ALS - Adult Flashcards
First line treatment for polymorphic VT (Torsades de Pointes)
Magnesium Sulphate 2g/10 minutes
Indication for beta blockers?
- Narrow-complex regular tachycardias, if uncontrolled by vagal manoeuvres/adenosine (alternative - calcium channel blockers)
- AF/atrial flutter rate - when ventricular function preserved
Atenolol dose?
5mg/ 5 minutes
Adenosine - action?
Slows transmission across AV node
Adenosine - indications?
Praroxysmal SVT with re-entrant circuits that include the AV node.
Benefit of adenosine if not a re-entrant narrow-complex tachycardia?
Will slow ventricular response so can see atrial rhythm.
Adenosine - dose?
6mg
2nd line to adenosine?
Verapamil
WPW - give adenosine?
Promote accessory pathway conduction -> dangerous ventricular response and rarely AF, if supra ventricular arrhythmia
Amiodarone - indications?
- Stable monomorphic VT, polymor- phic VT and wide-complex tachycardia of uncertain origin.
- Paroxysmal SVT uncontrolled by adenosine, vagal manoeuvres or AV nodal blockade
- To control rapid ventricular rate due to accessory pathway conduction in pre-excited atrial arrhythmias.
- Unsuccessful cardioversion
What causes hypotension associated with amiodarone?
Vasoactive solvents - benzyl alcohol/polysorbate 80.
Use aqueous to reduce risk?
Peripheral or central veins for amiodarone?
Thrombophlebitis if peripheral
Unstable bradycardia 1st line?
Atropine 500 mcg IV
Why are we bad at spotting deterioration to CA in hospital?
Patients often have slow and progressive physiological deterioration, involving hypox- aemia and hypotension that is unnoticed or poorly managed by ward staff. Essentially - infrequent, late or incomplete vital signs assess- ments; lack of knowledge of normal vital signs values; poor design of vital signs charts; poor sensitivity and specificity of ‘track and trigger’ systems; failure of staff to increase monitoring or escalate care, and staff workload
When should we consider a DNACPR?
If unlikely to survive or does not wish to have CPR.
What do the guidelines suggest to improve in hospital CA recognition and management?
Appropriate levels of care for critically ill. Early warning systems - frequent obs. Clear and usable charts for the above. Clearly identified response plan for critical illness. Education/training. Empower the call for help. Identify DNACPR pts early. Audit.
Commonest cause of SCD?
Coronary artery disease.
Non- ischaemic cardiomyopathy and valvular disease account for most other SCD events in older people
Commonest cause of SCD in young people?
Inherited abnormalities (e.g. Brugada syndrome, hypertrophic cardiomyopathy), congenital heart disease, myocarditis and substance abuse
How do you manage children/young people with symptoms of arrhyhmogenic syncope?
Specialist cardiology assessment, which should include an ECG and in most cases an echocardiogram and exercise test
Characteristics of arrhythmic syncope?
Syncope in the supine position, occurring dur- ing or after exercise, with no or only brief prodromal symptoms, repetitive episodes, or in individuals with a family history of sudden death.
What factors increase the risk of syncope being arrhythmic?
Non-pleuritic chest pain, palpitations associated with syncope, seizures (when resistant to treatment, occurring at night or precipitated by exercise, syncope, or loud noise) and drowning in a competent swimmer should raise suspi- cion of increased risk
Signs of LQTS?
A family history of syncope or SCD, palpitations as a symptom, supine syncope and syncope associated with exercise and emotional stress are more common in patients with long QT syndrome (LQTS).
What are the common causes of inexplicable drowning in competent swimmers?
LQTS or catecholaminergic polymoprhic VT.
NB - association between LQTS and seizure phenotype.
Predictors of arrhythmic syncope in older patients?
If there is NO nausea and vomiting before syncope and ECG abnormalities is an independent predictor of arrhythmic syncope.
Rules for termination of resuscitation prehospitally?
The rule recommends termination when
there is no ROSC, no shocks are administered and EMS personnel do not witness the arrest.
Or 20 mins ALS, no ROSC, no reversible cause.
Rate of ventilation in an intubated patient?
10 breaths/minute
What is continuous Et CO2 monitoring useful for?
Quality indicator of CPR.
Sign of ROSC if it increases.
How often do you rhythm check/give adrenaline?
- Rhythm check every 2 mins.
- Adrenaline 1mg every 3-5 minutes. (in practice this is about once every two cycles, so after 2 shocks)
When do you give amiodarone and how much?
For Vf/pVT
300mg, after three shocks.
Can give another 150mg after 5 shocks.
What initial defibrillation shock levels are indicated in biphasic/pulsed biphasic shocks?
Biphasic: at least 150J.
Pulsed biphasic: 120-150J.
Energy level for second and third shocks?
150-360J (biphasic)
How does the management of VT/VF differ in a witnessed arrest?
Three stacked shocks.
Check for rhythm change/ROSC -> immediate chest compressions if has not worked.
When do you give adrenaline in a witnessed VT/VF arrest?
Do three shocks -> start compressions 2 minutes -> shock -> compressions 2 minutes -> shock -> then adrenaline.
When is the use of precordial thump appropriate? (And how deliver?)
Only when used without delay whilst awaiting the arrival of a defibrillator in a monitored VF/pVT arrest.
Using the ulnar edge of a tightly clenched fist, deliver a sharp impact to the lower half of the sternum from a height of about 20 cm, then retract the fist immediately to create an impulse-like stimulus
What are all drugs followed by?
20 ml flush of saline
Alternative to amiodarone?
Lidocaine 1mg/kg
PEA: define
Pulseless electrical activity - cardiac arrest in the presence of electrical activity (other than ventricular tach- yarrhythmia) that would normally be associated with a palpable pulse.
Pseudo-PEA?
Some mechanical myocardial contractions, but these are too weak to produce a detectable pulse or blood pressure.
4 Hs/4 Ts
Hypoxia
Hypotension
Hyperkalaemia/hypok/hyperm/hypom - metabolic disorders.
Hypothermia.
Thrombosis
Tension Pneumothorax
Tamponade (cardiac)
Toxins
What to check in asystole?
- Position of leads.
P waves - can pace.
Treatment of hyperkalaemia, hypocalcaemia and CCB overdose?
Calcium chloride IV.