ALS Algorithm Flashcards
Heart rhythms in connection to cardiac arrest are of which two groups?
Shockable (VF and pVT)
Non-shockable (Asystole and PEA)
What are the most important and primary treatments in the ALS algorithm?
High quality, uninterrupted compressions
Early defibrillation (when appropriate)
Revise the ALS algorithm
Revise the manual defibrillator sequence
Revise the manual defibrillator sequence
If compressions are paused, what timeframe are we aiming?
Less than 5 seconds
What is the defibrillator joules? and what can it be increased to on second and subsequent shocks?
200J
360J
If a patient has had no response to effective compressions and VT is displayed, then treat as?
pVT
If during a rhythm check, a rhythm compatible to life is found, then do what?
Check for pulse, signs of life and end tidal CO2
If there is doubt between asystole and extremely fine VF, what do you do?
Don’t attempt defibrillation as CPR may increase the amplitude of the VF into a shockable VF
What is the chance of survival with asystole / PEA arrest if a reversible cause cannot be found?
Unlikely
What do you do if during CPR VF is seen (and it was asystole / PEA)?|
Wait until charge and check
What rate do you ventilate lungs during CPR?
10RR
With a supraglottic airway is inserted, do you stop to ventilate?
No, continuous CPR is now possible
How long can you pause CPR for passing a tube between the chords?
5 seconds
What is the CPR rate?
100-120 compressions per minute
Breathing efforts, movements and eye opening MAY indicate ROSC, how do you confirm?
Rhythm check and pulse check
ALS requires what kind monitoring?
ECG via pads, paddles or electrodes, ETCO2, Blood sampling (AVOID finger prick and ABG)
When is ETCO2 more reliable? What ventilation technologies?
Less with BVM but more reliable with SGA / ET
What ETCO2 value may indicate ROSC?
Approaching normal values or normal values
What is the role of ETCO2 in CPR
Tracheal placement
Monitoring ventilation
Monitoring quality of compressions
If ROSC is suspected, should you give adrenaline (if algo requires)?
No
What ETCO2 values are associated with poor prognosis?
Failure to get ETCO2 >20mmHg after 20 mins of CPR
What are the IO sites?
Humerus head, proximal / distal tibia, distal femur / sternum
Common site: Proximal tibia (Flat bone 2-3cm from patella and 2cm medial)
When not to do IO?
Previous attempt in the area, broken bone, prosthesis, failure to identify landmarks
How to confirm IO placement?
Aspirate (absence of aspiration is not absolute sign of failure)
IO site can be used for what?
Blood tests (but must be sent to lab with identification of it beings IO), DRUGS, FLUIDS, BLOOD PRODUCTS
With CPR, work to identify and correct the 4 H and 4 Ts, which are?
Hypovolaemia
Hypoxia
Hyperkalamia, hypok+, hypoglycaemia, hypocalcemia, acideaemia
Hypothermia
Toxins
Thrombus
Tension pneumothorax
Cardiac tamponade
What to do about hypoxia?
100% FiO2, check tube placement (ETCO2, auscultation), look for pre-arrest hypoxia if possible
What to do about hypovolaemia (which often causes PEA)?
Causes:
Haemorrhage (examine for evidence of this) - check wounds, drains -> fill the patient with fluid / bloods, stop the bleed
Distributive shock (anaphylaxis / sepsis) - fluid replacement
What to do about hyperkalaemia?
Give calcium chloride (stabilises cardiac cells in presence of high k+), sodium bic, 25g glucose and 10units short acting insulin
What is severe hyperkalaemia?
> 6.5mmol/L
What are some causes of hypocalcaemia?
Shock, sepsis, pancreatitis, drug toxicity
What to do about hypokalaemia? (<3.5mmol/L, severe is less than 2.5mmol/L)
5mmol IV K+; maybe 2g MgSo4 (helps with rapid correction)
What should I suspect in drowning?
Hypothermia (use low reading thermometer)
What is hyperthermia?
> 40.6 (Think hot environments and malignant hyperthermia)
Heat exhaustion vs heat stroke
Heat exhaustion causes nausea, vomiting, headache, malaise but has a core temperature below 40C
Heat stroke is systemic inflammation with core >40C (altered mental state, organ dysfunction)
In malignant hyperthermia (MDMA, meth, anaesthetics), what to give?
dantrolene
How to cool patient in CPR?
Cooling mats, wrapped ice packs, intravascular cooling, IV fluids
No drugs have been demonstrated as effective
If ACS is suspected with thrombus, what may be performed with CPR?
PCI, routine fibrinolytic is not recommended.
The most common thrombus is PE. What to give immediately?
This is when fibrinolytic is given immediately (at least 30 mins of CPR now needed up to 60-90mins)
What are pre-arrest signs of tension pneumothorax?
What sign in ventilated patient?
Common causes?
Chest pain, respiratory distress, tachycardia, air hunger, fall SPo2, hypotension, altered consciousness
In ventilated patients, high inspiratory pressures may indicate
Causes: Trauma, thoracic surgery, pacing wires, asthma, COPD
Ultrasound can help with diagnosis
How is needle thoracocentesis performed?
14G long cannula (second intercostal space, midclavicular)
What is cardiac tamponade?
Build up of pressure in pericardial space (early signs hypotension, distended neck veins)
Pre-arrest signs in cardiac tamponade?
Tachypnoea, dyspnoea, low voltage QRS, Kussmaul’s sign, pulsus paradoxus,
Beck’s triad: jugular venous distension, muffled heart sounds, low BP (often with narrow pulse pressure)
In cardiac arrest, what are some common causes that raises suspicion for cardiac tamponade?
Chest trauma, after cardiac surgery
What diagnostics can be helpful to confirm cardiac tamponade?
Echo
What treatments are possible for tamponade?
re-sternotomy, pericardiocentesis (ultrasound guided), thoracotomy
Antidote has been shown to work for toxins?
For cyanide toxicity (cardiac arrest, instability, acidosis, altered GCS), hydroxocobalamin (5mg up to 15mg)
Nalaxone 100mcg titrates
Sodium bicarbonate - TCAs
When is it generally accepted that asystole without reversible cause is a good time to stop?
20 mins of CPR
After stopping CPR, what is the means of diagnosing death?
Observe for 5 mins
Confirm loss of cardiac function by lack of central pluse and lack of auscultation of pulse + maybe asystole on ECG / lack of pulse of arterial line or echo
Any return of cardiac or respiratory activity should prompt another 5 mins of observation
After 5 mins of cardiorespiratory arrest, absence of pupil response, corneal reflex, motor response to supra-orbital pressure should confirm.
