to achieve electrical capture may indicate what?
Non viable myocardium
OR
Condition that presents successful pacing
52
hyperkalaemia can prevent successful pacing - true or false
true
53
A QRS complex guarantees myocardial contractility
False
A QRS complex without a pulse - ie. PEA
54
12 lead ECG is the best form of monitoring in resuscitation - true or false
True but not always quickest emergency setting
55
a normal PR interval is what length?
0.12-0.2 seconds (3-5 small sq)
56
a normal QRS complex is what length?
<0.12seconds
(3 small sq)
57
hypoxia and hypovolaemia are commonly seen in PEA - true or false
True
58
PEA means what?
Evidence of ventricular activity on ECG without detectable cardiac output
59
Asystole means what?
Complete absence of demonstrable electrical and mechanical electrical activity
60
where there is no communication between atria and ventricles this is called what?
3rd degree AV block
61
PR interval elongates until QRS is dropped - refers to what type of heart block?
2nd degreee, Mobitz I
62
Normal PR interval where QRS is regularly missed is called what?
2nd degree heart block, Mobitz II
63
which is more dangerous- Mobitz I or II heart block?
Mobitz II - can lead to haemodynamic instability and 3rd degree heart block
64
what is 1st degree heart block?
PR interval >0.2x
65
Torsades de pointes is a form of what type of ventricular tachycardia?
Polymorphic VT
66
what are the ECG changes in AF?
No P waves
irregularly irregular rhythm
Fibrillatory waves
67
What ECG signs are present in bundle branch block?
Wide QRS >2seconds
68
'William' - W in V1 and M in V6 is a sign of what ECG abnormality?
LBBB
69
'Marrow' - M in V1 and W in V6 is a sign of what ECG abnormality?
RBBB
70
what ECG changes are caused by hyperkalaemia?
Tall tented T waves
Prolonged PR
P wave flattening
VF
71
Hypocalcaemia causes what changes in an ECG?
Prolonged QTc interval
72
Agonal breathing is an early sign of cardiac arrest and should start CPR - true or false
True
73
A break in CPR should be made for ventilation prior to an advanced airway being inserted - true or false
True
74
CPR should occur at what rate?
100-120 compressions per min
75
adrenaline acts on what receptors?
Alpha and beta agonist
76
adrenaline causes systemic vasocontriction - true or false
True (alpha effect)
77
fast loading of amiodarone can cause hypertension or hypotension?
Hypotension
78
amiodarone has a long or short half life?
Long half life
79
how does amiodarone work?
Prolongs duration of action potential and refractory period in both atrial and ventricular tissue
80
what ECG changes can amiodarone cause?
- Slow sinus HR
- Prolong PR interval
- Widen QRS
- Prolong QT interval
81
through what mechanism is tricyclic overdose harmful to the myocardium?
Sodium channel blockage slowing of depolarisation of the cardiac action potential through the myocardium and conducting tissue.
82
what ECG features are seen in tricyclic overdose?
Widened QRS
Prolonged QTc
83
when should sodium bicarb be used in tricyclic overdose?
- acidosis
- QRS >120ms
- arrhythmias
- hypotension resistant to fluid resuscitation
84
what fluid can be given in TCA overdose in arrhythmias?
Hypertonic saline - can reverse sodium blockage
85
what concentration of oxygen is achieved if a bag mask reservoir system is attached to maximum oxygen flow?
85%
86
how many people should be a part of optimal bag mask ventilation?
2 - hold seal
87
does the patients expired air refill the reservoir bag in bag mask ventilation?
No - goes out via one way valve
88
limb should be elevated for 10-20s after giving drugs peripherally - true or false
True
89
amiodarone is highly irritant to peripheral veins - true or false
true
90
atrial and ventricular systole produces what trace on ECG?
line with no deflections but with slight undulation of baseline
91
heart’s electrical current flows toward its positive axis for which lead?
Lead II
92
which lead is used most commonly to monitor ECG?
Lead II - hearts electrical current flows towards its positive axis
93
initial assessment for signs of life in an unconscious patient should take how long?
