Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Life Support 2 (ALS2) > Chapter 6 ALS algorithm > Flashcards

Chapter 6 ALS algorithm Flashcards

1
Q

On the ALS support for adults algorithm, what is under “During CPR”

A 
Airway adjuncts (ETT, LMA)
Oxygen
Waveform capnography
IV/IO access
Plan actions before interrupting chest compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drugs are standard given during ALS?

A

SHOCKABLE

  • Adrenaline 1mg after 2nd shock (then ever 2nd loop)
  • Amiodarone 300mg after 3 shocks

NON-SHOCKABLE
- Adrenaline 1mg immediately (then every 2nd loop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 4 H’s?

A

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hypothermia/hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 T’s?

A

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary, coronary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is needed for “Post-resuscitation Care” according to ALS algorithm

A 
Re-evaluate ABCDE
12 lead ECG
Treat precipitating cause
Aim for SpO2 94 - 98%, normocapnea and normoglycaemia
Targeted temperature management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the COACHED acronym for defibrillation stand for?

A

C: Continue CPR
O: Oxygen away (1 meter, can leave if airway secure)
A: All others away (visual check)
C: Charging (top clear, middle clear, bottom clear)
H: Hands off (state “I’m safe”)
E: Evaluate rhythm
D: Defibrillate or disarm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do you do if you see organised electrical activity compatible with cardiac output during a rhythm check?

A

Dump charge
Seek evidence of ROSC (check for signs of life, central pulse, end-tidall CO2)
If no signs of ROSC, switch to non-shockable algorithm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many joules should be provided during a shock?

A

200J biphasic for first shock for

Can increase up to 360J biphasic for second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is it not needed to check for a pulse during every rhythm check?

A

1) Even if defibrillation has worked, it takes time for ROSC
2) Delay to continued CPR dangerous
3) If perfusing rhythm is restored, doing CPR won’t increase changes of VF recurring
4) In presence of post-shock asystole, chest compressions may usefully induce VF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would you consider a second (150mg) dose of amiodarone?

A

When VT/VF persists or recurs after 5 shocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What dose of lignocaine could be given if there was no amiodarone available

A

1mg/kg

Do not give if amiodarone has already been given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is important to check in shock refractory VT/VF

A

The position and the contact of the pads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

During a VT/VT arrest, you do a rhythm check and it is now organised electrical activity. What should you do?

A

Look for signs of life
Check for a pulse
Look for sudden increase end-tidal CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

You are unsure of the rhythm is asystole or very fine VF. Do you deliver a shock?

A

Do not attempt defibrillation
Continuing effective CPR may increase the amplitude and frequency of the VF and improve changes of of subsequent successful defibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you give 3 stacked shocks?

A

Witness and monitored VT/VF
Can be delivered within 20 seconds
Patient was well oxygenate and perfused prior to arrest
(3 shocks counts as 1st shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would you do if you saw ventricular standstill (P waves over a flat trace)

A

Consider attempting cardiac pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What settings on the defibrillator would you check if the rhythm was asytole?

A

Ensure ECG pads are attached to the chest and correct monitoring mode is selected
Ensure gain setting is appropriate
Look for P waves and consider cardiac pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

During a pause to provide ventilation, you see the rhythm is VT/VT. Should you provide a shock now?

A

No, wait till 2 minutes has elapsed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

During the first rhythm check you see electrical activity that could be consistent with a cardiac output, but there is no pulse and you confirm PEA. Do you need to keep checking for a pulse each rhythm check?

A

No, assume PEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

You have inserted an LMA/ETT and are ventilating at a rate of 10 breaths per minute with continuous CPR, but you notice significant air leaking. What do you do?

A

Go back to 30:2 allowing a pause for two breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

There are no studies that show tracheal intubation increases survival after cardiac arrest and incorrect placement is frequent if done by unskilled personnel during CPR. What is an alternative?

A

Supra-glottic airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When may a brief pause be acceptable during ETT placement?

A

While passing the ETT between the vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you confirm ETT position placement is correct?

A

End tidal CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Does the pH of an arterial blood gas correlate well with tisssue pH?

A

No

But central venous blood provides better estimation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Can end tidal CO2 be used with a SGA?

A

Yes, but it’s more accurate with an ETT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

You are not sure if you have ROSC (subtle signs, but not enough to stop CRP to check), the nurse is about to give adrenaline, what do you do?

A

Without adrenaline until cardiac arrest if confirmed at next rhythm check.
1mg of adrenaline in a patient with ROSC could be harmful

27
Q

What are the benefit of end-tidal CO2 montioring?

