ALS Flashcards
What depth do you perform chest compressions?
5-6cm
What rate do you perform chest compressions?
100-120 bpm
How long can compressions be interrupted to allow endotracheal intubation?
5 seconds or less :|
What monitoring must be used during ET intubation?
Waveform capnography (canals be used to monitorr quality of CPR and when ROSC is achieved;)
What rate of manual ventilation should we aim for?
10 breaths per min
Can you continue chest compressions with an I-Gel in situ without stopping?
Yes, sometimes you can give uninterrupted CPR whilst ventilating with an iGel (supraglottic airway)
Do not stop compressions for ventilation :)
How often should you check for a pulse?
Every 2 minutes
In resp arrest what do you do?
- ventilate pts lungs
- check for a pulse every minute
- if there are any doubts about whether there is a pulse, start chest compressions xo
ALL pts in resp arrest eventually with cardiac arrest
What happens if a pt has a monitored witnessed VT/VF arrest?
Give 3 successive stacked shocks
if the 3rd shock is unsuccessful, the 3 stacked shocks count as the first shock according to ALS algorithm
What is a not often practised method for witnessed VT/VT arrest not attached to a defib?
Precordial thump:/ can be given whilst waiting for a defibrillator
Deliver a sharp impact to the lower half of the sternum from a heigh of 20cm
What is the first monitored rhythm in 20% of cardiac arrests?
VT/VF (shockable rhythms)
What should you do before administering a shock when a pt is in VT/VF?
Tell everyone to stand clear
remove oxygen
make sure no one is near the pt
After delivering the 3rd shock in a VT/VF arrest what do you do next?
- Give adrenaline 1mg IV
- Give amiodarone 300mg
- Repeat another 2min CPR
- give adrenaline again after alternate shocks (approx every 3-5 mins)
What are the reversible causes of cardiac arrest??
- Thrombosis
- Toxins
-Tension pneumothorax - Tamponade
- Hypo/Hyperthermia
- Hypovolaemia
- Hyper/Hypokalaemia
- Hypoxia
How often do you give subsequent doses of adrenaline?
After alternate cycles of 2min CPR (every 3-5 mins)
Does insertion of an endotracheal airway improve likelihood of patient survival during cardiac arrest?
Nope.
Delay in compressions does but otherwise nah
What does waveform capnography check for?
- ensuring tracheal tube placement is correct
- monitoring ventilation during CPR
- monitoring quality of chest compressions
- identifying ROSC
What are low end-tidal CO2 values associated with during CPR
Lower ROSC rates and increased mortality
If you are struggling to gain venous access what access do you try to gain next?
Intraosseous access :)
If injecting drugs into a venous cannula, what should you do?
follow with a flush of atleast 20ml and elevate extremity for 10-20s to facilitate delivery of drug to central circulation
Do IO administered drugs work as quick as IV administered drugs?
IO injection delivers adequate plasma conc in time comparable with IV so yes (yay!!)
What are the three main insertion sites for IO access?
- proximal humerus
- proximal tibia
- distal tibia
What are contraindications to IO access
- trauma
- infection of a prosthesis
- recent IO access
- failure to identify landmarks
How to confirm correct placement of IO
- aspirate IO blood from the needle
What are potential complications of IO insertion?
- extravasation into soft tissue surrounding
- dislodgement of needle
- compartment syndrome
- fracture or chipping of the bone
- fat emboli :/
- infection/ osteomyelitis
How to minimise risk of hypoxia?
During CPR ventilate pt with 100% oxygen
ensure there’s adequate chest rise and bilateral breath sounds
How to rapidly restore intravascular volume when hypovolaemia is suspected as cause of arrest?
restore rapidly with fluids and/ or blood depending on suspected cause of hypovolaemia
also urgent intervention to stop haemorrhage
What medication is indicated in hyperkalaemia and hypocalcaemia and calcium channel blocker OD?
