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Final year > ALS > Flashcards

ALS Flashcards

1
Q

When examining a pulse in cardiac arrest, which 2 places do you palpate and for a maximum of how many seconds?

A

femoral and carotid

10 seconds

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2
Q

What energy is used with biphasic vs monophasic defibrillators?

A

150J Bi

360J Mono

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3
Q

If defib is not available, what manouvre can be done?

A

a precordial thump (20cm blow to lower sternum)

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4
Q

When is the first dose of adrenaline given in cardiac arrest? VF/VT vs PEA/asystole

A

VF/VT-after 3 shocks

PEA/asystole-ASAP

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5
Q

What 2 situations lead to PEA?

A

Failure of normal cardiac pumping mechanism

Obstruction to cardiac filling or output

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6
Q

Which situation will you be looking to treat reversible causes of cardiac arrest? VF/VT or PEA/asystole?

A

PEA/asystole

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7
Q

what is the treatment of torsades de pointes in digoxin toxicity?

A

magnesium sulphate

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8
Q

when should you be cautious about giving adrenaline in cardiac arrest?

A

sympathomimetics+cocaine overdose

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9
Q

Explain when you would give adrenaline+amiodarone in VF/pVT vs asystole/PEA.

A

VF/pVT- after 3rd defib shock give amiodarone 300mg and adrenaline 1mg, then adrenaline every other CPR cycle
Asystole/PEA-give adrenaline 1mg ASAP and then every other CPR cycle

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10
Q

What do you give if PEA arrest occurs in hyperkalaemia, hypocalcaemia, hypermagnesaemia, Ca2+ blocker overdose?

A

IV calcium chloride

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11
Q

When would you give sodium bicarbonate?

A

Hyperkalaemia, severe acidosis and TCA overdose

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12
Q

In what situation would you shock in PEA/asystole?

A

Rapid narrow complex tachycardia causing loss of cardiac output

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13
Q

Which type of patients do not have chest pain with STEMI? Name 3
What is the main symptom in these patients?

A 
elderly
diabetics
renal failure
females
peri op

BREATHLESSNESS

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14
Q

Name 5 risk factors for MI.

A 
hypercholestrolaemia
smoking
htn
renal disease
diabetes
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15
Q

What 2 arrhythmias can develop in acute stages of STEMI?

A

VT, VF

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16
Q

A post STEMI shows T wave inversion in which leads?

A

V1,2,3

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17
Q

When using transcutaneous pacing:

a) electrical capture (e.g. ventricular depolarisation) occurs at what current?
b) Hyper…. can prevent success
c) What can inhibit pacemaker?
d) does generation of electrical capture and QRS complex mean there is a pulse?

A

a) 50-100mA
b) kalaemia
c) movement
d) no, you can have PEA

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18
Q

In drowning, what happens initially?

Being submerged under water for less than how many minutes, produces a good outcome?

A

laryngospasm and breath holding to prevent water entry into lungs

<10 minutes

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19
Q

If a witnessed cardiac arrest occurs in CCU, cath lab, ITU and manual defib avail showing VF/pVT, what should you do straight away?

A

provide 3 stacked shocks

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20
Q

The first shock energy should be at least how many joules?

A

150J

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21
Q

If a patient is ‘for CPR’ should this be documented?

A

YES YES!

document every CPR decision!

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22
Q

when giving CPR to patients with TB or SARS, what should you do?

A

wear PPE

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23
Q

Name 4 adverse features that need to be recognised in arrhythmia.

A 
Syncope
Systolic BP <90 (shock)
Heart failure (pulm oedema/raised JVP)
Myocardial ischaemia
Extremes of HR:
-<40bpm 
->150bmp
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24
Q

Patients with arrhythmias who have exteremes of HR-i.e. >150 or <40, what do you need to be careful of in each situation?

A
  • > HR =less CO and less coronary supply causing potential MI

- <hr>

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25
Q

In tachyarrhythmia, what is 1st line rx if patient has adverse signs? What is 1st line in bradycardia?

A

Tachy=synchronised cardioversion

Brady=atropine and THEN pacing if atropine does not work

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26
Q

How do you treat VT if no adverse effects? broad complex regular tachy

A

300mg amiodarone over 30-60mins then 900mg over 24hours if doesn’t work

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27
Q

How do you treat regular narrow complex tachycardia with no adverse effects?

A

1) vagal manouveres
2) Adenosine-6, 12, 12mg-monitor ECG
If sinus achieved=paroxysmal SVT (e.g. AVRT/AVNRT)
If it doesn’t: verapamil 2.5-5mg IV
If sinus NOT achieved=atrial flutter (control rate with B blocker)

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28
Q

How do you treat irregular narrow complex tachycardia with no adverse effects?

A 
AF
B blocker
In asthmatics, use diltiazem
In HF patients use digoxin or amiodarone
Consider anti coagulation
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29
Q

In AF when do use electrical/chemical cardioversion?

