ALS algorithm

Question 1

How frequently is VF/pVT the first monitored rhythm is cardiac arrest?

Answer 1

20-30%

Question 2

What energy should the defibrillator be set to (for ALS)?

Answer 2

200J for the initial shock, 360J for subsequent shocks`

Question 3

When is adrenaline given?

Answer 3

Either immediately after rhythm check if not shockable or after 2nd shock in shockable then every 2nd cycle once given

Question 4

When is Amiodarone given during the ALS algorhythm? how much?

Answer 4

300mg after 3 shocks

can give a further 150mg after 5

Question 5

What are the 4 Hs and Ts

Answer 5

Hypoxia
Hypovolaemia
Hypo/Hyperthermia
HypoK/glycaemia etc
Thrombus (PE/ACS)
Tamponade
Tension
Toxins

Question 6

When should you check for a pulse during ALS?

Answer 6

If organized electrical activity compatible with cardiac output is seen during a rhythm check - check pulse and waveform capnography

Question 7

If it is unclear whether the rhythm is asystole or very fine VF what should be done?

Answer 7

dump charge, CPR. if it is VF it will become more clear with high quality CPR

Question 8

What should you look for when assessing a PEA rhythm?

Answer 8

P waves - ventricular standstill may be treated by pacing

Question 9

What is the normal range for end-tidal CO2?

Answer 9

35-45mmHg

Question 10

describe the phases of waveform capnography

Answer 10

https://media.springernature.com/original/springer-static/image/chp%3A10.1007%2F978-3-319-55862-2_6/MediaObjects/371567_1_En_6_Figc_HTML.gif

Question 11

Where should IO placement occur? describe the landmarks and confirmation

Answer 11

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

Question 12

Describe the treatment of severe hyperkaelemia and cardiac arrest

Answer 12

1. 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.
2. glucose 25g + 10 units Novorapid
3. consider 50mmol sodium bicarbonate if severe acidosis or renal failure is present

Question 13

Describe the difference between calcium gluconate and calcium chloride

Answer 13

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

Question 14

How should hypokalaemia be corrected during cardiac arrest?

Answer 14

5mmol potassium bolus IV +/- 2g Magnesium sulfate

Question 15

Describe the difference between heat exhaustion and heat stroke

Answer 15

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

Question 16

How long should CPR be performed in the setting of thrombolysis of massive PE?

Answer 16

at least 30min up to 60-90 min

Question 17

Describe the treatment of a tension pneumothorax + Cardiac arrest

Answer 17

14G cannula to 2nd intercostal space in the mid clavicular line then insertion of a chest tube.

Question 18

What are the clinical signs of tamponade?

Answer 18

Becks Triad: jugular venous distension, muffled heart sounds, hypotension with narrow pulse pressure

also kussmauls sign and pulses paradoxus, electrical alternans

Question 19

What is the treatment for cyanide toxicity? where would someone get cyanide toxicity?

Answer 19

Parenteral hydroxocobalamin 5mg with repeat dosing up to 15mg

Mining

Question 20

What is the dose of naloxone

Answer 20

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

Question 21

What is the treatment of tricyclic toxicity?

Answer 21

Sodium bicarb bolus for cardiac conduction abnormality (wide QRS is a feature)

Question 22

how many minutes of asystole without reversible cause is generally considered reasonable grounds for ceasing resus?

Answer 22

20mins