IV calcium chloride
What can be done during CPR if thrombosis including pulmonary embolism is suspected?
administer a fibrinolytic drug
Following administration of fibrinolytic drug how long should you aim to continue CPR
60-90 minutes
How to diagnose tension pneumothorax
Clinically or by ultrasound of the chest
How to try and quick fix a tension pneumothorax
thoracostomy or needle thoracocentesis then insertion of a chest drain
How to diagnose cardiac tamponade during cardiac arrest
with great difficulty!! as distended neck veins and hypotension are hard to assess when in cardiac arrest. focused cardiac ultrasound needs to be done, possible to see pericardial effusion
What is extracorporeal CPR
Vascular access and a circuit with a pump and oxygenator - performs circulation of oxygenated blood to restore tissue perfusion
should be implemented within 1hr of collapse
What are signs of complete airway obstruction?
paradoxical chest and abdominal movement “see-saw” breathing (chest is drawn in and abdomen expands)
accessory muscles in use - neck and shoulder muscles contract AND breathing will be silent
Partial airway obstruction sounds like what??
NOISY - stridor
Stridor on inspiration, wheeze on expiration, gurgling or snoring
Causes of airway obstruction are?
- unconscious pt may have obstruction from the pharynx, more often at the soft palette and epiglottis rather than the tongue
- vomit or blood
- foreign body
- laryngeal obstruction as a result of burns oedema
- inflammation
- anaphylaxis
Treatments of adult choking?
- encourage them to cough
- give UP TO 5 back blows
- 5 sharp blows between the scapula with heel of hand
- if back blows fail, give UP TO 5 abdominal thrusts
- put arms around upper abdomen and pull inwards and upwards sharply
- if obstruction continues alternating 5 back blows and 5 abdominal thrusts
- becomes unconscious? shit, start CPR
- as soon as appropriately skilled individual arrives they can perform laryngoscopy and remove foreign object with MAGILLS forceps <3
What is the basic manoeuvre for opening the airway?
- head tilt
- chin lift
- jaw thrust
What are basic adjuncts for airway?
-oropharyngeal
-nasopharyngeal
When to never use nasopharyngeal
in pt with suspected basal skull fracture (yikes)
What are more advanced airway adjuncts?
Igel (supraglottic airway_
Laryngeal mask airway
Tracheal intubation
What are key post intubation procedures?
- ventilate with highest possible oxygen conc
- inflate cuff of ET tube to stop air leak
- confirm correct placement of tube (capnography, listening to chest)
- secure the damn tube
- SOMETIMES? an op can be inserted alongside th tracheal tube to maintain the position of the tube and prevent biting damage if pt starts to wake up !!
What are two commonly used aids in intubation?
Videolaryngoscopes
Suction
Cricothyroidotomy
What should the QRS (ventricular) rate be?
60-100bpm
What is normal for QRS duration?
0.12s (3 small squares)
What is the difference between polymorphic and monomorphic VT
polymorphic has variations in QRS and monomorphic doesn’t
What is classed as bradyarrhythmia?
A HR of <60bpm
What is emergency treatment of bradycardia?
ATROPINE or cardiac pacing
SOMETIMES it’s necessary to use isoprenaline or adrenaline
THE CHOICE of drug and treatment depends on haemodynamic stability
What characterises first degree atrioventricular block?
- the PR interval is >20 (common finding)
usually an isolated finding doesn’t often need intervention (YAAAS)
What is the normal duration of PR interval???
0.12 to 0.20s
What characterises 2nd degree atrioventricular block??
- Present when some, but not all P waves are conducted to the ventricles
- SO there is an absence of QRS after some P waves
- THERE ARE 2 TYPES - mobitz 1 and 2
What characterises Mobitz type 1 AV block?
- IT IS A TYPE OF SECOND DEGREE AV BLOCK
- also called WENCKEBACH :)
- the PR interval shows PROGRESSIVE prolongation after each P wave UNTIL a P wave occurs without a QRS
- in DUMMY terms the pr interval gets longer and longer until it QRS doesn’t even BOTHER to show up anymore
What characterises Mobitz type 2 AV block?