A

1) ensuring ETT placement in trachea
2) monitoring ventilation and CPR (CO2 values are high in effective CPR)
3) identifying ROSC (sudden increase)
4) Prognostiation (low CO2 = worse prognosis)

28
Q

What are the four phases of the capnography waveform?

A

1) flat part = end of inspiration
2) upstroke = start of expiration (alveoli air mixed with dead space)
3) plateau = expiration of alveoli air only
4) down stroke = start of inspiration

29
Q

Failure to achieve and end-tidal co2 > 10mmHg after 20 minutes of CPR is associated with a poor prognosis. True/false?

A

True

30
Q

What volume should drugs be flushed with?

A

20 ml. It may be easier to have continuously running IVF

31
Q

What sites can be used for IO access?

A

Proxial tibial
Distal tibia
Proximal humerus
Distal femur

32
Q

What are contraindications for an IO?

A 
Trauma/fracture
Infection
Prosthesis 
IO at same site within 48 hours
Failure to identify anatomical landmarks
33
Q

How can you confirm successful IO placement

A

Aspiration, if blood drawn back, success.

However may not always bleed so identifying anatomical landmarks and feeling it pass through bone is important

34
Q

What are the possible causes of hypovolaemia?

A

Haemorrhage - trauma or occult
Distributive shock (anaphylaxis, shock)
N&V, diarrhoea

35
Q

In addition to H for hypo/hyperkalaemia, what else would you check when thinking of electorlyte/chemical disturbances?

A

Hypoglycaemia
Hypocalcaemia
Acidaemia

36
Q

The patient has hyperkalaemia what specific doses would you give of the following:
Calcium chroride
Glucuse & insulin
Sodium bicarbonate

A 
Calcium chloride 10ml of 10%
Glucose 25g (50ml 50%)  + 10 units novorapid
Sodium bicarbonate 50mmol (if acidotic)

Consider dialysis on obtaining ROSC

37
Q

What is the benefit and draw-back of calcium gluconate?

A

Benefit: less irritating to veins
Draw-back: 3 x less calcium than calcium chlroide
Needs hepatic metabolism to release calcium – this will be slowed in cardiac arrest or liver failure

38
Q

What are the uses of IV calcium? Name 3

A

1) Hypocalcaemia
2) Hyperkalaemia
3) Calcium channel blocker overdose

39
Q

What are the causes of acute hypocalcaemia?

A

Shock
Sepsis
Pancreatitis
Drug toxcities

40
Q

You suspect the patient arrested due to hypokalaemia, the level is 2. How much potasium and how much magnesium shoud you give?

A

5mmol IV potassium bolus

10mmol/2.5g magnesium

41
Q

Match the condition to the symptoms/signs:

1) Heat stroke
2) Heat exhaustion
3) Hyperthermia

a) Temperature > 40.6
b) condition of fatigue caused by prolonged exposure to high temperature +/- humitidy, exercise. Symptoms include: headache, nausea, vomiting, malaise. Often recover quickly. Core temp usually < 40
c) Systemic inflammatory reponse with core temperature >40.6, accompanied by altered mental status, collapse of varying levels of organ dysfunction. Sweating often ceases (though may be profuse), hot dry skin

A 
1 = c
2 = b
3 = a
42
Q

Dantrolene is used in maligant hyperthermia due to anaesthetic agents. Can it be used in malignant hyperthermia from other drugs? Which ones?

A

Ecstacy

Amphetamines

43
Q

You presume a cardiac arrest is caused by a masissive PE and give a fibrinolytic agent. How long should you continue CPR for?

A

At least 30 minutes, up to 60 -90 minutes. Survival with good neurological outcome has been reported in excess of 60 minutes CPR.

44
Q

When would you consider using a fibrinolytic agent in an arrest?

A

Coronary thrombosis

Pulmonary embolism

45
Q

When would you consider transfer with ongoing CPR in a patient with suspected coronary thrombosis? What factors a favour a good outcome. Name 3.

