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GP exams > ALS1 > Flashcards

ALS1 Flashcards

1
Q

ALS1 - cardiac arrest - ddx to consider

A

4H and 4 T

  • hypothermia
  • hypokalaemia / hypoglycaemia / endocrine or electrolyte issue
  • hypoxia
  • hypovolaemia
  • Tension pneumothorax
  • tamponade
  • toxins
  • thrombosis - pulmonary/coronary
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2
Q

ALS1 - cardiac arrest - shockable rhythm - what drugs to administer and when

A
  • adrenaline 1mg after 2nd shock, then every 2nd loop

* amiodarone 300mg after 3 shocks

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3
Q

ALS1 - cardiac arrest - shockable rhythm - adrenaline - dosage, when to administer during algorithm

A

1mg per dose
first dose
- if shockable, after 2nd shock

repeat dose every 2nd loop

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4
Q

ALS1 - cardiac arrest - CPR - compressions: breath ratio

A

30 compression : 2 breaths

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5
Q

ALS1 - cardiac arrest - when to attach defibrillator

A

concurrent with CPR

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6
Q

ALS1 - percentage of in-hospital cardiac arrests that survive to discharge

A

20%

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7
Q

ALS1 - chain of prevention - elements of Early Warning Systems (7)

A 
respiration rate
oxygen saturation
supplemental O2 use
Temperature
systolic BP
heart rate
level of consciousness
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8
Q

ALS1 - airway obstruction - ddx to consider (11)

A

neuro
- CNS depression

physical objects

  • blood
  • vomitus
  • foreign body
  • bronchial secretions
  • blocked tracheostomy or laryngectomy

structural

  • direct trauma to face or throat
  • pharyngeal swelling
  • epiglottitis

spasm

  • laryngospasm
  • bronchospasm
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9
Q

ALS1 - target O2 saturations

A

94-98%

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10
Q

ALS1 - airway - positioning manœuvres to open the airway

A
  • nurse patient on the side
  • tilt head up
  • head tilt + chin lift
  • head tilt + jaw thrust
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11
Q

ALS1 - airway - signs & symptoms of partial airway obstruction (2)

A
  • efforts at breathing are noisy

- increased respiratory effort

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12
Q

ALS1 - airway - signs & symptoms of complete airway obstruction (4)

A
  • no movement of air at the mouth
  • strenuous respiratory movements if present
  • accessory respiratory muscle use ‘see-saw pattern’
  • central cyanosis
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13
Q

ALS1 - airway - s&s of complete airway obstruction - what is a ‘rocking horse’ or ‘see saw’ breathing pattern

A

at inspiration - chest draws in, abdomen expands
at expiration - chestt expands, abdomen draws in
(sounds like the abdomen is getting ventilated)

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14
Q

ALS1 - breathing issues - ddx (broad) (4)

A
  • inadequate respiratory drive (CNS depression)
  • inadequate respiratory effort (peripheral nervous system dysfunction)
  • acute on chronic lung disorders - exacerbation of COPD, asthma, PE etc
  • acute lung disease - pneumonia
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15
Q

ALS1 - breathing - how to assess (5)

A 
RATES
resp rate
auscultation of lungs
trachea position
effort of breathing
SaO2
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16
Q

ALS1 - tachypnea definition

A

RR > 25

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17
Q

ALS1 - breathing - best way to assess effectiveness of ventilation

A

PaCO2, measured via ABG

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18
Q

ALS1 - breathing - initial supplemental O2 management (non COPD)

A

15L per min O2 via high concentration reservoir mask, titrating fo 94-98%

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19
Q

ALS1 - circulation - ventricular fibrillation ddx (9)

A

cardiac

  • acute coronary syndrome
  • hypertensive heart disease
  • valve disease
  • inherited cardiac disease like long QT syndrome

endocrine/biochem

  • acidosis
  • abnormal electrolyte concentration

external

  • drugs like antiarrhythmics,TCA, digoxin
  • hypothermia
  • electrocution
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20
Q

ALS1 - breathing - signs of respiratory distress (4)

A
  • sweating
  • central cyanosis
  • use of accessory respiratory muscles
  • abdominal breathing
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21
Q

ALS1 - breathing - rattling airway noises suggest what dx

A

airway secretions

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22
Q

ALS1 - breathing - audible stridor or wheeze suggests what dx.

