ALS + Toxicology Flashcards
Describe the flowchart for adult cardiac arrest with a shockable rhythm
Start CPR Give O2 Attach monitor Shock CPR 2 mins - get IV/ IO access Epinephrine every 3-5 mins Consider advanced airway Amiodarone after 3 shocks Treat reversible causes
Describe the flowchart for adult cardiac arrest with a non-shockable rhythm
Start CPR Give O2 Attach monitor CPR 2 mins - get IV/ IO access Epinephrine every 3-5 mins Consider advanced airway Treat reversible causes
Describe the quality of CPR
>2 inches/ 5cm 100-120/ min Rotate compressor every 2 mins 30:2 If peCO2 <10, improve CPR quality With intra-arterial pressure, if diastolic pressure <20, improve CPR quality
Describe the flowchart for adult tachycardia with pulse
HR >150
Identify underlying cause
Attach cardiac monitor, BP + oximetry
Is there sign of shock or acute HF? if yes - synchronised cardioversion
If no - Wide QRS?
Yes = Adenosine if regular, consider anti-arrhythmic
No = Vagal manouvers, adenosine, BB or CCB
What anti-arrhythmic might you use for a wide QRS tachy?
Procainamide
Amiodarone
Sotalol
Describe the flowchart for adult bradycardia with pulse
HR <50 Identify underlying cause Attach cardiac monitor, BP + oximetry IV access + 12 lead ECG Is there sign of shock or acute HF? if yes - synchronised cardioversion If no - monitor If yes = atropine If ineffective = transcutaneous pacing OR dopamine OR epinephrine Consider transvenous pacing
What are the signs of shock?
Hypotension
Altered mental state
Ichemic chest discomfort
What are the 4 principles of toxicology?
Resus (A-E)
Screening
Decrease absorption
Increase elimination
What are the universal antidotes?
Dextrose
Oxygen
Naloxone
Thiamine (give BEFORE dextrose)
When to give dextrose?
Any pt with altered LOC
When is the only time you wouldn’t give oxygen in a toxicology pt?
If OD is with paraquat or diquat (herbicides)
When to give nalaxone?
Undifferentiated comatose pt
When to give thiamine in tox pts?
Give with glucose to all patients in undifferentiated comatose state
What can naloxone cause in chronic opioid users?
Can cause withdrawal
Minor = lacrimation, rhinorrhea, diaphoresis, yawning, piloerection, HTN, tachycardia
Severe = hot/ cold flashes, arthralgias, myalgias, N/V, abdo cramps
How can an ABG help to identify toxin?
Hypoventilation (high CO2) = CNS depressants
Hyperventilation = salicylates, CO
