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Draft ALS2 review > ALS2 review > Flashcards

ALS2 review Flashcards

1
Q

What are shockable rhythms?

A

VF and pulseless VT (VF/pVT)

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2
Q

What proportion of OHCA are shockable? Survivable?

A

A quarter are shockable. Survival rates are 12% overall, but 30% if it’s a shockable rhythm.

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3
Q

What are common non-shockable rhythms?

A

Asystole (50%) and pulseless electrical activity (PEA).

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4
Q

What proportion of IHCA shockable? ?Survivable

A

17% are shockable, 18% survival to d/c overall. If it is shockable 49%, and if not 10%.

If caught in the first 3-5 minutes of collapse, survival rates as high as 50-70%, but drops 10% every minute defib delayed

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5
Q

What are the components of Initial CPR?

A

CPRD:
CPR - 30:2 (2 minute cycle)
D - Defib applied, rhythm-check (aim for <3 minutes certainly, as survival drops 10% per minute !!)

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6
Q

What meds are given in shockable rhythms?

A

Shock up-front (SAAA)

  • shock
  • s/adrenaline 1mg
  • s/amidarone 300mg
  • s/adrenaline 1mg
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7
Q

What meds are given in non-shockable rhythms?

A

Adrenaline (ANAN)

  • adrenaline 1mg
  • no-shock (continue CPR)
  • adrenaline 1mg
  • no-shock (continue CPR)
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8
Q

What are the Hs and Ts?

A 
Hypoxia/Hypovolaemia
Hyper/Hypokalaemia
Hypothermia/hyperthermia
Tension pneumothoraxa/Tamponade
Toxins
Thrombosis - PE, MI
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9
Q

What are some differentials?

A 
Immune -
Infections -
Drugs - Toxins
Cancer - 
Vascular - Hypovolaemia/Hypoxia, PE/MI/tamponade
Endo/metabolic - Hypo/Hyperkalaemia
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10
Q

Post resus care components?

A
  • 12 lead ECG, treat the cause-
  • Aim SpO2 94-98%
  • Aim normocapnia/normoglycaemia
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11
Q

Ratio of ventilation to compression

A

30 compressions: 2 breaths

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12
Q

Time to check for breathing? (dRsabc)

A

<10 seconds

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13
Q

Hand positioning for CPR?

A

Middle of lower third of sternum

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14
Q

CPR rate

A

100-120 bpm

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15
Q

Precordial thump usage?

A

VT/VF within <20 seconds onset, and priority is still getting defib (don’t delay the defib).

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16
Q

Intubation size for adult male and female?

A

8mm and 7mm internal diameter, respectively

“8”/ate the tube

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17
Q

Laryngoscope for intubation

A

Curved macintosh blade

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18
Q

Confirmation of intubation?

A

Waveform capnography + auscultation (avoid eoso intubation)

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19
Q

Auscultation for bronchial vs oeso intubation?

A

Axilla (should hear breath sounds equally) and Epigastric (should not hear breath sounds)

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20
Q

Normal PR

A
  1. 12-0.20 (3-5 small squares)

- >0.2 is first deg AV block

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21
Q

Normal QRS

A

<0.12 (3 small squares)

- >0.12 is wide complex

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22
Q

Resuscitation outcomes based on duration sumersed?

A

<10 minutes - high chance good outcome.

>25 minutes - low chance good outcome (except children, in icy cold water)

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23
Q

Time taken to check WWP

A

2+5 = 7 seconds. Feel the hands - cool or warm. Apply cutaneous pressure for 5 s on fingertip at heart level. Normal is < 2 seconds for CRT.

24
Q

Urine output signs of poor cardiac output?

A

< 0.5 mL/kg /hr

25
Q

Adequate CPR compression metrics

A

> 1/3 AP diameter or >5cm depth

100-120 compressions per minute

26
Q

Likeliest arrest rhythm in hypovolaemia?

A

Pulse electrical activity (but shockable rhythsm can also develop initially or during arrest)

27
Q

Are cardiac arrests in hospital usually expected or unexpected (in ideal setting)?

A

Most (80%) have some deterioration in clinical signs few hours before

28
Q

PEA survivability?

A

PEA and asystole - Low survival, unless reversible cause found and treated quickly and effectively

29
Q

Treatment if PE thought to be cause of arrest

A

Immediate fibrinolytic drug, and CPR to >30 minutes, and up to 60-90 minutes (give it time). Survival has been reported in cases requiring over 60 minutes CPR.

30
Q

Flush needed for drugs through peripheral IVC

A

20mL

31
Q

Second line if no IVC placeable

A

Proximal/Distal Tibial IO - just as good, but need pressure from pressure bag or syringe (proximal humerus is another site, but the head is usually crowded area in resus)

32
Q

Sodium bicarbonate and calcium chloride interactions?