10 seconds
94
a cycle of CPR lasts how long?5-6
2 mins
95
high quality chest compressions achieve a depth of what?
5-6cm
96
you should allow the chest to recoil completely when performing high quality chest compressions - true or false
True
97
lidocaine 1mg/kg may be given as an alternative to amiodarone in shockable rhythms- true or false
true
98
Torsades de pointes may be treated with what drug?
Magnesium sulfate 2mg IV followed by maintenance infusion
99
what is the standard recommended positioning of electrodes in cardiac arrest?
One electrode to right of upper sternum below clavicle and other electrode in mid axillary line in level with V6
100
what is the survival to discharge rate of inhospital cardiac arrest?
24%
101
what is the survival rate of out of hospital cardiac arrest?
10%
102
what is the most common rhythm in cardiac arrest?
PEA
103
simple airway manoeuvres such as head tilt, chin lift, and jaw thrust resolves airway obstruction most of the time - true or false
true
104
what blood glucose should you aim for in critically unwell patients?
>4mmol
105
post arrest brain injury occurs in what percentage of out of hospital cardiac arrest that have survived to ITU?
68%
106
Myocardial stunting ie reduction in LVEF occurs for how long after cardiac arrest?
72 hours
107
which of decorticate or decerebrate posturing would earn 3 on the glasgow coma scale?
decorticate
108
which of decorticate or decerebrate posturing would earn 3 on the glasgow coma scale?
decerebrate - brainstem damage
109
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.
intra aortic balloon pump
110
what urine output figure should you aim for after ROSC?
0.5ml/kg/hr
111
seizures increase cerebral metabolism - true or false
true
112
a period of mild hypothermia may improve neurological outcome after cardiac arrest - true or false
True
113
hypercapnia causes cerebral blood vessel dilatation - true or false
True
114
what effect does hypocapnia have on cerebral blood flow?
causes cerebral vasoconstriction and therefore decreases blood flow
115
what temperature target should be aimed for after ROSC for 24 hrs?
32-36 degrees
116
at what rate should rewarming take place?
0.25°C h-1 to reduce the incidence of electrolyte abnormalities and cardiovascular instability.
117
hypothermia can cause what effects?
Shivering
arrhythmias
increased infection rates
electrolyte abnormalities and diuresis
hyperglycaemia
increase amylase concentration
slower clearance of sedative drugs
118
prognostication after ROSC from cardiac arrest should occur at what point?
72hr
119
myocardial contractility is impaired for how long afterr ROSC?
2-3 days
120
should antiepileptics be used in the absence of seizures?
no
121
most patients will be actively cooled post cardiac arrest - true or false
true
122
how is mild hypotheramia typically initiated in patients post cardiac arrest?
2L ice cold crystalloid
123
cooling should be delayed until the patient is on ITU - true or false
Falase
124
how long is the normal QRS complex?
0.12s
125
patients with continued atrial activity and ventricular standstill have a better outcome than no activity at all - true or false
true - may respond to ventricular pacing
126
in atrial fibrillation there is no relationship between atrial and ventricular activity - true or false
true
127
conduction through the AV node is relatively slow = true or false
true
128
the AV node connects to what
bundle of his
129
a negative T wave is normal in which leads
aVR, can be in V1, lead III
130
pathological bradycardia is caused by what
malfunction of the SA node or from partial or complete failure of atrioventricular conduction.
131
what is first degree AV block?
PR interval >0.2, can be normal
132
what is Mobitz Type I AV block (also called Wenckebach AV block)
progressive prolongation after each successive P wave until a P wave occurs without a resulting QRS complex
133
implanted devices that deliver pacing include
- pacemakers implanted for the treatment of bradycardia
(single or dual-chamber)
- biventricular pacemakers (implanted for left ventricular failure)
- ICDs (which have pacing capability).
134
percussion pacing may be used in preference to CPR in what circumstances?
when bradycardia is so profound it causes cardiac arrest
135
patients should be given analgesia and sedation for transcutaneous pacing - true or false
True
136
skin changes alone can indicate anaphylaxis - true or false
false
137
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
true
138
cardiac arrest in pregnancy - early delivery should be considered if the fetes is how old?
