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ACEM EM Certificate > ALS and BLS Course > Flashcards

ALS and BLS Course Flashcards

1
Q

What is the chain of survival?

A
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2
Q

What is the BLS algorithm?

A
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3
Q

What is the ALS algorithm?

A
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4
Q

Visualise the shockable algorithm cycle pattern in your head.

A
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5
Q

Visualise the non-shockable algorithm cycle pattern in your head.

A
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6
Q

Use the COACHED algorithm to lead an imaginary resuscitation scenario.

A
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7
Q

List the reversible causes of cardiac arrest.

A

The 4 H’s and 4 T’s.

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8
Q

Describe how you would treat hyperkalaemia.

A
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9
Q

How do you treat hypokalaemia?

A

IV potassium

IV magnesium can also help uptake of K.

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10
Q

How do you treat hypercalcaemia?

A

Fluid replacement

IV frusemide 1mg/kg

Hydrocortisone 200-300mg IV - often used in hypercalcemia of malignancy.

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11
Q

How do you treat hypocalcaemia?

A

Calcium chloride 10% (10-40mL)

Magnesium sulpate 50% 4-8mmol if necessary.

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12
Q

How do you treat hypermagnesaemia?

A

Calcium chloride 10%, 5-10mL repeated if necessary.

Saline diuresis - 0.9% saline with frusemide 1mg/kg IV.

Haemodyialysis.

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13
Q

How do you treat hypomagnesaemia?

A

2g 50% magnesium sulphate IV over 15 min.

Torsades de Pointes - give 2g 50% magnesium sulphate IV over 1-2 min.

Seizure - 2g 50% magnesium suphate over 10 min.

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14
Q

How would you treat tension pneumothorax?

A

Thoracostomy and chest drain.

Needle decompression no longer recommended.

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15
Q

How would you treat cardiac tamponade?

A

Pericardiocentesis or emergency thoracotomy.

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16
Q

How wouldyou treat benzodiazepine overdose?

A

Flumazenil, with caution, as withdrawal may cause seizures. If has hx of seizures, contraindicated.

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17
Q

How would you treat opioid overdose?

A

A & B very important.

Naloxone 0.4-2mg IV, IO, IM or SC, every 2-3 min.

Intranasal dosing is 1 mg in each nostril every 5 min.

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18
Q

How would you treat a beta-blocker overdose?

A

Glucagon and high-dose insulin dextrose.

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19
Q

Describe the modes of O2 delivery.

A
  1. Nasal prongs
    • 1-6 L/min
    • 24-44% O2
  2. Hudson mask
    • 5-8 L/min @ 40-60%
  3. Non-rebreather mask
    • 6-10 L/min @ 60-100%

A bag-valve mask can deliver 10 L/min at up to 90% oxygen.

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20
Q

Describe the different leads used and benefits in monitoring certain rhythms.

A
  1. Lead II - good for detecting axis shift. Cannot differentiate RBBB from LBBB.
  2. V1 - distinct P waves, good for analysing atrial activity. Best lead to differentiate BBBs and ectopic beats from aberrations.
  3. V2 - good for measuring QT interval.
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21
Q

What does the P wave represent?

What is its normal length?

A

P wave <0.11s.

Atrial depolarisation.

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22
Q

What does the QRS complex represent?

What is its normal length?

A

Ventricular depolarisation.

<0.12 sec.

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23
Q

What does the T wave represent?

What is its normal length?

A

Ventricular repolarisation.

<0.16 sec.

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24
Q

What is the U wave?

What can it indicate clinically?

A

Caused by repolarisation of interventricular septum, they always follow the T wave.

Can indicate hyperkalaemia, hypercalcemia or hyperthyroidism.

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25
Q

What is the PR interval?

What is its normal length?

A

3-5 small squares or 0.12-2.0 sec.

Meaured from beginning of P wave to beginning of QRS complex.

Measures the time taken for the impulse to travel from the sinus node through AV node and enter ventricles. It hence helps estimate AV node function.

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26
Q

What is the QT interval?

What is its normal length?

A

<0.38 sec.

The QT inteval is measured from the beginning of the QRS complex to the end of the T wave.

A prolonged QT interval is a risk factor for ventricular tachyarrhythmias and sudden death.

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27
Q

What is the ST-segment?

A

It connects the QRS complex and T wave.

It represents the period and ventricles are depolarised.

