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! NHS Normal Values > ALS ERC 2024 > Flashcards

ALS ERC 2024 Flashcards

1
Q

Vagal maneuvers

A
  1. Carotid sinus massage
  2. Valsalva maneuver
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2
Q

Causes of regular narrow complex tachycardia

A
  1. Sinus tachycardia
  2. AVNRT (commonest SVT)
  3. AVRT- associated with WPW syndrome
  4. AF with regular AV conduction (2:1 usually)
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3
Q

Causes of irregular narrow complex tachycarida

A

AFib with uncontrolled ventricular response
OR
AFlutter with variable AV block

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4
Q

Do not use ___ in obvious AFib or AFlutter

A

Adenosine

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5
Q

Cardiac arrest chain of survival

A
  1. Early recognition and calling for help
  2. Management of deteriorating patient to prevent cardiac arrest
  3. Prompt defibrillation, high quality CPR, minimal interruptions of chest compressions
  4. Treatment of reversible causes
  5. Post-resuscitation care
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6
Q

Causes of hypovolemia

A
  1. Hemorrhage (reduced intravascular volume)
  2. Severe vasdilation- sepsis, anaphylaxis, spinal cord injury
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7
Q

Post-cardiac arrest syndrome

A
  1. Brain injury
  2. Myocardial dysfunction
  3. Systemic ischemia/ reperfusion response
  4. Persistent precipitating pathology
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8
Q

Information provided by monitoring EtCO2 in CPR

A
  • Tube placement
  • Quality of CPR (2.0-2.5 kPa)
  • ROSC- immediate, sustained increase in EtCO2
  • Guide to rate of ventilation (help prevent hyperventilation)
  • Prognostication- higher EtCO2 during resus -> better results
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9
Q

Peri-arrest state

A
  1. Cardiovascular instability
  2. Hypotension
  3. Loss of peripheral pulse in uninjured region
  4. Deteriorating consciousness level without obvious CNS cause
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10
Q

4 E’s of successful resuscitative thoracotomy (RT)

A

Expertise
Equipment
Environment
Elapsed time

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11
Q

Anaphylaxis likely when all 3 are present:

A
  1. sudden onset and rapid progression of symptoms
    life-threatening Airway and/or
  2. Breathing and/or Circulation problems
  3. skin and/or mucosal changes (flushing, urticaria, angioedema)
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12
Q

Sepsis Hour-1 Bundle (5 steps)

A
  1. Measure lactate level
  2. Obtain blood cultures before administering antibiotics
  3. Administer broad spectrum antibiotics
  4. Rapid administration of 30ml/kg crystalloid fluids
  5. Apply vasopressors if hypotensive to maintain MAP ≥ 65mmHg
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13
Q

Function of aldosterone

A

Reabsorption of sodium, excretion of potassium in collecting tubule cells

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14
Q

5 key treatment strategies for hyperkalemia

A
  1. Cardiac protection
  2. Shifting potassium into cells
  3. Removing potassium from the body
  4. Monitoring serum potassium and glucose levels
  5. Prevention of recurrence of hyperkalemia
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15
Q

ECG changes of hyperkalemia

A
  • Peaked T-waves
  • Flat/absent p-waves
  • Broad QRS
  • Sine wave (S and T wave merged)
  • Bradycardia
  • VT
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16
Q

4 key steps in the treatment of hypokalemia

A
  1. Restore K+ level
  2. Check for potential exacerbating factors (e.g. digoxin, hypomagnesemia)
  3. Monitor serum K+
  4. Prevent recurrence
17
Q

Automatic resuscitator (ventilator) parameters

A
  • 6 ml/kg ideal body weight
  • 10 breaths/min
18
Q

5 step ABG interpretation

A
  • How is the patient?
  • Hypoxemic?
  • pH- acidosis or alkalosis
  • CO2 and HCO3-/ BE
  • Compensation
19
Q

3 mains sites of IO insertion for adults

A
  1. Proximal tibia
  2. Distal tibia
  3. Proximal humerus
20
Q

Potential reversible casues of TCA (traumatic cardiac arrest) (2H,2T)

A
  • Hypoxemia
  • Hypovolemia
  • Tension pneumothroax
  • Cardiac tamponade
21
Q

Termination of resuscitative efforts

A
  • No ROSC
  • Absence of reversible causes
  • DNACPR
  • Clear signs of irreversible death (e.g. rigor mortis, dependent lividity, decapitation, decomposition, incineration)
  • Physician’s clinical judgement
22
Q

Adult IV fluid challenge

A

500-1000 mL

23
Q

Child IV fluid challenge

A

20 mL/kg

24
Q

Adult and child IM adrenaline dose

A

Adult- 500 mcg (0.5 mL)
Child >12 yo- 500 mcg
6-12 yo- 300 mcg
<6 yo- 150 mcg

25
Q

5 key steps in the treatment of hyperkalemia

A
  1. Protect the heart
  2. Shift K+ into cells
  3. Remove K+ from the body
  4. Monitor serum K+ and glucose levels
  5. Prevent recurrence of hyperkalemia
26
Q

Adrenaline MOA

A

Acts on both alpha and beta adrenergic receptors
* Overall effect- vasoconstriction, increased HR, increased cardiac contractility, bronchodilation

27
Q

The Chain of Survival (4)

A
  1. Early recognition and call for help
  2. Early CPR
  3. Early defibrillation
  4. Post-resuscitation care
28
Q

Signs of life/ ROSC (return of spontaneous circulation)

A
  • Purposeful movement
  • Normal breathing
  • Coughing
  • Significant increase in EtCO2
  • Check central pulse
29
Q

Immediate post-cardiac arrest treatment

A
  1. ABCDE assessment
  2. SpO2 94-98%
  3. Aim for normal PaCO2
  4. 12-lead ECG
  5. Treat precipitating factors
  6. Targeted temprature management
30
Q

Reading the rhythm strip (6)

A
  1. QRS present? Pulse present?
  2. Ventricular (QRS) rate
  3. QRS width
  4. QRS rhythm regular or irregular?
  5. Atrial activity present?
  6. Is, and how is, atrial activity related to QRS
31
Q

Causes of bradyarrhythmia (< 60bpm)

A
  • Physiological- athletes
  • Cardiac- MI, MIschemia, SSS
  • Non-cardiac- vasovagal syndrome, hypothermia, hypoglycemia, hypothyroidism, raised ICP
  • Drug toxicity- digoxin, BB, CCB
32
Q

Energy Shock ALS (defib, cardioversion, internal defib, pacemaker)

A

Defibrillation:
* 150-200 J first shock (biphasic)
* 150-300J subsequent shocks (biphasic)
* 360J (monophasic)

Cardioversion:
* Broad complex tachycardia
* 120-150J (biphasic)
* 200J (monophasic)
* Narrow complex tachycarida
* 70-120J (biphasic)
* 100J (monophasic)

Internal defibrillation
* 10-20J (biphasic)
* 50J maximum (biphasic)

Pacemaker
* 50-100 mA
* Pace on R-wave

33
Q

8 stages of ECG interpretation

A
  1. Electrical activity present?
  2. QRS rate
  3. QRS narrow or broad?
  4. QRS rhythm regular?
  5. Atrial activity present?
  6. How is atrial activity related to QRS?
  7. ST level on isoelectric line?
  8. T-wave positive? QT interval normal?

! NHS Normal Values (6 decks)

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