Give 2 names of chemical cardioverters and contraindications to use

A

If adverse effects present and/or pt has been in AF for <48 hours

Flecanide-do not give in HF, IHD, long QT
Amiodarone-takes longer

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30
Q

How do you treat bradycardia?

A

1) Atropine

2) Pacing

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31
Q

Which is more likely to progress to asystole? Mobits 1 or 2?

A

Type 2

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32
Q

Name 3 symptoms of opioid poisoning.

A

pinpoint pupils
resp depression
coma

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33
Q

What 3 problems can acute opioid withdrawal cause?

A

pulm oedema
ventricular arrhythmia
Agitation

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34
Q

What are 3 sx of benzodiazepine (chlordiazepoxide, lorazepam etc-muscle relaxant and anxiolytic properties) overdose?

A

hypotension
LOC
resp depression

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35
Q

When should you not use flumazenil?

A

if pt has hx of seizures

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36
Q

what 3 sx do you get in serotonin syndrome?

A

LOC
seizures
arrhythmia

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37
Q

Why does TCA overdose cause hypotension, seizure and arrhythmia?

A

all LINK to hyponatraemia

CONSIDER TCA OVERDOSE IN SHOCKABLE ALS

38
Q

What rx can you give for TCA overdose?

A

sodium bicarbonate

39
Q

What sx do you get in cocaine overdose?

what can you give?

A

sympathetic
hypertension
hyperthermia
tachycardia

benzodiazepine

40
Q

what drug can you give in organophosphate poisoning?

A

atropine

41
Q

what drugs can be given in b blocker and Ca2+ blocker overdose?

A

vasopressors, inotropes, calcium, glucagon

transcut pacing in bradycardia

42
Q

Name 3 positive inotropic drugs.

A

dobutamine
dopamine
noradenaline

43
Q

when do you give magnesium? Name an arrhythmia and toxicity.

A

torsades de pointes

digoxin overdose

44
Q

Name 3 clinical signs and 3 measurements in life threatening asthma.

A

3 clinical- cyanosis, arrhythmia, altered consciousness, silent chest, poor resp effort

3 measure-PEF<33% predicted, O2<92% ‘normal PaCO2 4.6-6)-should be less if hyperventilating!!

45
Q

Name 4 features of acute severe asthma

A

PEF 33-50%
RR>25
HR>110
Inability to complete sentences

46
Q

Name 4 features of acute severe asthma

A

PEF 33-50%
RR>25
HR>110
Inability to complete sentences

47
Q

What symptoms do you get in TCA overdose?

A

Anticholinergic effects-mydriasis (dilated pupil), fever, dry skin, ileus, urinary retention

48
Q

What 2 ECG changes predict greater risk of arrhythmia in patients with TCA overdose?

A

RAD

Widened QRS

49
Q

Name 4 symptoms of local anaesthetic toxicity.

A 
LOC
tonic clonic seizures
agitation
ventricular arrhythmia
sinus brady
asystole
50
Q

What do you treat local anaesthetic toxicity with?

A

1) 1.5ml/kg 20% lipid emulsion bolus
2) 15ml/kg/hr IV infusion
3) Bolus every 5mins up till 12ml/kg

Stop infusion when toxicity reversed or 12ml bolus reached

51
Q

Name 5 causes of wheeze.

A 
Pneumonia
Asthma
COPD
anaphylaxis
FB
pulm oedema
PE
52
Q

Name 5 causes of wheeze.

A 
Pneumonia
Asthma
COPD
anaphylaxis
FB
pulm oedema
PE
53
Q

What is dynamic hyperinflation?

A

air trapping due to mechanical ventilation

54
Q

What is dynamic hyperinflation?

A

air trapping due to mechanical ventilation

55
Q

What 3 criteria need to be met for a dx of anaphylaxis?

A

sudden onset symptoms
life threatening ABC
skin and mucosal changes (urticaria, angiodema)

56
Q

What GI sx are seen in anaphylaxis?

A

vomiting
abdo pain
incontinence

57
Q

Patients in anaphylaxis with hypotension should be put in what position?
Ones who are breathing and unconscious should be placed how?

A

Legs raised and lying flat

Recovery position

58
Q

Patients in anaphylaxis with hypotension should be put in what position?
Ones who are breathing and unconscious should be placed how?

A

Legs raised and lying flat

Recovery position

59
Q

Explain the:
a) a adrenergic
b) b adrenergic
effects of adrenaline.

A

a) reverses perip dilation

b) inc myocardial contractility and bronchodilation. Also suppresses histamine release

60
Q

What are 2 second line drugs used in anaphylaxis?

A

antihistamine (chlorphenamine 10mg)

steroids (hydrocortisone 100mg)

61
Q

If a patient is in cardiac arrest due to anaphylaxis, do you give them 1mg adrenaline IV or 0.5mg IM?