Should be isoelectric, except where ischaemic damage is present.

28
Q

What does 1 large box represent (in seconds) on an ECG?

A

0.2 seconds.

29
Q

What does 1 small box represent (in seconds) on an ECG?

A

0.04 seconds, or 40 ms.

30
Q

Recite ‘The Heart Block Poem’.

A
31
Q

What rhythm is this? Describe it.

A

Every P followed by QRS.

Evenly spaced. Usually 60-100 BPM.

32
Q

What rhythm is this? Describe it.

A

ARREST RHYTHM.

Ventricular tachycardia.

Ventricles are being simulated by an ectopic focus.

100-300 BPM. Wide, bizarre complexes.

Quite regular in rhythm.

Usually P waves are missing.

33
Q

What rhythm is this? Describe it.

A

ARREST RHYTHM.

Torsades de Pointes.

Polymorphic ventricular tachycardia, most commonly associated with prolonged QT intervals. It may also be assciated with some anti-arrhythmic therapy.

150-250 BPM, has wide complexes with sinusoidal or undulating pattern.

34
Q

What rhythm is this? Describe it.

A

ARREST RHYTHM.

Ventricular fibrillation.

Irregular rate - chaotic fibrillatory waves.

35
Q

What rhythm is this? Describe it.

A

ARREST RHYTHM.

Asystole.

‘Flatlining’.

P waves may or may not be present.

36
Q

What rhythm is this? Describe it.

A

PERI-ARREST RHYTHM.

Bradycardia. If sinus, can be normal in fit, healthy person.

Problematic in heart failure or heart disease.

Rate <60 BPM, clinically significant if <40 BPM.

37
Q

What rhythm is this? Describe it.

A

PERI-ARREST RHYTHM.

First degree AV block.

There is delayed conduction of P wave through the AV node and the PR interval is greater than 0.2 seconds (i.e. 1 big square).

38
Q

What rhythm is this? Describe it.

A

PERI-ARREST RHYTHM.

2nd degree AV block - Mobitz 1 (aka ‘Wenkebach’).

There is a progressive lengthening of PR interval until a P wave occurs without a following QRS complex due to eventual loss of conduction. This is usually repeated in a regular pattern.

Irregular rhythm often due to dropped beats.

39
Q

What rhythm is this? Describe it.

A

PERI-ARREST RHYTHM.

2nd degree AV block - Mobitz 2.

Charcterised by constant PR interval until suddent block in conduction and QRS complex does not follow a P wave. Higher risk of complete heart block or asystole.

Atrial rate > ventricular

40
Q

What rhythm is this? Describe it?

A

PERI-ARREST RHYTHM.

Third degree or complete heart block is where there is no relationship between conduction in the atria and conduction throuh to the ventricles.

Usually wide QRS, but can vary.

41
Q

What rhythm is this? Describe it.

A

Atrial fibrillation.

No organised atrial activity.

Usually rate is 100-180 BPM. If <100 BPM is considered controlled, if >100 BPM is considered rapid.

Irregularly irregular.

42
Q

What rhythm is this? Describe it.

A

Atrial flutter.

‘Saw-tooth flutter waves’

Atrial rate is 250-400BPM, ventricular rate is 150-170BPM.

Only some of the flutter waves are conducted through the AV node and the ventricles. The resulting difference between atrial and ventricular rate is described as a block, e.g. 2:1, 3:1, 4:1.

43
Q

What rhythm is this? Describe it.

A

Atrial tachycardia/ supraventricular tachycardia.

Usually not life-threatening, however if prolonged the patient’s haemodynamic state can become compromised, so need to find cause and reverse.

Usually regular rhythm, rate >200BPM, P wave usually hidden in QRS complex. Impulse originates from above bundle of His.

44
Q

What is the shock energy for the different types of defibrillators?

A
  1. Monophasic: 360J for 1st and all subsequent shocks.
  2. Biphasic: 200J for 1st shock, 200J and over for all subsequent shocks.
45
Q

Where should the electrode pads be placed for the defibrillator?

A

Right pad over 2nd ICS, just under clavicle.

Left pad over 6th ICS, at mid-axillary line.

Alternatively, they can ‘sandwich’ the L praecordium.

46
Q

Use the Townsville ALS steps to manual defibrillation to run a resuscitation.

A
47
Q

When should a 3-stack shock sequence be delivered?

