ALS Management Flashcards

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1
Q

At what ratio would you do chest compressions to breaths in an adult?

A

30:2 at a depth of 5-6 cm; 2 per second

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2
Q

How long should you stop CPR to check for a rhythm/rescure breaths/electrical shocks?

A

5 seconds

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3
Q

How would you change your ratio of chest compressions to breaths once a definitive airway was in place?

A

Continuous compressions, venilating every 6 seconds/every 10 compressions

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4
Q

How often should you perform a rhythm check?

A

Every 2 minutes

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5
Q

If there is a pacemaker present in someone arresting, what would you want to make sure with regard to pad placement?

A

>8cm away from pacemaker

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6
Q

How would you approach chest compressions and ventilation if you were only using a Bag and mask?

A

30:2 compressions

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7
Q

How would you approach chest compressions and ventilation if a laryngeal mask/i-gel was in situe?

A

Continuous compressions with breaths every 6 seconds

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8
Q

What dose of adrenaline would you give in a cardiac arrest?

A

1mg IV (10 ml of 1:10000)

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9
Q

What would you want to do once IV access was established in an arrest situation?

A
  • Take bloods - VBG, FBC, U+E’s, Mg2+, G&S
  • Give IV fluids
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10
Q

When would you give adrenaline if the rhythm was non-shockable?

A

Immediately after IV access established

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11
Q

When would you give IV adrenaline in a shockable rhythm?

A

After 3rd shock, then every 3-5 minutes

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12
Q

Why is IV adrenaline given in an arrest situation?

A

Causes peripheral vasoconstriction and so maximises cardiac blood flow

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13
Q

Once first dose of adrenaline had been given in a cardiac arrest, how often would you repeat giving the same dose?

A

Every 3-5 minutes, regardless of rhythm

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14
Q

When would you give amiodarone in a cardiac arrest situation?

A

If following rhythms, and after 3 shocks

  • pVT
  • VF
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15
Q

Why is amiodarone given in pVT/VF?

A

Stabilises the myocardium

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16
Q

What dose of amiodarone would you give someone in pVT/VF after 3 shocks?

A

300 mg IV

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17
Q

What are the 4 H’s and 4 T’s?

A

H’s

  • Hypoxia
  • Hypovolaemia
  • Hypo/Hyperkalaemia
  • Hypothermia

T’s

  • Thrombosis
  • Tension pneumothorax
  • Tamponade
  • Toxins
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18
Q

How would you assess hypoxia as a reversible cause of cardiac arrest?

A
  • Ventilation adequacy
  • Oxygen flow rate
  • ABG
19
Q

How would you treat hypoxia as a cause of cardiac arrest?

A

15L/minute oxygen and good ventilation

20
Q

How would you assess hypovolaemia as a cause of cardiac arrest?

A
  • History
  • Drains
  • Haemorrhage
  • Fluid collections
21
Q

How would you manage hypovolaemia as a cause of cardiac arrest?

A

Fluid resus/blood products

22
Q

How would you assess hyper/hypokalaemia as a cause of cardiac arrest?

A
  • ABG/VBG
  • Latest blood results
23
Q

How would you treat hyperkalaemia asa cause of cardaic arrest?

A
  • 10 ml 10% calcium chloride
  • 10 units Actrapid insulin in 50ml 50% dextrose
24
Q

How would you treat hypokalaemia as a cause of cardiac arrest?

A

20 mmol KCL over 10 minutes

25
Q

How would you assess hypothermia as a cause of cardiac arrest?

A
  • Temperature on NEWS chart
  • Warmth
26
Q

How would you manage hypothermia in a patient in cardiac arrest?

A

Warm patient e.g. bear hugger, warm fluids etc.

27
Q

What is the commonest reversible cause of cardiac arrest?

A

Thrombosis - PE/MI

28
Q

How would you assess Thrombosis as a cause of cardiac arrest?

A
  • History
  • Risk factors
  • Legs (DVT)
  • Post-surgery
29
Q

How would you manage a PE as the cause of a cardiac arrest?

A

Thrombolysis

30
Q

How would you manage an MI as a cause of cardiac arrest?

A

Consult cardiology

31
Q

How would you assess for tension pneumothorax in someone in cardiac arrest?

A
  • Tracheal deviation
  • Hyper-resonance
  • Decreased breath sounds
32
Q

How would you manage tension pneumothorax in someone in cardiac arrest?

A

Cannula into 2nd intercostal space MC line

33
Q

How would you assess for cardiac tamponade in someone in cardiac arrest?

A
  • Recent trauma/surgery
  • Ultrasound
34
Q

How would you manage someone with cardiac tamponade as a cause of cardiac arrest?

A

Pericardiocentesis

35
Q

How would you assess toxins as a cause of cardiac arrest?

A
  • History
  • Drug Chart
  • Gather info
  • Capillary glucose
36
Q

How would you manage toxins as a cause of cardiac arrest?

A

Treat toxaemia e.g. naloxone for opioids

37
Q

How would you manage someone with ROSC after cardiac arrest?

A
  • Full ABCDE
  • Controlled oxygenation (94-98%)
  • Consider therapeutic hypothermia (32-38oC) for 24 hours
  • Post-arrest investigations
  • Treat cause
  • Consider ITU transfer
38
Q

What post-arrest investigations would you want to do?

A
  • CXR
  • 12-lead ECG
  • Full set of bloods
  • ECHO
  • ABG
  • Cap glucose
  • Cardiac Monitoring
39
Q

What extra things would you consider doing in someone who had a cardiac arrest and was pregnant?

A
  • Manually shift uterus to left to prevent IVC obstruction
  • Prepare for emergency C-section
40
Q

Where would you feel for a pulse in a child < 1 year?

A

Brachial pulse

41
Q

Where would you feel for a pulse in a child > 1 year?

A

Carotid Pulse

42
Q

What compression:ventilation ratio would you use for a child at birth?

A

3:1

43
Q

What CPR regime would you use in a child/infant?

A

5 rescure breaths, then 15:2

44
Q

What considerations would you take into account when managing an arrest due to an asthma attack?

A
  • Intubate early
  • Treat exacerbation
  • Consider tension pneumothorax
  • COnsider high shock energies - hyperexpanded chest