A

1mg IV as per ALS algorithm

62
Q

What specific test is done to confirm dx of anaphylaxis?

When should you take samples?

A 
mast cell tryptase blood test
1. asap after cpr has begun
2. 1-2 hours after symptom detection
3. 24hrs
in LFT bottle
63
Q

What 2 things can you do in a pregnant woman to improve blood flow and how does this work?

A

left lateral position
manual movement of uterus to left

prevent vena cava obstruction

64
Q

Due to IVC compression in pregnancy, what do you need to ensure when acquiring IV/IO access?

A

Access above diaphragm to ensure reach to heart

65
Q

What 2 things should you consider in a pregnant cardiac arrest patient?

A
  • delivery of foetus by c section

- early tracheal intubation

66
Q

Name 4 obstetric causes of haemorrhage.

A

Uterine rupture
Placental abruption
Placenta praevia
ectopic pregnancy rupture

67
Q

What mx should you consider in obstetric haemorrhage?

A 
ergometrine, prostaglandins, oxytocin and uterine massage in atony
Bimanual compression
B lynch sutures
intrauterine balloon
Artery ligation
Hysterectomy
68
Q

At how many weeks does a gravid uterus compress IVC?

A

20 weeks

69
Q

between how many gestational weeks, does delivery of the foetus mean only survival for mother during cardiac arrest?

A

20-23

70
Q

What is commotio cordis?

A

lethal disruption of heart rhythm due to direct blow to area over heart
Usually teenage male sports players

71
Q

What 3 things are associated with better outcome in traumatic cardiac arrest?

A

reactive pupils
organised ECG
resp activity

72
Q

Which 3 situations is CPR less effective than treating cause?

A

hypovolaemia caused by haemorrhage usually
tension pneumothorax
cardiac tamponade

73
Q

Which imaging can rapidly detect haemoperitoneum/pneumothorax, tamponade and tension pneumothorax?

A

ultrasound

74
Q

In trauma, uncontrollable haemorrhage patients should be given boluses of what mls of fluid and why?

A

250ml bc fluid will inc bleeding

75
Q

What is the mx strategy of choice in

a) pneumothorax and why
b) tamponade

A

a) thoracoStomy-small incision with drain (not thoracotomy) extending to clamshell thoracotomy IF needed. Cannulae kink and can block so needle thoracocentesis is NOT the best option
b) thoracotomy

76
Q

How do you give adrenaline in post op cardiac arrest?

A

in 50-100microgram increments

77
Q

In cardiac arrest after cardiac surgery, where 3 stacked shocks for VF/pVT are unsuccessful, what surgical procedure should be done?

A

resternotomy

78
Q

In resternotomy, what energy should internal defib take place at?

A

20j

79
Q

After prolonged immersion in water, patients tend to be what? and why?

A

hypovolaemic due to reduced hydrostatic pressure of water

80
Q

When may prophylactic abx be of use in post resus care of drowned patients?

A

submersion in sewage

81
Q

Below what temp is hypothermia? give the values of mild moderate and severe. Also state the 2 symptoms in each

A

<35
stage 1: mild 32-35 conscious and shivering
stage 2: moderate 28-32 unconscious and NOT shivering
stage 3: severe<28 unconscious with vital signs

82
Q

what temp is death imminent and irreversible in hypothermia?

A

<13.7 degrees

83
Q

How should you give CPR in a patient with core temp less than 28?

A

give for 5 mins stop for 5

84
Q

How should you give CPR in a patient with core temp less than 20?

A

give for 5 stop for 10mins

85
Q

How often do you give adrenaline >30 degrees and >35 degrees?

A

> 30=every 6-10mins

>35=normal 3-5mins

86
Q

AF and asystole are arrhythmias associated with hypothermia that resolve on warming patient. Which other is and does NOT resolve when temp increases?

A

VF

87
Q

When shocking in hypothermic patients and VF still persists after 3 shocks, at what temp should you wait until, before giving further shocks?

A

28-30

88
Q

In hypothermia stage 2-5 a hospital with what piece of equipment should the patient be transferred to?

A

ECLS

89
Q

Name 5 clinical presentations of heat stroke.

A 
hot dry skin
arrhythmia
hypotension
vomiting, flushed, headache, fainting
liver and renal failure
rhabdomyolysis
90
Q

Name 3 clinical conditions presenting similar to heat stroke.

A 
serotonin syndrome
drug withdrawal
sepsis
neuroleptic malignant syndrome
thyroid storm
pheochromocytoma
91
Q

Name 3 techniques for cooling patients.

A 
cool drinks
fanning
cold spray
immersion in cold water
cold IV fluids
cooling devices
92
Q

Name 3 techniques for warming patients.

A 
heat blanket, foil, warm environment
remove wet clothes
exercise if conscious
warm forced air and IV infusions
ECMO

Final year (8 decks)

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