A

If there is a high likelihood ROSC or where defibrillation is the preferred treatment. 3 shocks should be delivered within 30 seconds, with a rhythm check between each shock.

48
Q

When is synchronised cardioversion used?

What energy level is required?

A

To prevent R-on-T which can cause ventricular tachycardia.

In atrial tachyarrhythmias, shock may need 50-70J, however up to 360J may be required.

49
Q

What heart rates are associated with haemodynamic instability?

A

HR >150 BPM and HR <40 BPM are poorly tolerated.

50
Q

Describe the management of bradycardia.

A
  1. Asymptomatic bradycardia - monitor
  2. Symptomatic bradycardia:
    • Atropine 500 mcg - 600 mcg every 3-5 min to total of 3mg
    • Other drugs include: isoprenaline, adrenaline
    • Consider transcutaneous pacing and arrange for transvenous pacing
51
Q

Describe the management of tachycardia.

A

If adverse symptoms are present, cardioversion is preferred.

  1. Light sedation of patient.
  2. Synchronise defibrillator.
  3. Deliver shock:
    • 100-150J for broad complex tachycardia and atrial fibrillation
    • 70-120J for atrial flutter and regular narrow complex tachycardia
    • Start cardioversion at 100J for compromised patients, escalating in 50J increments to 200J

Use adenosine as rapid bolus or amiadarone as infusion or slow IV injection as per protocols.

52
Q

Describe the mechanism and use of adrenaline in cardiac arrest.

A

Adrenaline has alpha and beta-adrenergic effects, increasing systemic vasoconstriction which increases perfusion to brain and heart.

Increases rate and strength of contractions after ROSC.

1mg IV is given as per ALS protocols.

53
Q

Describe the mechanism and use of amiodarone in cardiac arrest.

A

Membrane-stabiliser and anti-arrhythmic.

Increases duration of action potential and refractory period and slows conduction through AV node.

If given quickly can cause histamine release, which can also lead to hypotension.

300mg IV bolus. Consider further dosing of 150mg if VF or VT persisting after 10 min. Infusion of 900mg over 24 hours may be required on ROSC.

54
Q

Describe the mechanism and use of magnesium in cardiac arrest.

A

Reduces sensitivity of motor end plates, less likely to have arrhythmias. Helps improve contractile response of stunned myocardium.

Give 5mmol peripherally via IV, may be repeated after 5-10min.

55
Q

Describe the mechanism and use of calcium in cardiac arrest.

A

Calcium can increase myocardium contractility. Rapid administration can cause bradycardia, so you need to be careful.

Give 10% calcium chloride or 10% calcium gluconate.

56
Q

Describe the mechanism and use of sodium bicarbonate.

A

Can buffer acidosis caused by metabolic or respiratory sources, use 50mmol.

Consider for documented hyperkalaemia or tricyclic overdose.

57
Q

What is acceptable urine output for an adult? How about for a child?

A

0.5mL/kg/hr and 1mL/kg/hr respectively.

58
Q

What thrombolytic therapy would you consider for a proven PE?

A
  • Reteplase 10 mg IV over 2 min then 10 unit IV bolus 30 min later
  • Alteplase 10 mg IV over 2 min then 90 mg infusion over 2 hours
  • Tenecteplase 500-600 mcg
59
Q

What therapy should you give in hypoglycaemia which is suspected or proven?

A

25g of 50% glucose solution (50mL of 50% solution).

60
Q

What therapy should you give for suspected narcotic overdose?

A

0.4-2mg for reversal of overdose.

61
Q

Describe the principles of ACS management.

A
  • MONA for all
  • PCI (1st line for STEMI)
  • Others:
    • Fibrinolysis, e.g. tenecteplase
    • Adjunctive
      • Anti-thrombins: ‘parins
      • Antiplatelets: ticagrelor, clopidogrel
62
Q

How many weeks does foetal viability start?

A

24-25 weeks.

  • 20 weeks or less, unlikely to compromise efforts of resuscitation
  • 20-23 weeks, save mother, baby will be lost
  • 24-25 weeks, save both
63
Q

What size for NPA airways?

A

7 - most women

8 - most men

64
Q

What size for OPA?

A

3 - medium, fits most adults, but should measure from incisors to angle of jaw.

65
Q

What size for LMA?

A

Size 4 for women, size 5 for men.

ACEM EM Certificate (18 decks)

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