ALS 2

Question 1

What is the bleeding risk score used in ACS?

Answer 1

CRUSADE

Question 2

Outline the immediate treatment of ACS

Answer 2

Aspirin 300mg
Sublingual glyceryl trinitrate - unless the patient is hypotensive
Oxygen if the patient is hypoxic
IV morphine plus anti-emetic

Question 3

How long from the onset of chest pain may reperfusion therapy be of no benefit?

Answer 3

12 hours

Question 4

What anti-thrombotic therapy is given to patients who will undergo PPCI?

Answer 4

Aspirin 300mg
Cloidogrel 600mg or Ticagrelor 180 mg or Prasugrel 60 mg

LMWH is given in the cath lab and in high risk cases a glycoprotein IIb/IIIa inhibitor may also be given

Question 5

How should you manage patients who have had NSTEMI or high risk instable angina?

Answer 5

Coronary angiography within 72h of presentation

Question 6

Outline the secondary prevention of ACS

Answer 6

Anti-thrombotic therapy - 75mg aspirin life long, 75mg clopidogrel min 1 year
ACE-i to preserve left ventricular function
Beta-blocker
Atorvastatin 80mg
Stop smoking

Question 7

Outline the in Hospital Resuscitation algorithm

Answer 7

Find collapsed patient and ensure personal safety (gloves)
Call for help and assess for signd of life
If no signs of life cal resus tream and commence CPR (30:2), apply pads and attempt defib if appropriate

Question 8

What’s the criteria for high quality chest compressions?

Answer 8

Depth 5-6 cm
Rate 100 - 120 compressions/min
Chest should recoil completely

Question 9

What should you do in the event if a respiratory arrest?

Answer 9

Ventilate the patient’s lung and check for a pulse every minute

Question 10

When is the first dose of adrenaline given?

Answer 10

During the 2 min period of CPR after delivery of the third shock

Question 11

What dose of amiodarone is given after the third shock?

Answer 11

300 mg

Question 12

What dose of amiodarone is given after the fifth shock?

Answer 12

150 mg

Question 13

What drug can br given instead of amiodarone?

Answer 13

Lidnocaine 1 mg kg

Question 14

What is important to do in shock refractory VF/pVT?

Answer 14

Check position and contact of defib pads

Question 15

What should you do if a rhythm compatible with a pulse is seen?

Answer 15

Try to palpate a central pulse and look for other evidence of ROSC (increased end-tidal CO2, evidence of CO on cardiac monitoring)
Pulse checks should only be undertaken if a rhythm compatible with pulse is seen.
Do not interrupt chest compressions to palpate a pulse unless patient shows signs of ROSC

Question 16

When do you give 1mg adrenaline in PEA and asystole?

Answer 16

As soon as intravascular access is achieved