ALS Flashcards
1
Q
Around what time after collapse does defibrillation produce the highest survival rates
A
50-70%
2
Q
What CPR rate is usually given in an adult
A
30:2
3
Q
Name the four Hs
A
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypo.hyperthermia
4
Q
Name the four Ts
A
Thrombosis
Tension Pneumothorax
Tamponade
Toxins
5
Q
After ROSC, what should be done
A
12-lead ECG
O2 monitoring
A-E
6
Q
Outline the SBARD criteria
A
S- situation
B- background
A - assessment (A-E0
R - recommendation
D - decisions
7
Q
At what NEWS level do we do continuous obs monitoring
A
7
8
Q
At what NEWS score are nurses supposed to escalate to the medical team
A
3 or above
9
Q
When do you NEWS for resp
A
<5 or >36
10
Q
When do you NEWS for pulse
A
> 140
<40
11
Q
What is a late sign of airway obstruction
A
Cyanosis
12
Q
Final line management of airway obstruction is NPA or OPAs fail
A
Tracheal intubation
13
Q
How do we assess Breathing
A
- Observatiob
- RR
3.Depth of breath - O2 conc
- Breath sounds
- Palpate, percuss, ascultate
14
Q
How do we assess Circulation
A
- Appearance
- Limb temp
- CRT
- Venous filling
- BP
- Auscultate
- Oliguria (urine output < 0.5ml/kg/hr).
- Large bore cannula (remember to take blood)
- 500ml warm crystalloid
- ECG (if pain)
15
Q
Management of ACS
A
MONA
16
Q
How do we assess disability
A
Drugs check
Pupils
GCS/AVPU
BGs
17
Q
How do we assess exposure
A
Clinical history
Ceiling of care
Notes
18
Q
What three factors result in ACS
A
- Acute thrombosis
- Contraction of smooth muscle cells
- Partial or complete obstruction of lumen
19
Q
If there is a non-shockable rhythm on the algorithm, what is the immediate action
A
CPR
20
Q
How long should CPR be done if pulmonary thrombosis is suspected
A
60-90 minutes
21
Q
Management of a coronary thrombosis
A
PCI or coronary angiography
22
Q
How do we diagnose tamponade
A
Cardiac ECHO
23
Q
When shoudl tamponade be considered
A
After penetrating chest trauma or after cardiac surgery
24
Q
Name two non shockable rhythms
A
Asystole and PEA
25
When are adrenaline and amiodarone indicated for VF or pVT
after the third shock
26
How many mls of fluid should drugs be flushed into circulation with
20mls
27
How much adrenaline and amiodarone is needed after the third shock
1mg adrenaline
300mg amiodarone
28
After the initial dose of adrenaline is given. How often should it be given there onwards
Every 3-5 minutes
29
How often should rescuers switch roles in chest compression
Every 2 minutes
30
What factor can influence the likelihood of successful resuscitation in VF/pVT
reduction of pre and post-shock pauses.
31
When should a pulse check be done in VF/pVT
Only when organised electrical activity compatible with a pulse is seen
32
When should intraosseous access be considered for cardiac arrests
If IV access has not been achieved within 2 minutes
33
When is external pacing indicated for asystole
p-wave asystole
not indicated for total asystole
34
What is the most common cause of adverse events in resuscitation
Lack of good non technical skills
35
Most common causes of cardiac arrest (2)
Hypotension and hypoxia
36
What is the most common cardiac arrest rhythm found in hospital arrests
PEA
37
When is an ECG indicated with syncope
Unexplained (during excercise)
Structural heart disease
Syncope and have an abnormal ECG (prolongued QT interval)
