ALS algorithm Flashcards
How frequently is VF/pVT the first monitored rhythm is cardiac arrest?
20-30%
What energy should the defibrillator be set to (for ALS)?
200J for the initial shock, 360J for subsequent shocks`
When is adrenaline given?
Either immediately after rhythm check if not shockable or after 2nd shock in shockable then every 2nd cycle once given
When is Amiodarone given during the ALS algorhythm? how much?
300mg after 3 shocks
can give a further 150mg after 5
What are the 4 Hs and Ts
Hypoxia Hypovolaemia Hypo/Hyperthermia HypoK/glycaemia etc Thrombus (PE/ACS) Tamponade Tension Toxins
When should you check for a pulse during ALS?
If organized electrical activity compatible with cardiac output is seen during a rhythm check - check pulse and waveform capnography
If it is unclear whether the rhythm is asystole or very fine VF what should be done?
dump charge, CPR. if it is VF it will become more clear with high quality CPR
What should you look for when assessing a PEA rhythm?
P waves - ventricular standstill may be treated by pacing
What is the normal range for end-tidal CO2?
35-45mmHg
describe the phases of waveform capnography
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Where should IO placement occur? describe the landmarks and confirmation
can be proximal/distal tibia, proximal humerus, distal femur
Proximal tibia is common as it is away from airway and CPR.
2cm Medial to tibial tuberosity, 2-3cm inferior to joint
confirm placement by aspirating IO blood - can be sent to lab if labelled IO blood
- flush with saline before use
- can put adrenaline and amiodarone through it
Describe the treatment of severe hyperkaelemia and cardiac arrest
- IV, Intraosseous: 500 to 1,000 mg over 2 to 5 minutes (10mL of 10% calcium chloride)
One gram of calcium chloride salt is equal to 270 mg of elemental calcium.
Dosages are expressed in terms of the calcium chloride salt based on a solution concentration of 100 mg/mL (10%) containing 1.4 mEq (27 mg)/mL elemental calcium. - glucose 25g + 10 units Novorapid
- consider 50mmol sodium bicarbonate if severe acidosis or renal failure is present
Describe the difference between calcium gluconate and calcium chloride
ampule of both is 10mL
10mL of gluconate has 8.9mg/mL elemental calcium
10mL of chloride has 27.2 mg/mL elemental calcium
gluconate must be hepatically metabolised before calcium is available
How should hypokalaemia be corrected during cardiac arrest?
5mmol potassium bolus IV +/- 2g Magnesium sulfate
Describe the difference between heat exhaustion and heat stroke
Exhaustion - fatigue due to prolonged exposures to high temps. Sx include HA, N/V, malaise. does not have core body temp >40. rapid recovery
Stroke - systemic inflam response with core body temp >40.6 (hyperthermia) with altered mental status or collapse +/- organ dysfunction
How long should CPR be performed in the setting of thrombolysis of massive PE?
at least 30min up to 60-90 min
Describe the treatment of a tension pneumothorax + Cardiac arrest
14G cannula to 2nd intercostal space in the mid clavicular line then insertion of a chest tube.
What are the clinical signs of tamponade?
Becks Triad: jugular venous distension, muffled heart sounds, hypotension with narrow pulse pressure
also kussmauls sign and pulses paradoxus, electrical alternans
What is the treatment for cyanide toxicity? where would someone get cyanide toxicity?
Parenteral hydroxocobalamin 5mg with repeat dosing up to 15mg
Mining
What is the dose of naloxone
Conservative: 100mcg aliquots to return spont resp
immediate+complete reversal: 2mg
IV, IM, SUBQ: Initial: 0.4 to 2 mg; may need to repeat doses every 2 to 3 minutes. A lower initial dose (0.1 to 0.2 mg) should be considered for patients with opioid dependence to avoid acute withdrawal or if there are concerns regarding concurrent stimulant overdose (Mokhlesi 2003). After reversal, may need to readminister dose(s) at a later interval (ie, 20 to 60 minutes) depending on type/duration of opioid
What is the treatment of tricyclic toxicity?
Sodium bicarb bolus for cardiac conduction abnormality (wide QRS is a feature)
how many minutes of asystole without reversible cause is generally considered reasonable grounds for ceasing resus?
20mins
