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ALS book Flashcards

1
Q

What rhythms are typical in cardiac arrest

A

50% is Asystole
25% is PEA
25% is shckable in VF or pulseless VT

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2
Q

Where do most cardiac arrests occur

A

At home/out of hospital

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3
Q

AT HOME - With those who have resus, how many get ROSC/make it out of hospital

A

30% ROSC

10% out of hospital

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4
Q

IN HOSPITAL - how many survive a cardiac arrest and get out of hospital?

A

25% get out of hospital

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5
Q

How many get out of hospital that have had VT/VF

A

50%

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6
Q

How many get out of hospital that have had a non-shockable rhythm?

A

15%

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7
Q

What is the chain of survival that contributes to successful outcome?

A

EARLY recognition
EARLY CPR
EARLY defibrillation - if done in 3-5minutes survival rates are 50-70%
Post-resus care

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8
Q

Describe the ALS algorithm

A

https://www.rcemlearning.co.uk/wp-content/uploads/modules/the-als-algorithm/new_als.png

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9
Q

What are the non-technical skills involved in ALS?

A

Situational swareness
Decision making
Team work
Task management

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10
Q

What are some communication methods used during handover

A 
SBAR
Situation
Background
Assessment
Response
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11
Q

How do we assess teams during an emergency

A

TEAM tool - team emergency assessment tool

Assesses:

  • Leadership
  • Teamwork
  • Task management
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12
Q

What makes survival more likely with cardiac arrest?

A

VF/VT
Causd by MI
Witnessed and monitored
Immediate defibrillation with success

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13
Q

What is PEA often caused by?

A

slow deterioration - hypoxia or hypovolaemia on wards

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14
Q

In how many patients is there a deterioration period before an arrest? (Lasting a few hours)

A

80%

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15
Q

What is the chain of prevention for cardiac arrest situations?

A

Education > monitoring > recognition of deterioration > call for help > response

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16
Q

What wound prompt an emergency call in ABCDE

A 
Airway compromise
Breaths <5 or >36
Pulse <40 or >140
Systolic <90
Decrease in GCS of >2
Repeated or prolonged seizures
Any other concerns
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17
Q

Causes of airway obstruction

A 
Angio-oedema
Something stuck
Epiglottitis
Trauma/ haematoma formation
Central nervous system depression
Blood
Vomit
Laryngospasm
Bronchospasm
Secretions
Blocked trachy
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18
Q

Treatment of airway compromise

A 
Head tilt chin lift/jaw thrust
Suction/ turn patient on side
airway adjuncts - NPA/OPA
I-gel/LMA
Intubation

OXYGEN
TREAT CAUSE

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19
Q

What is a respiratory arrest caused by

A

often multifactoral
Can be chest infection + chronic resp difficulty + muscle weakness + rib fractures - if blood is not oxygenated effectively there will ultimately be a cardiac arrest.

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20
Q

What are the catagories of causes of breathing disorders

A

Decreased drive - CNS

Decreased effort - innervation
- damage to the spinal cord can reduce action of phrenic nerve if cervical injury or can reduce action of intercostal muscles with spinal cord damage too

Lung disorders - haemothorax, pneumothorax - tension causes reduction of venous return to the heart and a fall in cardiac output which can lead to cardiac arrest, ARDS, infection, pulmonary oedema, PE

21
Q

Causes o fVF

A 
ACS
Acidosis
Valve problems
Toxins
Hypertension
Long QT
Electrolytes
Hypothermia
22
Q

What is the most common cause of sudden cardiac death? SCD

A

Coronary artery disease

23
Q

How does syncope related to death in cardiac diseasE?

A

In known cardiac disease, syncope is an independent RF for death

24
Q

What features of syncope make it more likely secondary to an arrhythmia?

A 
From supine - lying facing upwards
No pre-syncopal symptoms
Associated with palpitations/chest pain
History of inherited cardiac disease
Occurring during or after exercise
Repeated unexplained episodes
25
Q

If you have one episode of VF are you likely to have another?

A

Yes ! need preventative treatment - may need PCI or a defib

26
Q

Is central cyanosis an early or late sign of airway obstruction?

A

LATE

27
Q

How much oxygen to give with COPD patients

A

venturi at 24-28%

28
Q

What to do if patients breathing is inadequate

A

use bag valve mask - may need NIV

29
Q

What does a bounding central pulse indicate

A

sepsis

30
Q

What can you tell from the pulse pressure

A

NARROW - 35-45mg - arterial vasoconstriction as in hypovolaemia or cardiogenic shock

WIDE - arterial vasodilation - sepsis

31
Q

What to do if blood glucose less than 4 in arrest

A

50ml 10% glucose and repeat every minute until patient regains consciousness. Max 250 ml given then recheck BM

32
Q

WhT is causing ACS

A

Thrombosis within the vessel
Contraction of smooth muscle
Obstruction of lumen

33
Q

What is unstable angina

A

On exertion with increasing frequency - crescendo angina

  • not provoked by exercise
  • unprovoked prolonged episode but without ecg change and trop rise
34
Q

Ecg in unstable angina

A

Maybe ST depression

Maybe TWI

35
Q

Dominant symptoms of MI in women diabetics renal disease elderly

A

SOB

36
Q

Which arteries supply which part of the ecg

A

LAD - anterior
Inferior - right coronary or circumflex
Lateral - circumflex or diagonal branch of LAD
Posterior - circumflex or right coronary

Right side of heart - inferior or posterior with elevation in V1

37
Q

If someone has a right sided infarct what Will the clinical picture be like?

A

High jugular venous pressure and fluid responsive hypotension WITHOUT pulmonary venous congestion

38
Q

What about the territories in nstemi

A

Less related to site

39
Q

Other conditions causing ischaemic and infarction signs

A

TBI
PE - TWI in V1-4 due to dilated right ventricle
Takasubos
Brugada

40
Q

Other causes of trop rise

A 
Sepsis
CKD
acute or chronic heart failure
Myocarditis
PE
dissection
Arrhythmias
41
Q

What does the GRACE score do

A

Risk stratification for admission and 6 months

42
Q

Risk of bleeding in MI treatment?

A

Bad renal function
Increasing age
Bleeding complications
Low body weight

43
Q

ACS treatment

A 
Aspirin 300mg
Ticagrelor 180mg
IV morphine
Metoclopramide
GTN - unless hypotension
Oxygen if less than 94
44
Q

How quick does PPCI need to be done

What drug can be given IV or into the thrombus

A

Within 12h

Glycoprotein 2b/3a

45
Q

Why PPCI vs fibrinolytic

A

Less risk of ICH

46
Q

When can prasygrel not be given

A

Less than 60kg
Elderly >75
History of bleeding or stroke

47
Q

Absolute contraindications for fibrinolytic therapy

A 
Previous haemorrhaging stroke
Ischaemic stroke within 6 months
Active bleeding
Suspected dissection
Bleeding disorder
Major trauma/head injury/surgery within 3 months
CNS damage or neoplasm
48
Q

In how many patients does fibrinolytic therapy not work

A

20-30

49
Q

How do you know fibrinolytic therapy has failed

A

Failure of more than 50% of stevo to resolve

ALS (1 decks)

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