- There’s a constant and often prolonged PR interval but some P waves are not followed by a QRS
- Have an increased risk of going into full heart block and asystole >:(
What characterises third-degree AV block (complete heart block)???
- There is absolutely no relationship between P wave and QRS complexes
Often have a rate of 3-40bpm and can suddenly stop (asystole) - in dummy terms, P wave and QRS complex don’t speak anymore because they completely don’t chat anymore and have beef
What is an agonal rhythm?
a slow normally broad ventricular complex rhythm that usually does not generate a palpable pulse
commonly seen in later stages of unsuccessful Resus
progresses to asystole
Characteristics of Atrial fibrillation?
- very common
- disorganised electrical activity in the atria
- p waves not visible on egg
- irreg rhythm
Characteristics of Atrial flutter?
- atrial activity looks like it’s fluttering (saw tooth appearance)
- often caused by COPD, major PE, complex congenital heart disease, chronic congestive heart failure
What is the correct placement for defibrillator pads in a VF/ pVT?
one to the R of the upper sternum below the clavicle, and the apical pad is placed in the L mid-axillary line
What if the recommended range of defibrillation energy levels?
120-360J
When administering shocks via defibrillator to pt how far away should the oxygen be once removed?
1M away!!!
If using a manual defibrillator what range of energy would you choose for your first shock?
120 to 150J
What must you do to a patient before synchronised cardioversion?
anaesthetise or sedate the pt (don’t be a bitch)
If a pt has a pacemaker where should you place defibrillator electrodes?
> 8cm away !!
What are considered life threatening features?
- Shock :O - hypotension, pallor, sweating, cold extremities, confusion, impaired consciousness
- Syncope - Transient loss of consciousness
- Heart failure - pulmonary oedema, raised JVP
- Myocardial ischaemia - typical ischaemic chest pain and/or evidence in labs or ecg
- extremes of heart rate
When should you panic about tachycardia?
- HR >150bpm dramatically reduces cardiac output as the heart doesn’t have time to fill properly :(
When is bradycardia considered extreme?
HR <40bpm
What to do if a pt has life-threatening features with a tachycardia?
CARDIOVERSIOOOON
if cardioversion does not work and life threatening features persist, give amiodarone 300mg IV over 10-20 mins
The loading dose of amiodarone can be gfollowed by an infusion of 900mg over 24hrs given via a large vein (PREFERABLY central venous catheter)
At what point do you deliver a synchronised shock during synchronised cardioversion?
DURING THE R WAVE
if you do it during a T wave you can cause VF lmao oops
if you have a narrow complex tachycardia that is regular in rhythm (SVT) what is protocol? and the pt isn’t displaying life threatening features :)
- Vagal manoeuvres (syringe blowing or modified valsalva)
- ADENOSINE 6mg rapid IV bolus - if unsuccessful give 12mg, then 18mg
- if adenosine doesn’t work, verapamil or beta-blocker
What is the treatment for someone in VT with a pulse?
- amiodarone 300mg IV over 10-60 min followed by infusion of 900mg over 24h
How to treat torsades de pointes VT? (polymorphic VT with QRS variations)
- stop any drug that prolongs QT interval
- correct any electrolyte abnormalities especially hypokalaemia
- give mag sulfate 2g over 10 mins
What are common causes of bradyarrhythmia?
- physiological (athletes or during sleep)
- cardiac in origin eg <3 block or sinus nose disease
- non-cardiac in origin (vasovagal, hypothermia, hypothyroidism, hyperkalaemia)
- drug-induced - beta blockage? diltiazem, digoxin, amiodarone
If a bradycardia pt has adverse features you should….?
initially try pharmacological intervention, otherwise pace
What is a first line treatment drug for bradycardia?