A

airway obstruction

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23
Q

ALS1 - pneumothorax - exam findings to look out for (4)

A

hyper resonance on percussion
reduced or absent airway sounds
tracheal deviation
chest wall crepitus / surgical emphysema

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24
Q

ALS1 - supplemental O2 in COPD

A
  • venturi 28% or 24% mask

target 88-92% SaO2

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25
Q

ALS1 - patient is shocked - presumptive management in absence of cardiac cause

A

IV fluids - 500mL of 0.9% NaCl or Hartman’s over 15 mins

26
Q

ALS1 - signs of circulatory shock (2)

A

cool peripheries

tachycardia

27
Q

ALS1 - circulation - things to assess (6)

A
  • pulse rate
  • blood pressure
  • peripheral + central pulses
  • color of hands and fingers
  • temperature of hands
  • capillary refill time
28
Q

ALS1 - circulation - low diastolic blood pressure ddx (2)

A

suggests arteriolar dilation

  • anaphylaxis
  • sepsis
29
Q

ALS1 - circulation - what is pulse pressure, whats normal range

A

sysBP - diasBP (35-45)

30
Q

ALS1 - circulation - high pulse pressure ddx (2)

A

cariogenic shock, hypovolaemia

31
Q

ALS1 - circulation

  • how to measure capillary refill time
  • what does it assess
A

hold limb up to about cardiac height
apply enough pressure to blanch skin for 5s
remove pressure to see how long it takes to reperfuse

assess peripheral perfusion

32
Q

ALS1 - circulation - oliguria definition

A

< 0.5ml /kg per hour

33
Q

ALS1 - patient is shocked - presumptive management if history of cardiac disease

A

IV fluids -250mL of 0.9% NaCl or Hartman’s over 15 mins

listen to the chest for crackles

34
Q

ALS1 - disability/drugs - things to assess

A

check drug chart
examine pupils
conscious state - AVPU
blood glucose

35
Q

ALS1 - hypoglycaemia - BSL < 4.0 - immediate management

A

50mL of 10% glucose IV stat, repeat doses if not going up

36
Q

ALS1 - what is waveform capnography

A

non-invasive measurement of end-tidal CO2

37
Q

ALS1 - how to do a head tilt + chin lift

A

1 hand on the forehead/scalp, to extend the neck

the other hand on the chin - 2 fingers in a gun position, closing the mouth

38
Q

ALS1 - opening airway - option in ?cspine injury

A

jaw thrust + chin lift

39
Q

ALS1 - correct hand position for CPR

A

middle of lower half of sternum

40
Q

ALS1 target compressions per minute

41
Q

ALS1 - ventilation - how long per forced inspiration

42
Q

ALS1 target breaths per minute

43
Q

ALS1 - how long is each ‘loop’ of the ALS1 algorithm

44
Q

ALS1 - when to give ‘stacked shocks’

A
  • patient has monitored and witnessed cardiac arrest
  • was well oxygenated prior to arrest
  • you can give the first shock within 20 seconds
  • patient has VF or pulseless VT
45
Q

ALS1 - ‘stacked shocks’ protocol

A

3 defibrillator attempts in succession
in between each defibrillator, check for pulse and other signs of ROSC
start CPR if 3rd shock unsuccessful

46
Q

ALS1 algorithm - nonCPR things to establish while CPR is happening (4)

A

airway adjuncts
oxygen
IV/IO access
waveform capnography

47
Q

ALS1 algorithm - amiodarone - when to administer, what dose

A

shockable rhythm, 3 shocks have been done

give 300mg

48
Q

ALS1 - defibrillator shock - joules range

49
Q

ALS1 - when to do a precordial thump

A
  • monitored witnessed pVT/VF

- defibrillator not arrived yet

50
Q

ALS1 - how to do a precordial thump

A
  • make a fist
  • aim it at lower half of sternum
  • go from 20cm height down, and quickly remove
  • recommence CPR
51
Q

ALS1 - insertion sites for intra osseous access (3)

A

proximal tibia, distal tibia

proximal humerus

52
Q

ALS1 - role of waveform capnography in CPR

A
  • check that tube is placed correctly
  • monitors ventilation rate
  • monitor quality of chest compressions during CPR (better CPR = better end-tidal CO2 value)
  • identifying ROSC during CPR
  • prognosticating during CPR
53
Q

ALS1 - hyperkalaemia - immediate management

A

calcium chloride 10%, 10mL IV
glucose 25g + 10 IU short acting insulin
HCO3- 50mmol IV if severe acidosis

54
Q

ALS1 - hyperkalaemia - why treat with calcium

A

stabilise cardiomyocyte resting membrane potential

55
Q

ALS1 - what is pulsus paradoxus

A

abnormally large drop in BP mmHg on inspiration

56
Q

ALS1 - beck’s triad, what condition does it suggest

A

distended JVP
muffled/distant heart sounds
hypotension, with narrow pulse pressure
suggests pericardial tamponade

57
Q

ALS1 - choking - immediate actions

A

5 back blows
then
5 chest thrusts

alternate between the 2

58
Q

ALS1 - how to size a guedel airway

A

mouthpiece to mouth, other piece to angle of jaw. should be just long enough

59
Q

ALS1 - LMA sizing for adults

A

men - 5

women - 4

60
Q

ALS1 - LMA - inflating the bubble how much volume needed

A

size 5 = 40mL

size 4 = 30mL

GP exams (115 decks)

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