38
Outline the 6 stage approach to reading an ECG
1. Is there any electrical activity
2. What is the QRS rate
3. Is QRS rhythm regular or irregular
4. Is QRS narrow or broad
5. Is atrial activity present
6. Is atrial activity linked to ventricular.
39
What is torsades de pointes
Polymorphic VT
40
What is the prognosis of PEA
Poor
41
WHat can cause PEA
Blood loss
Tampoande
PE
Tension pneumothorax
42
Name the lateral leads
I, aVL, V6
43
Name the inferior leads
II, III, aVF
44
Name the anterior leads
V2-4
45
IN which leads is there normal deflection
aVR
46
In which v lead are t waves ngetaive
V1
47
in which lead, I, II or III can t waves be negative
III
48
What is the normal PR interval
0.2ms
49
What is the most common cause of death in patients who have had an out of hospital cardiac arrest
Post-cardiac arrest brain injury
50
Name three factors that can cause post cardiac brain injury
Hypercapnia, hypoxia, hypoglycaemia, pyrexia
51
What is post cardiac arrest myocardial dysfunction
Reduced LV EF and CO
52
Management of post cardiac arrest myocardial dysfunction
Self resolves within 72 hours
53
Name the four forms of post-cardiac arrest syndrome
Post cardiac arrest brain injury
Post cardiac arrest myocardial dysfunction
Systemic ischaemia-reperfusion response
Persistence of the precipitating pathology
54
What is normocarbia
4.7-6
55
How do we monitor Co2
end tidal co2 + waveform capnography and ABG
56
What is an issue with intubation we need to keep an eye on when A-E
That the tracheal tube might only have gone into the right main bronchus - check that airway entry is present bilaterally
57
Why should a gastric tube be inserted following ROSC
Decompress the stomach following mouth-to-mouth or bag-mask ventilation
58
List the GCS components
Motor:
Nil
Extension
Abnormal Flexion
Flexion
Localises
Obeys commands
59
What investigations should be considered in the post resuscitation phase
ABG
FBC
ECG
ECHO
60
Why is insulin given as part of post-resuscitation care on ITU
To keep glucose < 10.
61
How is enteral nutrition given post-resuscitatio
NG Tube
62
Most common side effect after ROAC
Pyrexia
63
Why is pacing and defibrillator pads put on post-resus
Arrythmias are common after a cardiac arrest
64
What drug is given post resuscitation
Inotropes to keep MAP high
65
Whys is hypercapnia bad
Results in cerebral blood vessel dilatation and increased blood flow
66
How long should fevers be prevented for before porgnosis becomes poor
For 72 hours
67
Name three ways we get ACS
- Atherosclerotic plaque rupture
- Smooth muscle contraction
- Thrombus formation
68
Name three types of ACS
NSTEMI
STEMI
UNSTABLE Angina
Not stable angina
69
Troponin levels in unstable angina
Normal
70
ECG reading in unstable angina
Normal
71
What ECG rading in an unstable angina shows a high risk of porgression to MIs
ST Depression
72
What is the immediate treatment for all acute coronary syndromes
300mg Aspirin
GTN
Oxygen (if sats under 94%)
Morphine
73
Antithrombotic management of unstable angina and NSTEMI
BATMAN
B - Base the decision about angiography/PCI
A - Aspirin 300mg
T - Ticagrelor
M - Morphine
A - Fondaparinux
N - Nitrates
74
If someone with unstable angina and NSTEMIs at a high risk, what other triple combination therapy agent should be given for thrommbotic medication
glycoprotein IIb/IIIa inhibitor
75
Management of STEMIs
Emergency reperfusion therapy: PCI (within 2 hours) or fibrinolytic therapy if no access to PPCI
76
If thrombolysis fails, what is the next step
Transfer to hospital who offer PCIs
77
Absolute contraindications to antifibrinolytic therapy
Haemorrhagic stroke
CVA within past 6 months
Neoplasm
INternal bleeding
Dissection
Major durgery
Bleeding disorder
78
Long term management of a STEMI
AAAA
A- Atenolol
A - Aspirin 75mg
A - Atorvastatin (80mg)
A - AceI
79
Three steps following ROSC
ECG
ECHO
A-E assessment
80
Define tachycardia
Over 100BPM
81
Management of adult tachycardia if life threatening features are seen
DC Shock 3 times
82
If DC shock does not work the third time for someone with tachycardia, what should be done
Amiodarone 300mg IV over 10-20mins
Then repeat the shock
83
If a patient with tachycardia has no life threatening features, what is the next investigation
ECG to check if QRS is narrow or not
84
If QRS is narrow, but regular in someone with tachycardia, what should be done
Vagal manoeuvres
85
If QRS is narrow but irregluar, what should bve done
AF. Rate control. Anticoagulation after 48 hours
86
If QRS is broad but regular in someone who is tachycardic, what should be done
Possible VT: Amiodarone 300mg IV over 20-60mins