Atropine <3 500mcg IV and if necessary repeat every 3-5mins to a total of 3mg
What second lie drugs can be used for bradycardia with adverse features after atropine and before pacing?
- glucagon if a calcium channel blocker or beta blocker may be responsible
- aminophylline 100-200mg slow iv bolus
- isoprenline infusion (starting dose 5mcg per min)
- adrenaline (2-10mcg per min)
- dopamine (2.5-10mcg kg-1 min-1)
When shouldn’t you give atropine in bradycardia?
if the pt has had a cardiac transplant (THERE’S ENOUGH DAMAGE)
How to prevent electrolyte disorders?
- remove precipitating factors (e.g drugs, diet)
- monitor electrolyte conc
- monitor renal function
- review renal replacement therapy e.g haemodialysis to avoid electrolyte shift
What is the normal conc of potassium in blood?
3.5 - 5.0mmol
What happens to potassium conc when your blood PH decreases (acidaemia)?
serum potassium increases BECAUSE potassium shifts from cellular space to vascular space
What’s the most common electrolyte disorder associated with cardiac arrest?
HYPERKALAEMIA
What can sometimes chronically cause hyperkalaemia?
impaired excretion by the kidneys :(
What is the defined value of hyperkalaemia?
a serum potassium of >5.5mmol/L
severe hyperkalaemia is >6.5mmol
What are the main causes of hyperkalaemia?
- renal failure (AKI or CKD)
- drugs
- tissue breakdown (rhabdomyolysis, tumour lysis, haemolytic)
- metabolic acidosis - DKA or renal failure
- endocrine disorders - eg Addisons disease >:(
- diet
- spurious??? FALSE high K result from clotting in blood AAAA
How can hyperkalaemia be clinical recognised?
- weakness or progressive flaccid paralysis
- paraesthesia
- depressed deep tendon reflexes
- ECG abnormality typically seen in K >6.7mmol/L
What ECG changes can be seen with hyperkalaemia?
- First degree HB (prolonged PR interval >0.2s)
- flattened P wave or absent P wave
- tall peaked T waves
- ST depression
- S and T wave merging :S
- widened QRS
- VT
- bradycardia
What do we give to correct hyperkalaemia?
- insulin in glucose (10 units in a 25g glucose over 15-30mins)
- calcium gluconate 30ml over 15mins or calcium chloride 10ml 10% over 2-5min
- salbutamol 10-20mg nebulised
What is the definition of sepsis?
life-threatening organ dysfunction cause by dysregulated host response to infection >:(
Signs of sepsis are?
- hypotension
- oliguria
- acute confusion
- lactate >2mmol L
SHOULD COMMENCE TREATMENT WITHIN THE HOUR
What’s the hour 1 sepsis care bundle pathway?
- HIGH FLOW O2
- BLOOD CULTURES
- BROAD SPECTRUM ABX
- FLUID RESUS
- MEASURE LACTATE
- MEASURE URINE OUTPUT
What does opioid poisoning look like?
- respiratory depression
- pinpoint pupils
- coma
- resp arrest
What do we give for opioid OD?
NALOXONEEEE <3 400mcg IV 800mcg IM 800mcg SC or 2MG IN
you can titrate up to 10mg
What is the duration of action for naloxone?
45-70min
however resp depression can persist for 4-5 hrs after
What are clinical signs of benzodiazepine OD?
- loss of consciousness
- resp depression
- hypotension
What do we give for Benzo OD?
Flumazenil <3 but be careful as can cause significant toxicity
What are clinical signs of tricyclic antidepressants OD?
- hypotension
- seizures
- coma
- arrhythmias
VT :|
What are examples of tricyclic antidepressants?
- amitriptyline
- desipramine
- imipramine
- nortriptyline
- dozen
- clomipramine
What are clinical signs of stimulant OD? (EG COCAINE)
- agitation
- tachycardia
- hypertension
- hyperthermia
- myocardial ischaemia
- angina
What can be used to treat stimulant OD?