A

Witnessed cardiac arrest
Bystander CPR
Intermittent ROSC
Initial shockable rhythm

46
Q

Name 3 conditions that increase the risk of tension pneumothorax. Consider the categories trauma, iatrogenic, diseaeses

A

Trauma:

  • thoracic trauma (penetrating or blunt)
  • pulmonary barotrauma

Iatrogenic -recent thoracic procedures:

  • insertion temporary pacing wire
  • existing chest drain (misplaced or blocked)
  • premanent pacemakrer/ICD insertion
  • transthoracic needle aspiration or biopsy
  • subclavian or jugualar vein catherterisation
  • thoracocentesis
  • closed pleural biopsy

Diseases

  • asthma
  • COPD
47
Q

In an awake patient with tension pneumothorax the signs and symptoms are more obvious ( chest pain, trachynpoea/air hunger, terminal decreasing RR, hypoxia, tachycardia, hypotension, altered GCS).
In an intubated patient, what would point to the diagnosis of tension pneumothorax?

A 
Progression may be rapid
High ventilation pressure
Hypoxia
Hypotension
Tachycardia

Abnormal chest rise and fall on affected side
Decreased breath sounds on affected side
Hyper-expanded chest, increased percussion note
Tracheal deviation away from affected side (late sign)

48
Q

What investigations will help to investigate for tension pneumthorax (stable patient)

A

CXR

USS

49
Q

What are the complications/causes of failure of emergency needle thoracocentesis for a pneumothorax?

A

Obstruction by:

  • blood
  • tissue
  • cannula kinking/compressed

Missing a localised tension pneumothorax (needle too short)
Inability to drain large air leak
Moving, dislodging, falling out
Requirement for repeated needle decompression

50
Q

What location and what needle would you use emergency needle thoracocentesis for a tension pneumothorax?

A

14 g LONG needle

2nd intercostal space mid-clavicular line

51
Q

Name 3 situations when cardiac tamponade may be a likely differential

A 
Thoracic trauma (blunt/penetrating)
Recent thoracic/cardiac surgery
Insertion of central lines
Temporary pacing wire
Recent angiography/PCI
Recent myocardial infarction
Recent permannet pacemaker/defibrilator insertion
Thoracic neoplasm or mediastinal radiation therapy
Known pericardial effusion
Renal failure (uraemia)
Pericarditis
Infectious disease e.g tuberculosis
52
Q

What is Beck’s triad for cardiac tamponade?

A

Elevated JVP
Muffled heart sounds
Hypotensoin (with narrow pulse pressure)
May only be breifly present before cardiac arrest

53
Q

What are the signs and symptoms of cardiac tamponade?

A 
Tachypnoea
Dyspnoea
Pulsus paradoxus
Low voltage QRS or electrical alternans
Kussmauls  sign (rise of JVP with inspiration)
54
Q

A patient has had cardiothoraic surgery and arrested. You are wanting to do re-sternotomy. Should you withold CPR while preparing for this?

A

No

55
Q

In patient with cardiothoracic surgery, when should re-sternotomy be considered?

A

Cariac arrest
In appropriately staff ICU
Poor outcomes outside of this setting

56
Q

A patient has cardiac tamponade and are hypotensive. Should you give fluid while preparing for pericardiocentesis?

A

Yes

57
Q

You need to do a pericariocentesis for cardiac tamponade but do not has access to an USS. What other monitoring can help you?

A

Telemetry

Watch for arrhythmias indicating needle is contacting myocardium

58
Q

What the most common complications of pericardiocentesis?

A 
Cardiac dysrhythmia
Cardiac puncture
Pneumothorax
Coronary vessel injury
Diaphragmatic injury
Death
59
Q 
Name the antidotes to the following drugs
Digoxin
Opioids
Benzodiazapines
Cyanide
Tricyclic antidepressant 
Amphetamines
A

Digoxin specific antibody (digibind) 38mg (one vial) over 30 minutes
Naloxone 100mcg to 2mg
Flumazenil 100 -200mcg
Hydroxycobalmin 5mg up to 15mg
Sodium bicarbonate 50 - 150 mmol
Benzodiazapines, dantrolene 2.5mg/kg if malignant hyperthermia

60
Q

How can amphetamines cause a cardiac arrest?

A

Induce myocardial ischaemia/necrosis due to coronary artery spasm
Directly induced myocardial necrosis
Massive efflux of K+ due to necrosis inducing arrhythmia

61
Q

Where should your probe be and when should you look for a pericarial effusion during CPR?

A

Subxiphoid

Just prior to rhythm check (brief pause in chest compressions)

62
Q

When would you consider prolonged CPR?

A

Patient remains in VT/VF

Identified/treating reversible cause

63
Q

A patient has been a asystole for more than 20 minutes with no reversible casue found. Should you continue CRP?

A

Probably not

64
Q

How long should you wait to confirm death after CPR has ceased?

A

5 minutes

Advanced Life Support 2 (ALS2) (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions