ALS Flashcards by M H

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

femoral and carotid

10 seconds

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What energy is used with biphasic vs monophasic defibrillators?

150J Bi

360J Mono

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

a precordial thump (20cm blow to lower sternum)

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

VF/VT-after 3 shocks

PEA/asystole-ASAP

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What 2 situations lead to PEA?

Failure of normal cardiac pumping mechanism

Obstruction to cardiac filling or output

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

PEA/asystole

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

magnesium sulphate

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

sympathomimetics+cocaine overdose

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

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

IV calcium chloride

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When would you give sodium bicarbonate?

Hyperkalaemia, severe acidosis and TCA overdose

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In what situation would you shock in PEA/asystole?

Rapid narrow complex tachycardia causing loss of cardiac output

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

elderly
diabetics
renal failure
females
peri op

BREATHLESSNESS

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Name 5 risk factors for MI.

hypercholestrolaemia
smoking
htn
renal disease
diabetes

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What 2 arrhythmias can develop in acute stages of STEMI?

VT, VF

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A post STEMI shows T wave inversion in which leads?

V1,2,3

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

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In drowning, what happens initially?

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

laryngospasm and breath holding to prevent water entry into lungs

<10 minutes

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

provide 3 stacked shocks

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

150J

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

YES YES!

document every CPR decision!

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

wear PPE

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

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

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

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

- <hr>

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

Tachy=synchronised cardioversion | Brady=atropine and THEN pacing if atropine does not work

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

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

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

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)

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

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

In AF when do use electrical/chemical cardioversion? | Give 2 names of chemical cardioverters and contraindications to use

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

How do you treat bradycardia?

1) Atropine | 2) Pacing

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

Type 2

Name 3 symptoms of opioid poisoning.

pinpoint pupils resp depression coma

What 3 problems can acute opioid withdrawal cause?

pulm oedema ventricular arrhythmia Agitation

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

hypotension LOC resp depression

When should you not use flumazenil?

if pt has hx of seizures

what 3 sx do you get in serotonin syndrome?

LOC seizures arrhythmia

Why does TCA overdose cause hypotension, seizure and arrhythmia?

all LINK to hyponatraemia CONSIDER TCA OVERDOSE IN SHOCKABLE ALS

What rx can you give for TCA overdose?

sodium bicarbonate

What sx do you get in cocaine overdose? | what can you give?

sympathetic hypertension hyperthermia tachycardia benzodiazepine

what drug can you give in organophosphate poisoning?

atropine

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

vasopressors, inotropes, calcium, glucagon transcut pacing in bradycardia

Name 3 positive inotropic drugs.

dobutamine dopamine noradenaline

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

torsades de pointes | digoxin overdose

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

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!!

Name 4 features of acute severe asthma

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

Name 4 features of acute severe asthma

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

What symptoms do you get in TCA overdose?

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

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

RAD | Widened QRS

Name 4 symptoms of local anaesthetic toxicity.

``` LOC tonic clonic seizures agitation ventricular arrhythmia sinus brady asystole ```

What do you treat local anaesthetic toxicity with?

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

Name 5 causes of wheeze.

``` Pneumonia Asthma COPD anaphylaxis FB pulm oedema PE ```

Name 5 causes of wheeze.

``` Pneumonia Asthma COPD anaphylaxis FB pulm oedema PE ```

What is dynamic hyperinflation?

air trapping due to mechanical ventilation

What is dynamic hyperinflation?

air trapping due to mechanical ventilation

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

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

What GI sx are seen in anaphylaxis?

vomiting abdo pain incontinence

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

Legs raised and lying flat Recovery position

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

Legs raised and lying flat Recovery position

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

a) reverses perip dilation | b) inc myocardial contractility and bronchodilation. Also suppresses histamine release

What are 2 second line drugs used in anaphylaxis?

antihistamine (chlorphenamine 10mg) | steroids (hydrocortisone 100mg)

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

1mg IV as per ALS algorithm

What specific test is done to confirm dx of anaphylaxis? | When should you take samples?

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

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

left lateral position manual movement of uterus to left prevent vena cava obstruction

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

Access above diaphragm to ensure reach to heart

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

- delivery of foetus by c section | - early tracheal intubation

Name 4 obstetric causes of haemorrhage.

Uterine rupture Placental abruption Placenta praevia ectopic pregnancy rupture

What mx should you consider in obstetric haemorrhage?

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

At how many weeks does a gravid uterus compress IVC?

20 weeks

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

20-23

What is commotio cordis?

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

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

reactive pupils organised ECG resp activity

Which 3 situations is CPR less effective than treating cause?

hypovolaemia caused by haemorrhage usually tension pneumothorax cardiac tamponade

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

ultrasound

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

250ml bc fluid will inc bleeding

What is the mx strategy of choice in a) pneumothorax and why b) tamponade

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

How do you give adrenaline in post op cardiac arrest?

in 50-100microgram increments

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

resternotomy

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

20j

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

hypovolaemic due to reduced hydrostatic pressure of water

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

submersion in sewage

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

<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

what temp is death imminent and irreversible in hypothermia?

<13.7 degrees

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

give for 5 mins stop for 5

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

give for 5 stop for 10mins

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

>30=every 6-10mins | >35=normal 3-5mins

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

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

28-30

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

ECLS

Name 5 clinical presentations of heat stroke.

``` hot dry skin arrhythmia hypotension vomiting, flushed, headache, fainting liver and renal failure rhabdomyolysis ```

Name 3 clinical conditions presenting similar to heat stroke.

``` serotonin syndrome drug withdrawal sepsis neuroleptic malignant syndrome thyroid storm pheochromocytoma ```

Name 3 techniques for cooling patients.

``` cool drinks fanning cold spray immersion in cold water cold IV fluids cooling devices ```

Name 3 techniques for warming patients.

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