- IV benzo’s in small doses
- glyceryl trinitrate
- phentolamine
How many annual worldwide deaths are there due to asthma?
420,000
and 1400 in the UK
What are the features of severe asthma?
- a hx of near fatal asthma requiring intubation and mechanical ventilation
- hospitalisation within the past year
- requiring 3+ asthma medications
- increasing use and dependence of beta-2 agonists
- adverse behavioural or psychological factors eg non compliance with meds, MH, alcohol or drug dependence,LD
What causes cardiorespiratory arrest associated with asthma?
- severe bronchospasm and mucous plugging causing asphyxia
- cardiac arrhythmia caused by hypoxia
- dynamic hyperinflation
- tension pneumothorax
What do you do in your initial assessment of a critically ill asthmatic?
- administer oxygen and aim for sats >94%
- SALBUTAMOL 5mg via nebuliser, repeat dose every 15-30 mins
- add nebulised ipatropium bromide 500mcg 4-6 hourly
- STEROIDS prednisolone 40-50mg orally OR 100mg hydrocortisone iv 6hrly
- mag sulfate 2g (8mmol) IV
- CONSIDER aminophylline in severe or near fatal cases
- ICU review
- consider tracheal intubation when GCS reduces, decline in PF, hypoxia worsens, resp acidosis, agitation or confusion, progressive exhaustion
What is the adult dose of adrenaline in anaphylaxis?
IM 0.5mg (0.5ml of 1:1000 adrenaline)
Where should IM adrenaline be administered during anaphylaxis?
the anterolateral aspect of the middle third of the thigh
What position should a pregnant woman take if she has anaphylaxis?
LIE ON LEFT SIDE (left lateral position)
What is refractory anaphylaxis?
When following two doses of IM adrenaline, no respiratory or cardiovascular improvements are seen :(
What should be done if someone is in refractory anaphylaxis?
- CONTACT CRITICAL CARE !!
- establish dedicated peripheral IV or IO
- give rapid fluid bolus
- start adrenaline infusion
- give IM adrenaline every 5 minutes until infusion is commenced
- high flow O2
- monitoring
- take blood sample for mast cell tryptase
How common is cardiac arrest in pregnant women?
1 in 36,000 pregnancies
Why is the supine position bad for pregnant women?
The gravid uterus can cause compression or the abdominal vessels resulting in reduced venous return and cardiac output, hypotension and a reduction in uterine perfusion.
What are causes of cardiac arrest in pregnant women?
- cardiac disease
- pulmonary embolism
- epilepsy and stroke
- sepsis
- mental health conditions
- bleeding
- malignancy
- hypertensive disorders of pregnancy
What steps would you take to treat a compromised unwell pregnant woman?
- put her in left lateral position and/ or manually displace the uterus to the left if the lateral position is not possible
- give high flow o2
- give fluid bolus if hypotensive or evidence of hypovolaemia
- re-evaluate drugs currently being given
- CALL GYNAEEEE AND OBSTETRICS
- identify and treat underlying cause
What are the modifications for cardiac arrest in pregnancy?
- sometimes the uterus can press down against the inferior vena cava (IVC) and aorta which impeded venous return
- if potentially IVC is being compressed the IV or IO should be established above the diaphragm
- manually displace the uterus to the left to minimise IVC compression
- add left lateral tilt if feasible and pt can be placed against a hard surface to ensure successful chest compressions. if not possible keep manually displacing uterus to the left and keep pt in supine position.
- prepare for emergency caesarian section
- consider early tracheal intubation due to high risk of pulmonary aspiration of gastric contents.
How to treat haemorrhage in a pregnant woman?
- fluid resus and rapid infuser
- tranexamic acid and correction of coagulopathy
- oxytocin, ergometrine, prostaglandins and uterine massage
- uterine compression sutures, uterine packs
- interventional radiology
- surgical control
When a pregnant woman with eclampsia receives magnesium what can happen?