87
If QRS is broad for someone with tachycardia but irreglar, what should be done
Possible torsades de pointes - give MG Sulphate
88
If vagal manoeuvres do not work for narrow complex tachycardia (regular), what should be done
Give Adenosine 6mg
then 12mg if unsuccessful
Then 18mg if unsuccessful
If ineffective:
Verapamil
89
Normal PR interval
0.2s
90
Treatment of first degree heart block
Nothing
91
What is Mobitz type 2 heart block
Progressive elongation of PR interval until a p wave is dropped
92
What is Mobitz type 2 heart block
where p waves drop randomly
93
Management of Bradycardia
Atropine 500mcg IV
94
What other drugs can be given for Bradycardia as second line
Atropine again
Isoprenaline
Adrenaline
95
Long term management of bradycardia
Transvenous pacing
96
What is the total amout of atropine that can be given for bradycardia
3mg IV
97
If Atropine fails after 3ml IV, what should be done
Transcutaneous pacing
98
What can be used as an alternate to CPR in severe bradycardia
Percussion Pacing
99
Define bradycardia
<60 min
100
How many mcg of adrenaline is given to an adult in anaphylaxis
500
101
How many mcg of adrenaline is given to a child 6 - 12 years
300
102
How many mcg of adrenaline is given to a child 6 months to 6 years
150 mcg
103
What defines life threatening asthma
PEF < 33%
O2 < 92%
PaO2 < 8
Normal PaCo2
104
Why is disconnecting the ventilator and checking for air tapping done in asthma
Relieves gas trapping in the lungs (hyperinflation can be seen in asthma)
105
Signs of tricyclic antidepressants on ECG
Sinus tachycardia + wide QRS complexes
106
How many amps does electrical capture occur with in transcutaneous pacing
50-100 mA
107
How common is transcutaneous pacing successful in someone with hyperkalaemia
Not common
108
Should prophylactic antibiotic therapy given routinely following drowning
No
109
Why is there not immediate entry o water into the victim's lungs when drowning
Initially laryngospasming and breath holding to prevent water entering the lungs
110
Name three conditions in which calcium chloride 5ML 10% is indicated
Hyperkalaemia
Hypocalcaemia
Overdose from CCBs
111
What is the first monitored rhythm in cardiac arrests
PEA and systole
112
What is the rate of infusion of adrenaline in bradycardia
2-10 mcg mon-1
113
What is the role of sodium bicarbonate in a cardiac arrest
Shifts oxygen dissociation curve to the left, inhibiting release of oxygen to the tissues
114
What energy should be given in the first shock for VF
120J
115
Cardiac arrest is secondary to hypercapnia in asthma: T or F
False - hypoxia
116
What defines nes severe hyperkalaemia
>6.5
117
What calcium chloride amount is given in hyperkalaemia
10% 10mL IV
118
In ITU what glucose level should be targeted
<10
119
How common are seizures after ROS
30% incidence
120
How many cardiac arrests result in ROSC
30%
121
How many people survive to go home after ROSC is achieved
9.7%
122
What is the most common cause of cardiac arrest (rhythm)
No shockable
123
Bystander CPR rates in the UK
60%
124
Name two situations in which chest compressions can be stopped
During defibrillation attempts and rhythm checks only
125
Main causes of ventricular fibrillation
ACS
HTN
Valvular disease
Long QT syndrome
126
Prior to PPCI, what triple anticoagulation therapy is given
Prasugrel
Clopidogrel 600mg
Ticagrelor
127
What fibrinolytic therapy is given to patients with a STEMI
Aspirin 300mg + Ticagrelor 180mg
128
What fibrinolytic therapy is given to patients with a bleeding risk
Aspirin 300mg
Clopidogrel 300mg
Or Aspirin alone
129
4 indications for immediate PCI
St elevation > 0.2 in 2 adjacent chest leads
>0,1 mV in 2 or more adjacent limb leads
R waves or ST depression in V1-3
LBBB
130
After fibrinolytic therapy is given, when should an ECG be performed
60-90 mins after therapy is given
131
When is prasugrel contraindicated
>75 years
<60kg
132
What does of prasugrel is given
60mg loading dose and then 10mg daily
133
When is an aldosterone antagonist needed in HF
EF < 40%
134
How often should cardiac rhythm be assessed
Every 2 seconds
135
When should adrenaline and amiodarone be given in pVT and VF
After the third shock
136
How much amiodarone is given VF/pVT
300mg
137
If 300mg amiodarone does not work in pVT/VF, how much should subsequent doses be
150mg after 5 defibrillator attempted.
138
If amiodarone is not available for VT/pVT, what else can be given
Lidocaine
139
Management of Systole and PEA
30:2 chest compressions
1mg Adrenaline as soon as access is given
Continue 30:2 chest compressions.
Recheck rhythm after 2 mins
140
