ALS and peri arrest

Question 1

Explain the stepwise management of VF / pulseless VT

Answer 1

1. CPR 30 : 2 whilst attaching defibrillator
2. 1 shock
3. Continue CPR for 2 mins
4. Repeat until 3 shocks delivered
5. After 3 shocks : 1mg adrenaline and 300mg amiodarone

Question 2

What is administered after 3 shocks in VF / pulseless VT ?

Answer 2

• 1mg adrenaline (give every 3-5 minutes)
• 300mg amiodarone

Question 3

4 H’s of reversible causes of cardiac arrest

Answer 3

• H : Hypoxia
• H : Hypovolaemia
• H : Hyperkalaemia, hypokalamia, hypoglycaemia, hypocalcaemia and other metabolic disorders
• H : Hypothermia

Question 4

4 T’s of reversible causes of cardiac arrest

Answer 4

• T : Thrombosis
• T : Tension pneumothorax
• T : Tamponade
• T : Toxin

Question 5

If PE is suspected cause of cardiac arrest, what is done and how long is CPR continued for ?

Answer 5

• Thrombolysis
• 60-90 minutes

Question 6

Initial management of a peri arrest tachycardia in an UNSTABLE pt

Answer 6

Up to 3 synchronised DC shocks

Question 7

Mangament of a regular BROAD complex tachycardia if pt stable

Answer 7

300mg IV amiodarone

Question 8

Stepwise management of regular NARROW complex tachycardia (likely SVT) if pt stable

Answer 8

1. Vagal maenoevre (e.g. vasalva)
2. 6mg IV adenosine
3. Ineffective : verapamil, BB
4. Ineffective : Up to 3 synchronised DC shocks

Question 9

Management of IRREGULAR narrow QRS complex tachycardia if pt stable

Answer 9

• Probable AF = control rate with a BB

Question 10

Management of IRREGULAR broad QRS complex tachycardia if pt stable

Answer 10

• Likely AF with BBB -> treat as irregular narrow QRS complex tachycardia = BB

Question 11

Management of torsades de pointes

Answer 11

Magnesium 2g over 10 min

Question 12

Management of bradycardia in the presence of signs indicating haemodynamic comprimise

Answer 12

500mcg atropine IV

Question 13

Failure to respond to 500mcg IV atropine in bradycardia with adverse features

Answer 13

• Atropine, up to a maximum of 3mg
• Transcutaneous pacing
• Isoprenaline/adrenaline infusion titrated to response

Question 14

Regardless of the response to atropine, when would a patient in bradycardia be consider for transvenous pacing ?

Answer 14

If there is a risk of asytole

• Complete heart block with broad complex QRS
• Recent asystole
• Mobitz type II AV block
• Ventricular pause > 3 seconds