- pt can become oliguric (reduced UO)
- GIVE calcium to treat magnesium toxicity
What is eclampsia and pre-eclampsia in pregnant women?
- the development of convulsions and/or unexplained coma during pregnancy
- treat with magnesium sulfate
What is an amniotic fluid embolism in pregnant women?
- usually presents around the time of delivery
- in labour women presents with sudden cardiovascular collapse, SOB, cyanosis, hypotension, arrhythmia, and haemorrhage
What are causes of cardiorespiratory arrest in trauma?
- severe traumatic brain injury
- hypovolaemia in massive blood loss
- hypoxia from resp arrest or airway obstruction
- direct injury to vital organs and major vessels
- tension pneumothorax
- cardiac tamponade
What is commotio cordis?
- actual or near cardiac arrest caused by a blunt impact to the chest wall over the heart
- can cause VT/VF
What do you need to be cautious of in pt with traumatic brain injury?
blood pressure and raised intracranial pressure
What are the doses of tranexamic acid in haemorrhage?
loading dose 1g over 10 mins then 1g over 8hr
How do you manage an external haemorrhage?
COMPRESSION
ELEVATION
TOURNIQUETS
TOPICAL HAEMOSTATIC AGENTS
What is a cardiac tamponade?
when the pericardial sac is filled with fluid under pressure
most commonly occurs after penetrating trauma
requires immediate decompression of the pericardium
When would you do a thoracotomy?
hopefully never xo but also… in pts with penetrating chest trauma in whom less than 15 mins have gone since loss of vitals
What’s a tension pneumothorax?
the entry and trapping of air in the pleural cavity causes mediastinal shift, thereby obstructing venous return
How do you recognise a tension pneumothorax?
- ultrasound
- resp distress or hypoxia
- haemodynamic compromise
- absent breath sounds on auscultation
- chest crepitations
- subcutaneous emphysema (surgical emphysema)
- tracheal deviation
- jugular venous distension
How do you treat tension pneumothorax?
- chest cavity should be immedietaly decompressed
- via needle decompression - a needle is inserted perpendicular to the chest wall in the2nd intercostal or 4th/5th intercostal space in the mid axillary line
- open thoracostomy - incision made in chest wall (5th intercostal space) followed by dissection into the pleural space
- clamshell thoracotomy
How common is drowning in the UK?
every hour more than 40 people drown
What’s the definition of drowning?
a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium
How would you initially resus someone who has drowned?
- check for signs of life/ response
- give 5 initial ventilations (use o2 if available)
- start CPR - ensure you do 30:2 and include ventilations as most drownings arrest due to hypoxia and compressions alone won’t be as effective
- pt may regurgitate stomach contents and swallowed water, turn on their side briefly
What body temp is classified at hypothermic?
between 32-35 degrees = mild
between 28-32 = moderate
bellow 28 = severe
What are the five stages of hypothermia?
- stage I: 35-32, conscious, shivering
- stage II: 32-28, impaired consciousness without shivering
- stage III: 28-24, unconscious, vital signs recordable
- stage IV: cardiac arrest or low flow state temp <24
- stage V: death due to irreversible hypothermia <11.8 degrees
Is intermittent CPR indicated in hypothermic patients with a core temp of <28?
Yesssss, you can give 5 minutes of CPR then periods of 5 minutes without
What are modifications to ALS in hypothermic patients?
- check for signs of life for up to 1 min
- don’t delay tracheal intubation
- withhold adrenaline and other CPR drugs until pt core temp is >30 degrees
How to carefully rewarm someone who is hypothermic?
- ensure whole body is dried and insulated
- remove wet clothes
- apply heat packs to trunk (more for comfort in the conscious pt)
- heated IV fluids
What is malignant hyperthermia?
Caused by drug administration occurs in people who have a predisposition to malignant hyperthermia
How to treat malignant hyperthermia?
- stop triggering agents immediately
- give o2
- correct acidosis and electrolyte abnormalities
- start active cooling
- give dantrolene
If no cause for cardiac arrest can be found what test might you carry out next?
