ALS Flashcards
How often should rhythms be reassessed in cardiac arrest
After every 2min of CPR
What drugs to give when in shockable cardiac arrest
(After 1st 3 shocks)
1mg Adrenaline + 300mg Amiodarone
(Every 3-5min thereafter ie 2 rounds of CPR)
1mg Adrenaline
What drugs to give when in non-shockable cardiac arrest
(immediately)
1mg Adrenaline
Defibrillator setting in shockable cardiac arrest
Biphasic 150J
or monophasic 360J
Management of unstable bradycardia
- 500 micrograms atropine
2. External transcutaneous pacing
Management of anaphylaxis
- Treat anything life-threatening
- IM Adrenaline 1:1000 0.5ml
- IV fluids
- IM/IV Chlorphenamine 10mg
- IM/IV Hydrocortisone 200mg
What ABCD levels could be considered periarrest
A: threatened
B: RR<5 OR >36
C: HR <40 OR >140, sBP <90
D: GCS drop of >2, repeated/ prolonged seizures
Causes of VF
Heart problems
- ACS
- Hypertension
- long QT syndromes
Others
- Acidosis
- Abnormal K, Mg, Ca
- Hypothermia
- Electrocution
- Drugs: TCAs, digoxin, anti arrhythmics
For every minute that passes between collapse and defib, how much does mortality increase by?
Mortality increases by 7-10min
If a pt has a pacemaker/ICD, where should electrodes be placed
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
Should rhythm be re-assessed immediately after a shock
No. Continue CPR for 2min until next rhythm re-analysis
In transvenous pacing, where should the tip of the lead be
Tip should be in apex of right ventricle (least likely to be displaced here)
What energy level for synchronised cardioversion in:
Broad complex tachycardia/ a fib
Broad complex tachycardia/ a fib:
120-150 J
What energy level for synchronised cardioversion in:
Narrow complex tachycardia/ a flutter
Narrow complex tachycardia/ a flutter:
70-120J
During a witnessed cardiac arrest eg in cath lab, how many shocks at what energy level should be given
3 sequential stacked shocks at 360 J
Describe order of treatment for shockable cardiac arrest
- Non-synchronised shock 150J
- After 3rd shock, Amiodarone 300mg IV + Adrenaline 1mg IV
- Repeat Adrenaline 1mg IV after every 2nd shock thereafter
- Give additional dose Amiodarone 150mg IV or Lidocaine 1mg/kg after 5th shock
Describe order of treatment for non-shockable cardiac arrest
- Adrenaline 1mg IV
2. Repeat Adrenaline 1mg IV every 2nd shock thereafter
What patients will atropine not work in
Cardiac transplant patients
(their hearts are denervated)
Use isoprenaline/ adrenaline/ dopamine instead
What types of bradycardia have high risk of progression to asystole (so treat as if unstable)
- Recent asystole
- Type 2 mobitz block
- Complete heart block
- Ventricular pause >3s
Does acidaemia cause potassium to increase or decrease
Acidaemia:
Serum K increases when serum H decreases
Drug to treat bradycardia due to B blocker/ CCB
Glucagon
Drug to treat bradycardia complicating acute inferior wall myocardial infarction/ spinal cord injury
aminophylline 100-200mg by slow IV
Treatment for TCAs
Sodium bicarbonate
Where to place needle in needle decompression of tension pneumothorax
2nd ICS midclavicular OR
5th ICS midaxillary
Excess fluid can worsen massive haemorrhage. How much fluid should be given to a hypovolemic haemorrhaging patient?
250ml bolus until radial pulse achieved
Target sBP in massive haemorrhage
80-90 mmHg
In what arrest scenarios might a thoracotomy be useful
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)
Most common arrest rhythm in perioperative arrest
Asystole (41.7percent)
followed by
Vfib (35.4percent)
How to proceed with shockable cardiac arrest post-surgery
- Shock up to 3x
- After 3 failed shocks, do emergency resternotomy
- Shock with internal paddles at 20J
5 stages of hypothermia
- Mild hypothermia: 32-35C. Conscious, shivering
- Moderate hypothermia: 28-32C. Impaired consciousness without shivering
- Severe hypothermia: 24-28C. Unconscious
- Arrest: <24C
- Death due to irreversible hypothermia: <13.7C
What temperature is classified as heatstroke
> 40.6degrees
Vfib/asystole is most common after AC/DC
V fib: AC
Asystole: DC
What temperature should patients be kept at post-ROSC
32-36C
When does electrical capture occur in transcutaneous pacing
50-100mA
Which arrest rhythm is common after STEMI
V fib
Seizures occur in what percentage of pts who are comatose after ROSC
1/3
Target BM after ROSC
BM 4-10
