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ALS > ALS Revision > Flashcards

ALS Revision Flashcards

1
Q

What does the acronym DRSABCDE stand for?

A 
Danger
Response
Send for help
Airway (+ Cspine)
Breathing
Circulation
Disability
Exposure
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2
Q

What is the ALS algorithm?

A

Start CPR
Attach Defib/monitor
Assess the rhythm - is it shockable or non shockable?
Shockable → Shock and continue CPR for 2 minutes
Non shockable → no shock → continue CPR for 2 minutes
Assess for ROSC
If ROSC → Post resuscitation care

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3
Q

What additional tasks should be performed during CPR?

A 
Airway adjuncts
Oxygen
Waveform capnography (ETCO2)
IV/IO access
Plan actions before interrupting compressions
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4
Q

What are the 4 H’s?

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypo/hyperthermia

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5
Q

How do you treat the 4 H’s?

A

Hypoxia → O2 therapy
Hypovolaemia → IVT or blood products
Hypo/hyperkalaemia → K+ replacement/Calcium Gluconate or IV insulin & dextrose
Hypo/hyperthermia → Bair hugger, warm fluids/undress patient, cooled fluids

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6
Q

What are the 4 T’s?

A

Tamponade
Toxins
Thrombus
Tension pneumothorax

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7
Q

How do you treat the 4 T’s?

A

Tamponade → Pericardiocentesis
Tension pneumonothorax → ICC
Toxins → reversal if able
Thrombus → anticoagulant - herapin

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8
Q

What is included in post resuscitation care?

A 
Re-evaluate ABCDE
12 lead ECG
Treat precipitating causes
Re-evaluate O2 and Ventilation
Temperature (cool)
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9
Q

Name the 12 causes of airway obstruction

A

(FIT PELVIC BBB)

Foreign body
Inflammation
Trauma

Pharangeal Swelling
Epiglottitis
Laryngospasm
Vomit
Infection
CNS depression

Bronchial Secretions
Blood
Bronchospasm

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10
Q

How do you assess a patients airway?

A

Look for any foreign bodies, vomit or blood

Listen for inspiratory stridor or expiratory grunting

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11
Q

What is the triple airway manoeuvre?

A

Head tilt
Chin lift
Jaw thrust

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12
Q

What are the 4 airway adjuncts?

A

OPA
NPA
LMA
ETT

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13
Q

What are the causes of ineffective breathing?

A

Decreased respiratory drive
- CNS depression

Decreased respiratory effort

  • Muscle weakness
  • Nerve damage
  • Restrictive chest defect
  • Pain

Lung disorders

  • Pneumothorax
  • Haemothorax
  • Infection
  • Acute exacerbation of COPD
  • Asthma
  • PE
  • ARDS
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14
Q

How do you assess a patients airway?

A

Look

  • Respiratory distress
  • Use of accessory muscles
  • Cyanosis
  • Incr RR
  • Chest deformity
  • Conscious level

Listen

  • Noisy breathing
  • Auscultate

Feel

  • Expansion of chest
  • Percussion
  • Tracheal position
  • Subcut emphysema
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15
Q

What are the 6 primary causes of ineffective circulation?

A 
(AHHEAD)
ACS
Hypertensive heart disease
Hereditary heart disease
Electrolyte/acid base abnormalities
Arrythmias
Drugs
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16
Q

What are the 5 secondary causes of ineffective circulation?

A 
(BASHH)
Blood loss
Asphyxia
Septic Shock
Hypothermia
Hypoxia
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17
Q

What are the 5 different types of shock?

A 
(CORRD)
Cardiogenic
Obstructive
Restrictive
Relative
Distibutive
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18
Q

How do you assess a patients circulation?

A 
HR
Caprefill
BP
Organ perfusion (chest pain, mental state, urine output)
bleeding or fluid loss
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19
Q

What causes altered conscious state?

