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F1 and Stage 5 > ALS > Flashcards

ALS Flashcards

1
Q

How often should rhythms be reassessed in cardiac arrest

A

After every 2min of CPR

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2
Q

What drugs to give when in shockable cardiac arrest

A

(After 1st 3 shocks)
1mg Adrenaline + 300mg Amiodarone

(Every 3-5min thereafter ie 2 rounds of CPR)
1mg Adrenaline

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3
Q

What drugs to give when in non-shockable cardiac arrest

A

(immediately)

1mg Adrenaline

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4
Q

Defibrillator setting in shockable cardiac arrest

A

Biphasic 150J

or monophasic 360J

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5
Q

Management of unstable bradycardia

A
  1. 500 micrograms atropine

2. External transcutaneous pacing

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6
Q

Management of anaphylaxis

A
  1. Treat anything life-threatening
  2. IM Adrenaline 1:1000 0.5ml
  3. IV fluids
  4. IM/IV Chlorphenamine 10mg
  5. IM/IV Hydrocortisone 200mg
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7
Q

What ABCD levels could be considered periarrest

A

A: threatened

B: RR<5 OR >36

C: HR <40 OR >140, sBP <90

D: GCS drop of >2, repeated/ prolonged seizures

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8
Q

Causes of VF

A

Heart problems

  • ACS
  • Hypertension
  • long QT syndromes

Others

  • Acidosis
  • Abnormal K, Mg, Ca
  • Hypothermia
  • Electrocution
  • Drugs: TCAs, digoxin, anti arrhythmics
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9
Q

For every minute that passes between collapse and defib, how much does mortality increase by?

A

Mortality increases by 7-10min

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10
Q

If a pt has a pacemaker/ICD, where should electrodes be placed

A

Place at least 10-15cm away from device

Consider anterior-lateral or anterior-posterior positions

Anterior: over left precordium
Lateral: mid-axillary line
Posterior: inferior to left scapula

Normally have 1 on right upper sternum below clavicle, and 1 lateral

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11
Q

Should rhythm be re-assessed immediately after a shock

A

No. Continue CPR for 2min until next rhythm re-analysis

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12
Q

In transvenous pacing, where should the tip of the lead be

A

Tip should be in apex of right ventricle (least likely to be displaced here)

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13
Q

What energy level for synchronised cardioversion in:

Broad complex tachycardia/ a fib

A

Broad complex tachycardia/ a fib:

120-150 J

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14
Q

What energy level for synchronised cardioversion in:

Narrow complex tachycardia/ a flutter

A

Narrow complex tachycardia/ a flutter:

70-120J

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15
Q

During a witnessed cardiac arrest eg in cath lab, how many shocks at what energy level should be given

A

3 sequential stacked shocks at 360 J

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16
Q

Describe order of treatment for shockable cardiac arrest

A
  1. Non-synchronised shock 150J
  2. After 3rd shock, Amiodarone 300mg IV + Adrenaline 1mg IV
  3. Repeat Adrenaline 1mg IV after every 2nd shock thereafter
  4. Give additional dose Amiodarone 150mg IV or Lidocaine 1mg/kg after 5th shock
17
Q

Describe order of treatment for non-shockable cardiac arrest

A
  1. Adrenaline 1mg IV

2. Repeat Adrenaline 1mg IV every 2nd shock thereafter

18
Q

What patients will atropine not work in

A

Cardiac transplant patients
(their hearts are denervated)

Use isoprenaline/ adrenaline/ dopamine instead

19
Q

What types of bradycardia have high risk of progression to asystole (so treat as if unstable)

A
  • Recent asystole
  • Type 2 mobitz block
  • Complete heart block
  • Ventricular pause >3s
20
Q

Does acidaemia cause potassium to increase or decrease

A

Acidaemia:

Serum K increases when serum H decreases

21
Q

Drug to treat bradycardia due to B blocker/ CCB

A

Glucagon

22
Q

Drug to treat bradycardia complicating acute inferior wall myocardial infarction/ spinal cord injury

A

aminophylline 100-200mg by slow IV

23
Q

Treatment for TCAs

A

Sodium bicarbonate

24
Q

Where to place needle in needle decompression of tension pneumothorax

A

2nd ICS midclavicular OR

5th ICS midaxillary

25
Q

Excess fluid can worsen massive haemorrhage. How much fluid should be given to a hypovolemic haemorrhaging patient?

A

250ml bolus until radial pulse achieved

26
Q

Target sBP in massive haemorrhage

A

80-90 mmHg

27
Q

In what arrest scenarios might a thoracotomy be useful

A

Tension pneumothorax (if chest tube attempt unsuccessful)

Cardiac tamponade (if less than 15min CPR in penetrating trauma or less than 10min pre-hospital CPR in blunt trauma)

28
Q

Most common arrest rhythm in perioperative arrest

A

Asystole (41.7percent)

followed by
Vfib (35.4percent)

29
Q

How to proceed with shockable cardiac arrest post-surgery

A
  • Shock up to 3x
  • After 3 failed shocks, do emergency resternotomy
  • Shock with internal paddles at 20J
30
Q

5 stages of hypothermia

A
  1. Mild hypothermia: 32-35C. Conscious, shivering
  2. Moderate hypothermia: 28-32C. Impaired consciousness without shivering
  3. Severe hypothermia: 24-28C. Unconscious
  4. Arrest: <24C
  5. Death due to irreversible hypothermia: <13.7C
31
Q

What temperature is classified as heatstroke

A

> 40.6degrees

32
Q

Vfib/asystole is most common after AC/DC

A

V fib: AC

Asystole: DC

33
Q

What temperature should patients be kept at post-ROSC

A

32-36C

34
Q

When does electrical capture occur in transcutaneous pacing

A

50-100mA

35
Q

Which arrest rhythm is common after STEMI

A

V fib

36
Q

Seizures occur in what percentage of pts who are comatose after ROSC

A

1/3

37
Q

Target BM after ROSC

A

BM 4-10

F1 and Stage 5 (29 decks)

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