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ALS 2 > ALS Algorithm > Flashcards

ALS Algorithm Flashcards

1
Q

Heart rhythms in connection to cardiac arrest are of which two groups?

A

Shockable (VF and pVT)

Non-shockable (Asystole and PEA)

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2
Q

What are the most important and primary treatments in the ALS algorithm?

A

High quality, uninterrupted compressions

Early defibrillation (when appropriate)

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3
Q

Revise the ALS algorithm

A
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4
Q

Revise the manual defibrillator sequence

A
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5
Q

Revise the manual defibrillator sequence

A
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6
Q

If compressions are paused, what timeframe are we aiming?

A

Less than 5 seconds

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7
Q

What is the defibrillator joules? and what can it be increased to on second and subsequent shocks?

A

200J

360J

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8
Q

If a patient has had no response to effective compressions and VT is displayed, then treat as?

A

pVT

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9
Q

If during a rhythm check, a rhythm compatible to life is found, then do what?

A

Check for pulse, signs of life and end tidal CO2

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10
Q

If there is doubt between asystole and extremely fine VF, what do you do?

A

Don’t attempt defibrillation as CPR may increase the amplitude of the VF into a shockable VF

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11
Q

What is the chance of survival with asystole / PEA arrest if a reversible cause cannot be found?

A

Unlikely

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12
Q

What do you do if during CPR VF is seen (and it was asystole / PEA)?|

A

Wait until charge and check

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13
Q

What rate do you ventilate lungs during CPR?

A

10RR

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14
Q

With a supraglottic airway is inserted, do you stop to ventilate?

A

No, continuous CPR is now possible

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15
Q

How long can you pause CPR for passing a tube between the chords?

A

5 seconds

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16
Q

What is the CPR rate?

A

100-120 compressions per minute

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17
Q

Breathing efforts, movements and eye opening MAY indicate ROSC, how do you confirm?

A

Rhythm check and pulse check

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18
Q

ALS requires what kind monitoring?

A

ECG via pads, paddles or electrodes, ETCO2, Blood sampling (AVOID finger prick and ABG)

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19
Q

When is ETCO2 more reliable? What ventilation technologies?

A

Less with BVM but more reliable with SGA / ET

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20
Q

What ETCO2 value may indicate ROSC?

A

Approaching normal values or normal values

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21
Q

What is the role of ETCO2 in CPR

A

Tracheal placement
Monitoring ventilation
Monitoring quality of compressions

22
Q

If ROSC is suspected, should you give adrenaline (if algo requires)?

A

No

23
Q

What ETCO2 values are associated with poor prognosis?

A

Failure to get ETCO2 >20mmHg after 20 mins of CPR

24
Q

What are the IO sites?

A

Humerus head, proximal / distal tibia, distal femur / sternum

Common site: Proximal tibia (Flat bone 2-3cm from patella and 2cm medial)

25
Q

When not to do IO?

A

Previous attempt in the area, broken bone, prosthesis, failure to identify landmarks

26
Q

How to confirm IO placement?

A

Aspirate (absence of aspiration is not absolute sign of failure)

27
Q

IO site can be used for what?

A

Blood tests (but must be sent to lab with identification of it beings IO), DRUGS, FLUIDS, BLOOD PRODUCTS

28
Q

With CPR, work to identify and correct the 4 H and 4 Ts, which are?

A

Hypovolaemia
Hypoxia
Hyperkalamia, hypok+, hypoglycaemia, hypocalcemia, acideaemia
Hypothermia

Toxins
Thrombus
Tension pneumothorax
Cardiac tamponade

29
Q

What to do about hypoxia?

A

100% FiO2, check tube placement (ETCO2, auscultation), look for pre-arrest hypoxia if possible

30
Q

What to do about hypovolaemia (which often causes PEA)?

A

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

31
Q

What to do about hyperkalaemia?

A

Give calcium chloride (stabilises cardiac cells in presence of high k+), sodium bic, 25g glucose and 10units short acting insulin

32
Q

What is severe hyperkalaemia?

A

> 6.5mmol/L

33
Q

What are some causes of hypocalcaemia?

A

Shock, sepsis, pancreatitis, drug toxicity

34
Q

What to do about hypokalaemia? (<3.5mmol/L, severe is less than 2.5mmol/L)

A

5mmol IV K+; maybe 2g MgSo4 (helps with rapid correction)

35
Q

What should I suspect in drowning?

A

Hypothermia (use low reading thermometer)

36
Q

What is hyperthermia?

A

> 40.6 (Think hot environments and malignant hyperthermia)

37
Q

Heat exhaustion vs heat stroke

A

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)

38
Q

In malignant hyperthermia (MDMA, meth, anaesthetics), what to give?

A

dantrolene

39
Q

How to cool patient in CPR?

A

Cooling mats, wrapped ice packs, intravascular cooling, IV fluids

No drugs have been demonstrated as effective

40
Q

If ACS is suspected with thrombus, what may be performed with CPR?

A

PCI, routine fibrinolytic is not recommended.

41
Q

The most common thrombus is PE. What to give immediately?

A

This is when fibrinolytic is given immediately (at least 30 mins of CPR now needed up to 60-90mins)

42
Q

What are pre-arrest signs of tension pneumothorax?

What sign in ventilated patient?

Common causes?

A

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

43
Q

How is needle thoracocentesis performed?

A

14G long cannula (second intercostal space, midclavicular)

44
Q

What is cardiac tamponade?

A

Build up of pressure in pericardial space (early signs hypotension, distended neck veins)

45
Q

Pre-arrest signs in cardiac tamponade?

A

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)

46
Q

In cardiac arrest, what are some common causes that raises suspicion for cardiac tamponade?

A

Chest trauma, after cardiac surgery

47
Q

What diagnostics can be helpful to confirm cardiac tamponade?

A

Echo

48
Q

What treatments are possible for tamponade?

A

re-sternotomy, pericardiocentesis (ultrasound guided), thoracotomy

49
Q

Antidote has been shown to work for toxins?

A

For cyanide toxicity (cardiac arrest, instability, acidosis, altered GCS), hydroxocobalamin (5mg up to 15mg)

Nalaxone 100mcg titrates

Sodium bicarbonate - TCAs

50
Q

When is it generally accepted that asystole without reversible cause is a good time to stop?

A

20 mins of CPR

51
Q

After stopping CPR, what is the means of diagnosing death?

A

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.

ALS 2 (14 decks)

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