Appendices

Question 1

Anaphylaxis guidelines:

Answer 1

Question 2

Adrenaline - Shockable (VF/pVT) - how to dose:

Answer 2

1. Dose: 1 mg (10 mL 1:10 000 or 1 mL 1:1000) IV
2. Given after the 3rd shock once compressions have resumed
3. Repeated every 3-5 min (alternate cycles)
4. Given without interrupting compressions

Question 3

Adrenaline - Non-Shockable (PEA/Asystole) - how to dose:

Answer 3

1. Dose: 1 mg (10 mL 1:10 000 or 1 mL 1:1000) IV
2. Given as soon as IV access achieved
3. Repeated every 3-5 min (alternate cycles)
4. Given without interrupting compressions

Question 4

What are the alpha-adrenergic effects of ADR?

Answer 4

1. Systemic vasoconstriction
2. Increases coronary perfusion pressures
3. Increases cerebral perfusion pressures

Question 5

What are the beta-adrenergic effects of ADR?

Answer 5

1. +ve Inotropic
2. +ve Chronotropic
3. May increase coronary blood flow
4. May increase cerebral blood flow

Increases myocardial O2 demand

Question 6

Amiodarone - Shockable (VF/pVT) - how to dose:

Answer 6

1. Dose: 300 mg bolus IV diluted in 5% dextrose (or other suitable solvent) to a volume of 20 ml
2. Given during compressions after 3 shocks
3. Further dose of 150 mg if VF/pVT persists after 5 shocks

Question 7

Amiodarone - Non-Shockable (PEA/Asystole) - how to dose:

Answer 7

1. Not indicated

Question 8

MOA of amiodarone:

Answer 8

1. Membrane-stabilising drug
2. Increases the duration of the action potential & refractory period in atrial & ventricular myocardium
3. AV conduction is slowed

Question 9

What to flush amiodarone with?

Answer 9

1. 0.9% sodium chloride
2. Or 5% dextrose

Question 10

Indications for NaHCO3:

Answer 10

1. Cardiac arrest ass. w/ HyperK
2. TAD OD

Question 11

What dose of NaHCO3 is used?

Answer 11

1. 50 mmol (50 ml of 8.4% soln.) IVI

Question 12

Is NaHCO3 used routinely in cardiac arrest?

Answer 12

1. NO

Only when HyperK present

Question 13

Adverse effects of using NaHCO3:

Answer 13

1. Produces CO2
2. Worsens intracellular acidosis
3. Negative inotrope
4. Produces large osmotically active Na load to brain
5. Shifts O2 dissociation curve to the left - inhibiting O2 release

Question 14

When are fibrinolytics used in cardiac arrest?

Answer 14

1. NOT used routinely
2. ONLY when suspected or proven acute PE

Question 15

Dosage of fibrinolytics when suspecting / Dx acute PE:

Answer 15

1. Alteplase 50 mg IV bolus
2. or Tenecteplase 500 - 600 mcg/kg IV bolus

Question 16

Indication for adenosine:

Answer 16

1. Paroxysmal SVT

6mg - 12mg - 18mg as rapid IV bolus + rapid flush (short half life)

Question 17

Indications for Adrenaline apart from cardiac arrest:

Answer 17

1. Bradycardia
2. Anaphylaxis

Question 18

Dose of adrenaline for bradycardia:

Answer 18

1. 2-10 mcg/min

Question 19

Dose of adrenaline for anaphylaxis:

Answer 19

1. 0.5 mg IMI (repeat every 5 min)
2. 50 mcg IV bolus titrated to effect while awaiting infusion
3. 1 mg ADR in 100 ml 0.9% NaCl starting @ 0.5 - 1.0 ml/kg/hr IVI titrated to clinical response

Question 20

Indications for amiodarone other than shockable rhythm cardiac arrest:

Answer 20

1. Rx of haemodynamically stable monomoprhic VT, polymorphic VT & wide-complex tachycardia of uncertain origin
2. Rate control &/or chemical cardioversion of pre-excited atrial arrhythmias (AF)
3. To increase liklihood of electrical cardioversion

Question 21

Dosage of amiodarone for Rx of arrhythmias:

Answer 21

1. 300 mg IVI over 10-60 min
2. Followed by 900 mg infusion over 24 hrs

Question 22

Indications for atropine:

Answer 22

1. Unstable sinus, atrial or nodal bradycardia
2. Unstable AV block

Question 23

Dose of atropine:

Answer 23

1. 500 mcg IVI stat
2. Repeated up to 6 doses for max of 3 mg

Question 24

Indications for B-Blockers:

Answer 24

1. Stable regular narrow complex tachycardias unresponsive to vagal manoeuvres or Adenosine
2. Rate control AF & atrial flutter

Question 25

Indications for Verapamil:

Answer 25

1. Stable regular narrow complex tachycardias unresonsive to vagal manoeuvres or Adenosine
2. Rate control AF & atrial flutter when duration < 48 hrs

Question 26

Indications of digoxin:

Answer 26

1. AF w/ fast ventricular response

Question 27

Indications for inotropes & vasopressors:

Answer 27

1. Hypotension in absence of hypovolaemia
2. Cardiogenic shock

Question 28

Dosages of Noradrenaline & Dobutamine:

Answer 28

1. Noradrenaline 0.05 - 1 mcg/kg/min
2. Dobutamine 5 - 20 mcg/kg/min

Question 29

Indications for Mg:

Answer 29

1. Polymorphic VT - Torsades de Pointes
2. Digoxin toxicity
3. Rx of hypoMg

Question 30

Dosage of Mg:

Answer 30

1. 2 g IV over 10 min

Question 31

Indications for Nitrates:

Answer 31

1. Prevention or relief of angina
2. ACS
3. Acute & chronic LVF