A

Do not give them together - in the same line, as the hypertonic/caustic medication causes muscle necrosis

33
Q

Dose of sodium bicarb?

A

50mmol = 50mL of 8.4% solution

34
Q

Dose of adrenaline IV/IO

A

1mg = 1mL of 1:1000 or 10mL of 1:10,000

35
Q

Heart rate estimation

A

Paper speed = 25mm=5x5 small squares per sec.
Count 3 seconds (3 big squares of 5 small) - x20.
Count 6 seconds (6 big squares of 5 small) - x10.

36
Q

Difference between disconnected wire and asystole?

A

Perfectly flat line (disconnected wire) vs undulating line (asystole).

37
Q

Risk factors for VT deteriorating into pVT or VF? How is they treated?

A

Risks include - impaired LV function, severe LVH and aortic stenosis. pVT/VF are both treated same by immediate defibrillation.

38
Q

RR interval and HR in VT

A

Generally RR only has slight variation during a single episode (apart from response to anti-arrhythmics). Rate may be anything from 100-300bpm, rarely faster.

39
Q

Risk factors increasing the likelihood a broad complex tachy is VT?

A

Following an MI, most are ventricular. Safest to regard all broad complex tachys as VT until otherwise. They can occur alternatively from SVT with bundle branch block.

40
Q

Likelihood of needing cardioversion based on HR in itachyarrhythmia?

A

Adverse events rare if HR<150, unless structural heart or severe lung disease. Otherewise wouldn’t cardiovert necessarily unless faster.

41
Q

Treatment for a broad complex tachycardia considered to be VT?

A

Amiodarone 300mg IV over 20-60 min, followed by infusion of 900mg over 24 h. Continue monitoring throughout.
(nb. ?cause, ?angio; also amiodarone good for CCF-AF/RVR too, not keen to up b-blocker too high… more accepta ble in elderly, less time to get thyroid/lung S/E’s; -glau, barnes, als2 pg123)

42
Q

Treatment of Bradycardia with adverse features (shock, syncope, heart failure, MI)?

A

Atropine 500-600 microg IV/IO.
Repeat Q3-5min, to total of 3mg total.
Give it rapid (or paradoxical slowing)

If persistent or asystole-risks - then consider pacing (or 2nd line drugs), transcutaneous, or transvenous.
Asystole risks: recent asystole, mobitz II block, CHB with broad QRS, ventricular pause >3 seconds.

43
Q

Adrenaline infusion or isoprenaline infusion doses? (2nd line in bradycardia)

A

Isoprenaline 5 microg/min.

Adrenaline 2-10 microg/min. (range of 5 mics a min)

44
Q

Can mouth to mouth transmit disease?

A

Yes more commonly resp ones like sars, TB. Others less likely HIV-never been reported.

45
Q

Tracheal suction risks?

A

Use cautiously if alert/has intact gag reflex, as can cause vomiting.

46
Q

Normally suction is done with wide-bore rigid Yankauer sucker. What can be used in the nasopharynx for sucking the sputum from deeper or through a smaller opening?

A

Fine bore flexible suction can be used in those with smaller mouth openings, and can be used through oropharyngeal or nasopharyngeal airways.

47
Q

Most common nasopharyngeal airway size - and use?

A

6-7mm. Good for clenched jaws, trismus or maxillofacial injuries. Theoretical risk of insertion at a skull fracture, but if the airways is oherwise obstructed, then the benefits outweigh risks if gently done.

48
Q

Most common oropharyngeal sizes?

A

Size 2, 3 and 4 for small, medium and large. It is better to be slightly too big than slightly too small.

49
Q

Sizing of Oropharyngeal Guedel airway?

A

Incisor to angle of jaw = tip to tip straight line distance

50
Q

Treatment of STEMI if onset <12hrs?

A

Primary PCI (>12 hrs not as useful to treat)

51
Q

Presentation to Balloon aims for Primary PCI?

A

60-90 minutes max (aim 60 minutes, if onset of symptoms <60min; and 90 minutes if later than that)

52
Q

Amiodarone dose

A

300mg bolus IV/IO

53
Q

Use of synchronised cardioversion?

A

Only if used to convert atrial or ventricular tachyarrhythmias. The shock is sync’d to the R waves, to avoid R on T (shocking in the relatively refractory period can induce VF). It is not needed in VF/pVT.

54
Q

VF/pVT shock energies

A

200J initially. Then escalation, subsequently, up to 360 J.

55
Q

CPR Compressions or shock prioritised?

A

As soon as Defbrillator is available, it should be used.. Prioritise the shock.

56
Q

If VF or somethings shockable seen during the 2 breaths of the 30:2 CPR cycle, go and shock it or keep on CPR-ing?

A

Keep CPR-ing, and shock when the time comes at the 2 minute check (but mentally prepare to give a shock)

Draft ALS2 review (1 decks)

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