>20 weeks
139
seizures are a complication of flumenazil - true or false
true
140
gastric lavage is indicated in tricyclic overdose
FALSE - contraindicated
141
cardiac arrest is a secondary event in drowning victims
true
142
adrenaline provides short or long term benefits in cardiac arrest
short term
143
what is the dose of adrenaline infusion that can be given in bradycardia?
2-10mcg/min IV
144
what is the dose of isoprenaline that can be given in bradycardia?
infusion 5mcg/min IV
145
absence of pupillary light and corneal light reflexes at 72hrs post ROSC can aid prognostication - true or false
True
146
post ROSC what PaCO2 should be aimed for?
normocapnia
147
sodium bicarbonate facilitates release of oxygen to tissues - true or false
False - shifts O2 dissociation curve to left, inhibiting o2 release to tissues
148
Primary PCI should be done within what time frame of call for help?
120min
149
what initial shock energy should be used in shockable rhythms?
120J atleast, increase for subsequent shocks if needed
150
what dose of magnesium sulphate can be given in asthma to aid bronchodilation?
2mg IV
151
in anaphylaxis what dose of adrenaline is given?
0.5mg IM
152
steroids are given early in anaphylaxis - true or false
False
*may be used if ongoing asthma like features
153
what is considered severe hyperkaleamia
>6.5
154
Mobitz type I or type II is more likely to progress to asystole?
Type II
155
in pts with an ICD where should the self adhesive pads be placed?
Atleast 10-15cm away from ICD or in anteroom-posterior position
156
troponin may be increased in PE - true or false
true
157
major surgery within how many weeks is an absolute contraindication to fibrinolytic therapy
3 weeks
158
Hi-flow oxygen produces an inspired FIO2 of what percentage?
80%
159
if a pt is receiving high flow O2 what would you expect there PaO2 to be?
60-70kPA
160
following ROSC what should the pt blood glucose be maintained at ?
4-10mmol
161
ventricular fibrillation can be associated with cardiac output - true or false?
False
162
300 divided by the number of large squares between each R wave equates to what
heart rate
163
what dose of glucose should be given in an insulin-glucose infusion for hyperkalaemia?
50ml 50% glucose with 10 units insulin
164
what dose of insulin should be given in treatment of hyperkalaemia?
10 units with 50ml of 50% glucose/125ml 20% glucose
165
what drug should be used for cardio protection in hyperkalaemia?
10ml 10% calcium chloride IV or 30ml 10% calcium gluconate IV
166
dialysis in hyperkalaemia in what situation?
Hyperkalaemia resistant ti medical treatment
end stage renal disease
Oluguric AKI
Marked tissue breakdown
167
what electrolyte abnormality causes U waves?
Hypokalaemia
168
what are the ECG features of hypokalaemia?
U waves
T wave flattening
ST segment changes
169
what ECG changes are seen in hypercalcaemia?
Short QT interval
Prolonged QRS interval
Flat T waves
AV block
170
what ECG changes are seen in hypocalcaemia?
Prolonged QT interval
T wave inversion
Heart block
171
low magnesium causes what ECG changes?
Prolonged PR and QT intervals
ST segment depression
T wave inversion
Flattened P waves
Increase QRS
Torsades de pointes
172
hypermagnesaemia causes what?
Prolonged PR and QT intervals
T wave peaking
AV block
173
activated charcoal can be used within what time period of poisoning?
1 hr
174
routine use of gastric lavage is recommended in poisoning - true or false
False
175
Flumenazil is associated with severe toxicity - true or false
True - seizure, arrhythmia, hypotension
176
mydriasis, fever, dry skin, delirium, tachycardia, ileus and urianry retention are examples of what?
Anticholingergic effects
177
the hypothermic heart may be unresponsive to cardio-active drugs - true or false
True (and also electrical pacing and attempted defibrillation)
178
atropine is a parasympathetic antagonist that blocks the action of acetylcholine - true or false
true
179
Bilaterally absent N20 SEEP wave indicated a poor outcome post ROSC - true or false
true
180