CT brain and/or CTPA
When you get ROSC (yayyyyyyy) what should the next steps be?
- temp control
- maintain normoxia and normocapnia
- avoid hypotension
- echocardiography
- maintain normoglycemia
- diagnose/ treat seizures
What’s a normal paO2 reading on an arterial blood gas?
BETWEEN 10-13 kPa
What is the normal pH range of blood?
7.35-7.45
What are the normal values of base excess?
+2 to -2 mmil L-1
What would an alkalotic base excess look like? (METABOLIC ALKALOSIS)
+8mmol (Would require +8mmol of acid to return the pH back to normal BASICALLY, so the blood has too many alkaline substances in the blood and needs more acid to neutralise) pt therefore has METABOLIC ALKALOSIS
What would an acidotic base excess look like? (METABOLIC ACIDOSIS)
-8mmol (requires addition of 8mmol of strong base to return pH to normal)
What base excess level indicates metabolic acidosis?
-2mmol
What base excess level indicates metabolic alkalosis?
+2mmol
There is a high chance of VF occurring in STEMI’s, true or false?
True <3
When using transcutaneous pacing, electrical capture occurs between 50-100amps true or false?
true!!!
Hyperkalaemia can prevent successful transcutaneous pacing? true or false?
true!!!
continuous monitoring via self-adhesive pads is preferable to using the ECG electrodes true or false?
false </3
What Is the most common cardiac arrest heart rhythm in hypovolaemic arrest?
PEA
When’s the best time to make an anticipatory decision about whether to do CPR on a patient?
Before they become acutely unwell
If a patient is deemed to be for CPR should you discuss it also with the patient?
YA they might decide they don’t want to be Resus’d :(
TRUE OR FALSE adrenaline has purely alpha-adrenergic effects?
FALSE it has beta-adrenergic and alpha-adrenergic effects
Giving 8.4% sodium bicarbonate can exacerbate intracellular acidosis? true or false?
truuuuuue
Is sodium bicarb routinely recommended in cardiac arrest?
No
sodium bicarbonate does what to oxygen?
inhibits release of oxygen into the tissue
in NSTEMI (ST depression) is PPCI the preferred treatment?
no, there is not evidence of benefit from immediate reperfusion therapy
How much is the initial shock? in joules
120J then you can increase afterwards for subsequent shocks :O
true or false, adrenaline should be given to all patients in cardiac arrest?
false, if a pt is in VT or VF arrest and after or before 3 shocks gets ROSC adrenaline was never needed x
TRUE OR FALSE - a PaCO2 of 5.3 kPa is normal in an asthmatic pt having an acute exam of asthma?
FALSE, high CO2 indicated they are getting exhausted, you would expect a LOW CO2 as they have a high resp rate but it shows inadequate gas movement
can magnesium sulfate be used as a bronchodilator in asthmatic pts?
yassss
do you give steroids early in asthmatic resus
no it’s not necessary for resus
What is the dose for calcium chloride when treating hyperkalaemia?
10ml of 10%
TRUE OR FALSE - a pt can demand to be resuscitated even if it’s not clinically appropriate
FAALSE
true or false - self-adhesive pads must be placed in the antero-posterior position in a patient with an implantable cardiover-defibrillator (ICD)
FALSE it can be placed anteroom-posterior however it can also just be placed 10-15cm away from the ICD
If a rhythm suddenly changes from asystole to VF a shock should be immediately given?
NOPE - finish your 2 min cycle of compressions and THEN you can assess and shock
does raised troponin always indicate an MI
no, it can rise due to other cardiac issues
If a patient has had surgery within 3 weeks can they have thrombolysis?
nope it’s an absolute contraindication
if fibrinolytic therapy as good as PPCI
no it’s not as good
AGAIN, how long should PR interval be?
between 0.12 to 0.20 s
How many seconds is one small teeny square on ECG
0.04 s
