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ALS > ALS algorithm > Flashcards

ALS algorithm Flashcards

1
Q

What is the first monitored rhythm in 20% of cardiac arrests?

A

VF/pVT

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2
Q

What is the dose of amiodarone?

A

300mg IV

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3
Q

What is the dose of adrenaline in cardiac arrest?

A

1mg IV

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4
Q

When should adrenaline be with-held?

A

When there are signs of ROSC

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5
Q

What is an easy way to ensure adrenaline is given at the correct time in the shockable side of the algorithm?

A

Give after alternate shocks (starting after the third shock)

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6
Q

When can the second dose of amiodarone be given in the shockable side of the algorithm?

A

After the 5th shock

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7
Q

When should lidocaine be used?

A

Only if amiodarone is not available (dose 1mg kg)

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8
Q

What should you check in shock refractory VF/pVT

A

position of pads

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9
Q

What should you consider in shock refractory VF/pVT?

A

Changing the pad to AP

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10
Q

When should pulse checks be carried out?

A

Only if there is a rhythm that could be compatible with a pulse
Only interrupt the chest compressions if if there are signs of ROSC

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11
Q

When should stacked shocks be given?

A

Immediately after witnessed and monitored VF/pVT arrest

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12
Q

If you use the stacked shocks method when should drugs be administered?

A

Amiodarone immediately after third stacked shocks, adrenaline after a further 2 shocks

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13
Q

If P waves are detected on ECG during PEA arrest what should be done?

A

Ventricular standstill may be effectively treated by cardiac pacing

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14
Q

When should adrenaline be given in PEA/asystole arrests?

A

Immediately after IV access is achieved then every 3-5 minutes (during alternate cycles of CPR)

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15
Q

What should be used for ventilation in the absence of personnel skilled in tracheal intubation?

A

Bag-mask or SGA

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16
Q

How much CO2 do we produce each day?

A

400L

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17
Q

What does pCO2 mean

A

partial pressure of CO2

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18
Q

What does paC02 mean?

A

partial pressure of CO2 in arterial blood

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19
Q

What is the normal range of PaCO2?

A

4.7-6

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20
Q

What is the end tidal CO2?

A

The partial pressure of CO2 at the end of an exhaled breath

21
Q

What does end tidal CO2 reflect?

A

Cardiac output and pulmonary blood flow as well as the ventilation minute volume

22
Q

What is the role of waveform capnography in CPR

A

ensuring ET tube placement in the trachea
monitoring ventilation rate
monitoring the quality of chest compressions
identifying rosc
prognosticatoin

23
Q

What may waveform capnography show if ROSC is achieved?

A

Increase in end-tidal CO2

24
Q

How do capnographs work?

A

Take a small sample of gas (50ml/min) and analyse it using absorption of infrared light

25
Q

What does the section AB represent in capnography?

A

baseline- indicates the end of inspiration

26
Q

What does the section BC represent in capnography?

A

start of expiration

27
Q

Why does the initial portion of BC have low CO2?

A

It has come from the anatomical dead space

28
Q

What does the section CD represent in capnography?

A

The alveolar plataeu- slight increase is because not all alveoli empty at the same rate

29
Q

What does the section DE represent in capnography?

A

As inspiration starts air containing no CO2 is mixed with the small amount of residual expired gas

30
Q

When is the end co2 at its maximal?

A

D- normally 4.8 in healthy patients

31
Q

What end CO2 value is associated with a poor outcome

A

Failure to achieve end tidal CO2 of 1.33 after 20 minutes of CPR is associated with a poor outcome

32
Q

What are clinical signs of life?

A

Waking, purposeful movement

33
Q

What are physiological signs of life?

A

sharp rise in end CO2

34
Q

What should be done if there is a combination of clinical and physiological signs of life?

A

Consider stopping chest compressions for rhythm analysis and if appropriate a pulse check

35
Q

What must any administration of drugs be followed by?

A

a 20mL flush and elevation of the extremity for 10-20 seconds

36
Q

What are the recommended sites for IO injection?

A

proximal humerus
proximal tibia
distal tibia

37
Q

What are the contraindications for IO

A

trauma, infection or a prosthesis at the target site, recent IO access (48hrs) in the same limb including a failed attempt, or a failure to identify the anatomical landmarks

38
Q

What are the complications of IO

A

extravasation into the soft tissues
dislodgement of the needle
compartment syndrome due to extravasation
fracture or chipping of the bone during insertion
pain related to the infusion of drugs/fluid
fat emboli
infection/osteomyelitis

39
Q

What are the 4Hs and 4Ts

A

Hypoxia
Hypo/hyperthermia
Hypovolaemia
Hyper/hypo kalaemia
Toxins
Tamponade
Tension
Thrombosis

40
Q

PEA due to hypovolaemia is usually due to

A

Severe haemorrhage

41
Q

When should you suspect hypothermia?

A

In any drowning incident

42
Q

What is the commonest cause of thromboembolic or mechanical circulatory obstruction?

A

Massive PE

43
Q

What should be considered if the cause is felt tp be massive PE?

A

Fibrinolytic drugs

44
Q

If a fibrinolytic drug is given how long should CPR be continued?

A

For 60-90 minutes

45
Q

What are clinical signs of tamponade pre-arrest?

A

Distended neck veins and hypotension

46
Q

What should be considered if cardiac arrest occurs after chest stabbing?

A

Resuscitative thoracotomy

47
Q

What position is recommended for US?

A

Sub xiphoid

48
Q

What does ECPR require?

A

Vascular access
circuit with a pump and an oxygenator

49
Q

It is generally accepted that asystole for more than __ minutes in the absence of … is grounds for stopping resus attempts

A

20 minutes in the abscence of a reversible cause with ongoing ALS

ALS (15 decks)

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