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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
Adequate CPR compression metrics
>1/3 AP diameter or >5cm depth | 100-120 compressions per minute
26
Likeliest arrest rhythm in hypovolaemia?
Pulse electrical activity (but shockable rhythsm can also develop initially or during arrest)
27
Are cardiac arrests in hospital usually expected or unexpected (in ideal setting)?
Most (80%) have some deterioration in clinical signs few hours before
28
PEA survivability?
PEA and asystole - Low survival, unless reversible cause found and treated quickly and effectively
29
Treatment if PE thought to be cause of arrest
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
Flush needed for drugs through peripheral IVC
20mL
31
Second line if no IVC placeable
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
Sodium bicarbonate and calcium chloride interactions?
Do not give them together - in the same line, as the hypertonic/caustic medication causes muscle necrosis
33
Dose of sodium bicarb?
50mmol = 50mL of 8.4% solution
34
Dose of adrenaline IV/IO
1mg = 1mL of 1:1000 or 10mL of 1:10,000
35
Heart rate estimation
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
Difference between disconnected wire and asystole?
Perfectly flat line (disconnected wire) vs undulating line (asystole).
37
Risk factors for VT deteriorating into pVT or VF? How is they treated?
Risks include - impaired LV function, severe LVH and aortic stenosis. pVT/VF are both treated same by immediate defibrillation.
38
RR interval and HR in VT
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
Risk factors increasing the likelihood a broad complex tachy is VT?
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
Likelihood of needing cardioversion based on HR in itachyarrhythmia?
Adverse events rare if HR<150, unless structural heart or severe lung disease. Otherewise wouldn't cardiovert necessarily unless faster.
41
Treatment for a broad complex tachycardia considered to be VT?
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
Treatment of Bradycardia with adverse features (shock, syncope, heart failure, MI)?
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
Adrenaline infusion or isoprenaline infusion doses? (2nd line in bradycardia)
Isoprenaline 5 microg/min. | Adrenaline 2-10 microg/min. (range of 5 mics a min)
44
Can mouth to mouth transmit disease?
Yes more commonly resp ones like sars, TB. Others less likely HIV-never been reported.
45
Tracheal suction risks?
Use cautiously if alert/has intact gag reflex, as can cause vomiting.
46
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?
Fine bore flexible suction can be used in those with smaller mouth openings, and can be used through oropharyngeal or nasopharyngeal airways.
47
Most common nasopharyngeal airway size - and use?
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
Most common oropharyngeal sizes?
Size 2, 3 and 4 for small, medium and large. It is better to be slightly too big than slightly too small.
49
Sizing of Oropharyngeal Guedel airway?
Incisor to angle of jaw = tip to tip straight line distance
50
Treatment of STEMI if onset <12hrs?
Primary PCI (>12 hrs not as useful to treat)
51
Presentation to Balloon aims for Primary PCI?
60-90 minutes max (aim 60 minutes, if onset of symptoms <60min; and 90 minutes if later than that)
52
Amiodarone dose
300mg bolus IV/IO
53
Use of synchronised cardioversion?
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
VF/pVT shock energies
200J initially. Then escalation, subsequently, up to 360 J.
55
CPR Compressions or shock prioritised?
As soon as Defbrillator is available, it should be used.. Prioritise the shock.
56
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?
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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