ALS Flashcards
What are the two most important things in the chain of survival?
good quality CPR
early defibrillation
What are the two shockable rhythms according to the ALS guidelines?
Ventricular tachycardia and ventricular fibrillation
What are the non-shockable rhythms according to the ALS guidelines/protocol?
asystole, pulseless electical activity/sinus rhythm
What is the number of joules used to shock an adult? a child?
Adult: 200J (150J minimum). Child: 4J/kg
What does COACHED stand for and what is it in reference to?
Defibrillation: CPR continued, Oxygen away, All others away, Charging, Hands off (stop CPR), Evaluate rhythm, Deliver or dump the charge.
What are the 5 H’s and 5T’s and what are they in reference to?
Correctable causes of a cardiac arrest: Hypoxia, hypovolaemia, hypo/hyperthermia, hypo/hyperkalaemia, hydrogen ions (acidosis), tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis
What are the doses of adrenaline used in adults and children in cardiac arrest?
Adult: 1mg (dilute 1mg in 10ml syringe with 9ml water for injection so 1ml = 0.1mg, followed by 20ml flush). Children: 10microg/kg (dilute 1mg in 100ml burrette so 1ml = 10microg, followed by 20ml flush) - includes neonates
When should adrenaline be given in a shockable rhythm and nonshockable rhythm? What other medication can be given in a shockable rhythm?
Shockable: following third shock then every 2nd loop. Nonshockable: immediately then every other loop. Amiodarone 300mg (adult) after the 3rd shock - 5mg/kg in paediatrics.
What are the compression to ventilation ratios for adults, children and neonates?
Adults = 30:2. Children = 15:2. Neonates= 3:1
What is the procedure for newborn/neonatal life support?
dry the baby (stimulates baby), suction to mouth to clear any meconium etc, assess heart rate, tone and breathing.
Open airway (neutral position) and give 5 inflation breaths.
Reassess heart rate, if chest moving then ventilate and HR<60 or undetectable for 30 seconds.
Reasses heart rate, if <60 then start chest compressions.
Continue for 30 seconds then reassess, if still <60 then consider IV adrenaline
What is the procedure for paediatric advanced life support?
Unresponsive/not breathing etc -> call for help, 5 initial breaths then 15:2, attach defib.
assess rhythm and shock at 4J/kg if shockable rhythm - VF/pulseless VT, if not then give 10microg/kg adrenaline (repeat every other loop)
immediately resume CPR for 2 mins
reassess rhythm
continue as above, give adrenaline 10microg/kg and amiodarone 5mg/kg after the third shock
repeat adrenaline every alternate cycle and repeat amiodarone one further time after 5th shock
What does DRSABCD stand for?
Dangers?
Responsive?
Send for help
Open Airway
Normal breathing?
Start CPR
Attach Defibrillator
What are the actions of adrenaline as a resuscitation drug?
Vasopressor (also reduces microcirculation, and severe hypertension after resuscitation)
increases myocardial and cerebral perfusion pressure via vasoconstriction (also increases myocardial oxygen consumption)
increasing frequency and amplitude of VT waveform which increases the chance of ROSC following defib (causes tachyarrhythmia’s)
Tissue necrosis can occur if extravasation occurs
What is the action of amiodarone?
anti-arrhythmic membrane stabiliser
increases duration of action potential and refractory period
slows conduction through the AV node
SE: bradycardia, hypotension, heart block and ventricular standstill
What is the action of lignocaine and when can it be used?
sodium channel blocker - slows the heart so it is an antiarrhythmic.
Can be used in VF/VT arrest (at 1mg/kg) provided that amiodarone hasn’t already been given
SE: bradycardia, hypotension, heart block, asystole, slurred speech, altered consciousness, muscle twitching, seizures
What is the indication for atropine and what is the method of action?
symptomatic bradycardia (NOT in asystole or PEA) - 500mvg - 1 mg IV every 3-5 minutes up to 3 mg
reverses slow heart rates by antimuscarinic action which counteract cholinergic mediated responses and AV node conduction abnormalities
SE: dryness of mouth, blurred vision, sensitivity to light, reduced sweating, dizziness, nausea and loss of balance
When is magnesium sulphate indicated and what is the mode of action?
Torsades de pointes, cardiac arrest with digoxin toxicity, pulseless VF/VT, hypokalaemia, hypomagnesium, eclampsia, severe asthma attack
anti-arrhythmic by causing muscle relaxation and membrane stabilisation
SE: excessive use can cause muscle weakness and respiratory failure
What is the first line treatment for hypokalaemia and what are some of the side effects?
Potassium chloride 5 mmol bolus
SE: hyperkalaemia with bradycardia, hypotension and possible asystole, extravasation leads to tissue necrosis
What are the indications for calcium gluconate? What is the mode of action and what are some of the side effects?
hyperkalaemia, hypocalcaemia or overdose of calcium channel blockers
Increases calcium levels or binds excess potassium or magnesium in the blood, also increases myocardial excitability, contractility and peripheral resistance
SE: possible increase in myocardial and cerebral injury by mediating cell death, tissue necrosis with extravasation
What are the indications for sodium bicarbonate use in the ALS setting?
What is the mechanism of action and some of the side effects?
prolonger resuscitation, tricyclic antidepressant overdoses, hyperkalaemia or preexisting metabolic acidosis
It’s an alkalinising solution and activates adrenaline and calcium
SE: excess CO2 production contributing to intracellular acidosis in myocardial and cerebral cells, compromised cerebral perfusion pressure, reduced systemic vascular resistance