A

Hypoxia
Hypercapnia
Cerebral hypo perfusion
Recent administration of analgesia and sedatives

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20
Q

What assessments are used to assess CNS?

A

AVPU
GCS
Pupils
Limb Strength

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21
Q

How do you elicit a response?

A

Grab and squeeze trapezius
“open your eyes”
“squeeze my hand”

Response - maintain ABCDE
No response - call for help, place pt on back, ABCDE

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22
Q

What do you do if the patient has no signs of life?

A 
Commence compressions (30:2)
Middle lower half of sternum
High quality compressions
5cm depth of chest
Rate 100-120/min
Allow full recoil of chest
Minimise interruptions
Place pads on
Change operator every 2 mins to avoid fatigue
Recommence compressions immediately post defib
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23
Q

Bradycardia Algorithm (write out)

A
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24
Q

Tachycardia Algorithm (write out)

A
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25
Q

What are some considerations for trans thoracic impedence?

A 
Dry skin
Shave chest if required
Chest pads are moist
Do not use open pads
Ensure pads are adhered to chest
26
Q

What are the two different types of pad placement?

A

Aterior-posterior (AP)

Postero-lateral

27
Q

What do we need to consider when using a defib with a pacemaker?

A

Place pads at least 8cm away from PPM. As it can cause burns to where wires meet myocardium

28
Q

What is a synchronised cardioversion?

A

Synchronisation of a shock to occur on a R wave. This avoids refractory period and decreases risk of VF

29
Q

What are the indications of synchronised cardioversion?

A

VF with pulse
SVT
AF

30
Q

When can we administer 3 stacked shocks?

A

When a patient who is previously well and cardiac monitored with defib attached is observed to go into a shockable rhythm.

3 stacked shocks can be given (within 20 seconds of rhythm change). If nil sign of ROSC after 10 seconds post - commence CPR.

31
Q

What are the 13 steps in the ALS shockable rhythm?

A
  1. Confirm cardiac arrest
  2. Call for help
  3. Commence CPR/apply defib
  4. Plan actions/avoid interruptions of CPR
  5. C, O, A
  6. C
  7. H
  8. E, D
  9. Recommence CPR
  10. CPR 2 mins
  11. Repeat steps 4-10
  12. Adrenaline 1mg second shock then every 2nd loop
  13. Amiodarone 300mg after 3rd shock
32
Q

What are the 11 steps in ALS of a Non-Shockable Rhythm

A
  1. Confirm cardiac arrest
  2. Call for help
  3. Commence CPR/apply defib
  4. Plan actions/avoid interruptions of CPR
  5. C, O, A
  6. C
  7. H
  8. E, D
  9. Recommence CPR
  10. Give adrenaline 1mg immediately then every second loop
  11. Repeat steps 4-10
33
Q

Some key points during ALS

A

Emphasis on high quality uninterrupted CPR
Recognising and treating reversible causes
Attempts to secure airway must be completed with minimal interruptions to CPR
When airway is secured continue CPR with nil pause for ventilation. Aim 6-8bpm

Airway adjuncts

  • OP 1st instance
  • LMA no longer than 30 second attempt
  • ETT no longer than 10 sec interruption of CPR

O2

  • HR O2 until ABG measurable
  • BVM
  • when airway secured confirm with end tidal

IV

  • peripheral preferred
  • 20ml flush and elevate limb

IO
- If unable to establish IV in 2 mins of resus

34
Q

What are the 2 shockable rhythms?

A

VT

VF

35
Q

How would you describe VF?

A

An asynchronous chaotic ventricular rhythm
No regular pattern
No cardiac output
No P waves

36
Q

How would you describe VT?

A

Wide complex tachycardia
May or may not produce cardiac output
No pwaves

37
Q

What are the non-shockable rhythms?

A

Asystole

PEA

38
Q

How would you describe Asystole?

