ALS algorithm Flashcards
What is the first monitored rhythm in 20% of cardiac arrests?
VF/pVT
What is the dose of amiodarone?
300mg IV
What is the dose of adrenaline in cardiac arrest?
1mg (10mL 1:10000) IV
When should adrenaline be with-held?
When there are signs of ROSC
What is an easy way to ensure adrenaline is given at the correct time in the shockable side of the algorithm?
Give after alternate shocks (starting after the third shock)
When can the second dose of amiodarone be given in the shockable side of the algorithm?
After the 5th shock
When should lidocaine be used?
Only if amiodarone is not available (dose 1mg kg)
What should you check in shock refractory VF/pVT
position of pads
What should you consider in shock refractory VF/pVT?
Changing the pad to AP
When should pulse checks be carried out?
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
When should stacked shocks be given?
Immediately after witnessed and monitored VF/pVT arrest
If you use the stacked shocks method when should drugs be administered?
Amiodarone immediately after third stacked shocks, adrenaline after a further 2 shocks
If P waves are detected on ECG during PEA arrest what should be done?
Ventricular standstill may be effectively treated by cardiac pacing
When should adrenaline be given in PEA/asystole arrests?
Immediately after IV access is achieved then every 3-5 minutes (during alternate cycles of CPR)
What should be used for ventilation in the absence of personnel skilled in tracheal intubation?
Bag-mask or SGA
How much CO2 do we produce each day?
400L
What does pCO2 mean
partial pressure of CO2
What does paC02 mean?
partial pressure of CO2 in arterial blood
What is the normal range of PaCO2?
4.7-6
What is the end tidal CO2?
The partial pressure of CO2 at the end of an exhaled breath
What does end tidal CO2 reflect?
Cardiac output and pulmonary blood flow as well as the ventilation minute volume
What is the role of waveform capnography in CPR
ensuring ET tube placement in the trachea
monitoring ventilation rate
monitoring the quality of chest compressions
identifying rosc
prognosticatoin
What may waveform capnography show if ROSC is achieved?
Increase in end-tidal CO2
How do capnographs work?
Take a small sample of gas (50ml/min) and analyse it using absorption of infrared light
What does the section AB represent in capnography?
baseline- indicates the end of inspiration
What does the section BC represent in capnography?
start of expiration
Why does the initial portion of BC have low CO2?
It has come from the anatomical dead space
What does the section CD represent in capnography?
The alveolar plataeu- slight increase is because not all alveoli empty at the same rate
What does the section DE represent in capnography?
As inspiration starts air containing no CO2 is mixed with the small amount of residual expired gas
When is the end co2 at its maximal?
D- normally 4.8 in healthy patients
What end CO2 value is associated with a poor outcome
Failure to achieve end tidal CO2 of 1.33 after 20 minutes of CPR is associated with a poor outcome
What are clinical signs of life?
Waking, purposeful movement
What are physiological signs of life?
sharp rise in end CO2
What should be done if there is a combination of clinical and physiological signs of life?
Consider stopping chest compressions for rhythm analysis and if appropriate a pulse check
What must any administration of drugs be followed by?
a 20mL flush and elevation of the extremity for 10-20 seconds
What are the recommended sites for IO injection?
proximal humerus
proximal tibia
distal tibia
What are the contraindications for IO
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
What are the complications of IO
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
What are the 4Hs and 4Ts
Hypoxia
Hypo/hyperthermia
Hypovolaemia
Hyper/hypo kalaemia
Toxins
Tamponade
Tension
Thrombosis
PEA due to hypovolaemia is usually due to
Severe haemorrhage
When should you suspect hypothermia?
In any drowning incident
What is the commonest cause of thromboembolic or mechanical circulatory obstruction?
Massive PE
What should be considered if the cause is felt tp be massive PE?
Fibrinolytic drugs
If a fibrinolytic drug is given how long should CPR be continued?
For 60-90 minutes
What are clinical signs of tamponade pre-arrest?
Distended neck veins and hypotension
What should be considered if cardiac arrest occurs after chest stabbing?
Resuscitative thoracotomy
What position is recommended for US?
Sub xiphoid
What does ECPR require?
Vascular access
circuit with a pump and an oxygenator
It is generally accepted that asystole for more than __ minutes in the absence of … is grounds for stopping resus attempts
20 minutes in the abscence of a reversible cause with ongoing ALS
