ALS Flashcards
Draw ALS algorithm including drugs
- adrenaline 1mg IV (10ml of 1:10000 or 1ml of 1:1000)
- shockable rhythms:
- give after 3rd shock
- non-shockable rhythms
- give as soon as circulatory access is obtained
- for both: repeat every 3-5 minutes (alternate cycles)
- shockable rhythms:
- amiodarone (NOT INDICATED IN NON-SHOCKABLE RHYTHMS)
- shockable rhythms:
- give 300mg bolus IV (diluted to a volume of 20ml) after third shock
- give further 150mg if VF/pVT persist after 5 shocks
- shockable rhythms:
Three outcomes from a 12 lead ecg
- ST elevation or new LBBB:
- STEMI
-Other ECG changes or a normal ECG: - Trop release:
- NSTEMI
- Trop consistently negative:
- Unstable angina if other causes of chest pain unlikely
- STEMI
6 features that indicate high risk NSTEMI
- ST segment depression
- dynamic ECG changes
- unstable rhythm
- unstable haemodynamics
- diabetes mellitus
- high grace score
what does grace score predict
Estimates admission to 6 month mortality for patients with acute coronary syndrome.
factors used in GRACE score
age
signs of heart failure
heart rate at presentation
blood pressure at presentation
serum creatinine concentration
ecg changes
trop concentration
cardiac arrest at presentation
use app or online calculator as it’s a complicated algorithm
initial managemement of ACS
- MONA
- Morphine
- Oxygen only if hypoxic
- Nitrates - give sublingual GTN
- Aspirin 300mg orally crushed or chewed asap
treatment for STEMI
- PPCI or fibrinolytic therapy
- lower risk of major bleeding than with fibrinolytic therapy
- PPCI way preferred
aim for call to balloon time
120 mins (time form call to help to attempted reopening of culpret artery)
before PCI what do patients need
- 300mg aspirin
- then one of the following loading doses:
- clopidogrel 600mg
- ticagrelor 180mg
Indications for immediate fibrinolytic therapy
- presentation within 12 hours of onset of chest pain AND:
- ST elevation >0.2mV in 2 adjacent chest leads
- > 0.1mV in 2 adjacent limb leads
- ST depression in anterior leads (posterior infarction)
- New LBBB
7 absolute contraindications for fibrinolytic therapy
- previous haemorrhagic stroke
- ischaemic stroke during previous 6 months
- cns damage or neoplasm
- recent (within 3 weeks) major surgery, head injury or other significant traum
- active internal bleeding or GI bleeding within last month
- known or suspected aortic dissection
- known bleeding disorder
how will you know if fibrinolysis is successful
- 12 lead ecg 60-90 mins after fibrinolytic therapy
- failure of ST elevation to resolve by >50% indicates that fibrinolytic therapy has failed
* they need urgent PCI (called rescue PCI)
what are the two immediate goals of treatment in NSTEMI and how are those things achieved
- prevent thrombus formation
- fondaparinux 2.5mg OD
- aspirin 75mg OD (after initial 300mg loading dose)
- ticagrelor (180mg then 90mg BD) OR clopidogrel (300mg then 75mg OD)
- reduce myocardial oxygen demand
- start beta blockade
- treat heart failure
what to do if the patient is not breathing but does have a pulse
this is respiratory arrest
ventilate the patient and check for a pulse every 1 minute]
start compressions if there are any doubts about the presence of a pulse
what to do if the patient has a monitored and witnessed cardiac arrest
- if shockable rhythm:
- give three stacked shocks
- check for pulse after each shock
- these three shocks are considered as giving the first shock in the ALS algorithm