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ALS > ALS > Flashcards

ALS Flashcards

1
Q

Draw ALS algorithm including drugs

A
  • 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)
  • 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
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2
Q

Three outcomes from a 12 lead ecg

A
  • 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
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3
Q

6 features that indicate high risk NSTEMI

A
  • ST segment depression
  • dynamic ECG changes
  • unstable rhythm
  • unstable haemodynamics
  • diabetes mellitus
  • high grace score
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4
Q

what does grace score predict

A

Estimates admission to 6 month mortality for patients with acute coronary syndrome.

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5
Q

factors used in GRACE score

A

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

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6
Q

initial managemement of ACS

A
  • MONA
    • Morphine
    • Oxygen only if hypoxic
    • Nitrates - give sublingual GTN
    • Aspirin 300mg orally crushed or chewed asap
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7
Q

treatment for STEMI

A
  • PPCI or fibrinolytic therapy
  • lower risk of major bleeding than with fibrinolytic therapy
  • PPCI way preferred
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8
Q

aim for call to balloon time

A

120 mins (time form call to help to attempted reopening of culpret artery)

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9
Q

before PCI what do patients need

A
  • 300mg aspirin
  • then one of the following loading doses:
    • clopidogrel 600mg
    • ticagrelor 180mg
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10
Q

Indications for immediate fibrinolytic therapy

A
  • 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
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11
Q

7 absolute contraindications for fibrinolytic therapy

A
  • 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
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12
Q

how will you know if fibrinolysis is successful

A
  • 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)
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13
Q

what are the two immediate goals of treatment in NSTEMI and how are those things achieved

A
  1. 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)
  2. reduce myocardial oxygen demand
    • start beta blockade
    • treat heart failure
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14
Q

what to do if the patient is not breathing but does have a pulse

A

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

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15
Q

what to do if the patient has a monitored and witnessed cardiac arrest

A
  • 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
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16
Q

what are the 4 Hs

A

Hypothermia
Hypo/hyperkalaemia
Hypovolaemia
Hypoxia

17
Q

What are the 4 Ts

A

Thrombosis (cardiac or pulomonary)
Tamponade
Tension pneumothorax
Toxicity

18
Q

what shock energies should be used in defibrillation

A

120-360J

19
Q

how many J for a synchronised cardioversion of broad complex tachycardia

A

start with 120-150 J biphasic shock
if this fails then increase in increments
maximum of three attempts

20
Q

how many J for a synchronised cardioversion of AF

A

start at maximum defib output

21
Q

how many J for a synchronised cardioversion of atrial flutter and narrow complex tachycardia

A

start with 70-120J biphasic

22
Q

Draw tachycardia algorithm

A
23
Q

what is a synchronised shock

A

a shock that coincides with the R wave
if a shock coincides with the T wave then it could cause VF

24
Q

what features constitute ‘life threatening features’ in tachycardia algorithm

A

shock
syncope
myocardial ischaemia
severe heart failure

25
Q

adult bradycardia algorithm

A

ALS (1 decks)

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