A

Absence of any electrical activity of the heart
No pattern
No cardiac output
No pwaves

39
Q

How would you describe PEA?

A

A presence of coordinated electrical rhythm
Can be regular
No Q waves
P waves can be present

40
Q

What are the actions of Adrenaline?

A

Catecholamine
Vasoconstricts vessels
Directs blood flow towards Brain and heart

41
Q

What are the indications of adrenaline?

A

VF
VT
Asystole
PEA

42
Q

What is the dosage of adrenaline in an arrest? Shockable VS Non-shockable

A

1mg NEAT
Shockable - 1mg NEAT 2nd shock, then every second loop
Non-Shockable - 1mg NEAT immediately, then every second loop

43
Q

What are the adverse effects of adrenaline?

A

Tachyarrythmias
Tissue necrosis at site
Post resuscitation HTN

44
Q

What are the actions of Amiodarone?

A

Class III antiarrythmic
Prolongs action potential
Reduces rate through AV node

45
Q

What are the indications of Amiodarone?

A

VT

VF

46
Q

What is the dosage and administration requirements of Amiodarone?

A

300mg IV in 20mls Glucose over 10-20 mins
If required - follow by 900mg/24 hours
Pre and post flush with glucose 20ml

In an arrest give Amiodarone after 3rd shock if shockable rhythm

47
Q

What are the adverse effects of Amiodarone?

A

Bradycardia

Prolonged QT

48
Q

What is the action of Atropine?

A

Anticholinergic

Increases firing rate of SA node

49
Q

What are the indications of atropine?

A

Severe bradycardia

2nd and complete heart block

50
Q

What is the dose and administration requirements of Atropine?

A

500-600mcg NEAT

Repeat 5 minutely up to 3mg

51
Q

What are the adverse effects of Atropine?

A

Tachyarrythmias
Dilated pupils
Increased ICP

52
Q

What are the actions of Adenosine?

A

Transiently blocks conduction through AV node

53
Q

What are the indications of adenosine?

A

Haemodynamically stable SVT

Paroxysmal SVT

54
Q

What is the dose and administration requirements of Adenosine?

A

6mg IV, then repeat 12mg and 12mg if required

Followed by a rapid flush as it has a short half life of 0.6-10 seconds

55
Q

What are the adverse effects of Adenosine?

A

Impending doom
Chest pain
Sinus arrest

56
Q

What are additional drugs not mentioned that can be used in ALS

A 
Metoprolol
Potassium
Digoxin
Magnesium
Lignocaine
Sodium Bicarbonate
57
Q

What is the defibrillation algorithm?

A 
(COACHED)
Continue compressions
Oxygen away
All others clear
Charging defib
Hands off
Evaluating rhythm
Defibrillate/disarm
58
Q

What are the steps for non-invasive transcutaneous pacing?

A 
(MRS Milliamps)
Mode
Rate
Synch
Milliamps (output)

Start pacing
Increase amplitude to 30mA
Slowly increase amps until capture is achieved (pacing spike before every QRS)
Increase slightly above capture to avoid loss of capture
Check mechanical capture (palpate pulse)
Monitor haemodynamic responsiveness

59
Q

Explain the different pacing modes.

A

Synch and Demand
Synch (Demand) - preferred as paces when pts HR falls below set level avoiding R on T
Asynch (Fixed) - paces at set rate. Can be used for transport to avoid artefact and unnecessary pacing

60
Q

Explain the procedure of Synchronised Cardioversion.

A

Place electrodes on patient
Turn mode selector to defib
Press SYNC on/off soft key
Verify that you see the word SYNC before the joules setting
Once in the SYNC mode the divide will display a down arrow markers above the R wave
(These markers indicate points in the cardiac cycle where discharge can occur)
Follow -OACHED algorithm (no compressions)
Select energy (200 joules)
Press charge
Shock
The defib will automatically revert to defib
Repeat process with starting SYNC soft key

ALS (1 decks)

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