ALS Management Flashcards
At what ratio would you do chest compressions to breaths in an adult?
30:2 at a depth of 5-6 cm; 2 per second
How long should you stop CPR to check for a rhythm/rescure breaths/electrical shocks?
5 seconds
How would you change your ratio of chest compressions to breaths once a definitive airway was in place?
Continuous compressions, venilating every 6 seconds/every 10 compressions
How often should you perform a rhythm check?
Every 2 minutes
If there is a pacemaker present in someone arresting, what would you want to make sure with regard to pad placement?
>8cm away from pacemaker
How would you approach chest compressions and ventilation if you were only using a Bag and mask?
30:2 compressions
How would you approach chest compressions and ventilation if a laryngeal mask/i-gel was in situe?
Continuous compressions with breaths every 6 seconds
What dose of adrenaline would you give in a cardiac arrest?
1mg IV (10 ml of 1:10000)
What would you want to do once IV access was established in an arrest situation?
- Take bloods - VBG, FBC, U+E’s, Mg2+, G&S
- Give IV fluids
When would you give adrenaline if the rhythm was non-shockable?
Immediately after IV access established
When would you give IV adrenaline in a shockable rhythm?
After 3rd shock, then every 3-5 minutes
Why is IV adrenaline given in an arrest situation?
Causes peripheral vasoconstriction and so maximises cardiac blood flow
Once first dose of adrenaline had been given in a cardiac arrest, how often would you repeat giving the same dose?
Every 3-5 minutes, regardless of rhythm
When would you give amiodarone in a cardiac arrest situation?
If following rhythms, and after 3 shocks
- pVT
- VF
Why is amiodarone given in pVT/VF?
Stabilises the myocardium
What dose of amiodarone would you give someone in pVT/VF after 3 shocks?
300 mg IV
What are the 4 H’s and 4 T’s?
H’s
- Hypoxia
- Hypovolaemia
- Hypo/Hyperkalaemia
- Hypothermia
T’s
- Thrombosis
- Tension pneumothorax
- Tamponade
- Toxins
How would you assess hypoxia as a reversible cause of cardiac arrest?
- Ventilation adequacy
- Oxygen flow rate
- ABG
How would you treat hypoxia as a cause of cardiac arrest?
15L/minute oxygen and good ventilation
How would you assess hypovolaemia as a cause of cardiac arrest?
- History
- Drains
- Haemorrhage
- Fluid collections
How would you manage hypovolaemia as a cause of cardiac arrest?
Fluid resus/blood products
How would you assess hyper/hypokalaemia as a cause of cardiac arrest?
- ABG/VBG
- Latest blood results
How would you treat hyperkalaemia asa cause of cardaic arrest?
- 10 ml 10% calcium chloride
- 10 units Actrapid insulin in 50ml 50% dextrose
How would you treat hypokalaemia as a cause of cardiac arrest?
20 mmol KCL over 10 minutes
How would you assess hypothermia as a cause of cardiac arrest?
- Temperature on NEWS chart
- Warmth
How would you manage hypothermia in a patient in cardiac arrest?
Warm patient e.g. bear hugger, warm fluids etc.
What is the commonest reversible cause of cardiac arrest?
Thrombosis - PE/MI
How would you assess Thrombosis as a cause of cardiac arrest?
- History
- Risk factors
- Legs (DVT)
- Post-surgery
How would you manage a PE as the cause of a cardiac arrest?
Thrombolysis
How would you manage an MI as a cause of cardiac arrest?
Consult cardiology
How would you assess for tension pneumothorax in someone in cardiac arrest?
- Tracheal deviation
- Hyper-resonance
- Decreased breath sounds
How would you manage tension pneumothorax in someone in cardiac arrest?
Cannula into 2nd intercostal space MC line
How would you assess for cardiac tamponade in someone in cardiac arrest?
- Recent trauma/surgery
- Ultrasound
How would you manage someone with cardiac tamponade as a cause of cardiac arrest?
Pericardiocentesis
How would you assess toxins as a cause of cardiac arrest?
- History
- Drug Chart
- Gather info
- Capillary glucose
How would you manage toxins as a cause of cardiac arrest?
Treat toxaemia e.g. naloxone for opioids
How would you manage someone with ROSC after cardiac arrest?
- Full ABCDE
- Controlled oxygenation (94-98%)
- Consider therapeutic hypothermia (32-38oC) for 24 hours
- Post-arrest investigations
- Treat cause
- Consider ITU transfer
What post-arrest investigations would you want to do?
- CXR
- 12-lead ECG
- Full set of bloods
- ECHO
- ABG
- Cap glucose
- Cardiac Monitoring
What extra things would you consider doing in someone who had a cardiac arrest and was pregnant?
- Manually shift uterus to left to prevent IVC obstruction
- Prepare for emergency C-section
Where would you feel for a pulse in a child < 1 year?
Brachial pulse
Where would you feel for a pulse in a child > 1 year?
Carotid Pulse
What compression:ventilation ratio would you use for a child at birth?
3:1
What CPR regime would you use in a child/infant?
5 rescure breaths, then 15:2
What considerations would you take into account when managing an arrest due to an asthma attack?
- Intubate early
- Treat exacerbation
- Consider tension pneumothorax
- COnsider high shock energies - hyperexpanded chest
