ERC - ALS Flashcards
What is a MET or RRT
medical emergency or rapid response team that responds to critically unwell patients in an attempt to reduce arrest cases
Syncope due to an arrhythmia is likely to present how
No prodrome
Can occur whilst supine or on exertion
What are the universal termination of resuscitation rules
Efforts to be terminated if no ROSC, no shocks administered, non EMS witnessed
You are in hospital and have a patient that is not breathing but you can feel a pulse, what do you do
Ventilate and check the circulation every 10 breaths to be sure there is still a pulse
Describe agonal breathing
Slow and laboured often with snoring and occasional gasps
Describe inspiratory time, volume and rate of ventilations given when performing in hospital CPR
1s per inspiration
Enough volume for normal chest rise (600-700ml)
10 breaths per minute
Once started, how much and how often is adrenaline given in an arrest
1mg (10ml 1:10,000) every 3-5 minutes (2 cycles)
When is adrenaline in cardiac arrest stopped
As soon as ROSC is suspected
Compare when adrenaline is started in VF/pVT and PEA/asystole
After the third shock for shockable
ASAP for non shockable
For what arrest rhythms is amiodarone given, at what dose and when
VF/pVT
300mg IV after 3rd shock
150mg IV after 5th shock
What is an acceptable alternative to amiodarone given to shockable rhythms in ALS
Lidocaine
What initial energy is used to shock someone in VF/pVT
At least 150J if used biphasic
120-150J is used pulsed biphasic
You don’t know which energy to use and there is no guidance on the defibrillator, what do you do
Use the highest energy possible
To escalate or not to escalate? (Defibrillation energy)
Escalate for failed shocks and refibrillation
You have shocked a patient, do you now pulse check? Why?
NO
Compressions won’t do any harm ie they won’t cause VF again
A pulse is unlikely to be palpable so soon after
Not starting compressions could further damage the myocardium
How soon after a peripheral injection does adrenaline exert it’s maximum benefit on coronary perfusion pressure
70 seconds
What is the role of compressions when there is a shockable rhythm
They increase oxygen delivery to the myocardium
Increase the amplitude and frequency of VF waveform
Increase chance of a shock working
What signs would indicate ROSC
Purposeful movements
Normal breathing and coughing
Raised ETCO2
You witness a patient go into VF/pVT on the monitor, in terms of CPR and shocks what do you do
3 shock strategy - give 3 successive shocks with a very quick rhythm check between each
Commence CPR after 3rd shock
A patient has had a 3 shock strategy and there is no ROSC, at what point do you give adrenaline
You treat the 3 shocks as the first. So give adrenaline after a further 2 shocks
A patient has had a 3 shock strategy and there is no ROSC, at what point do you give amiodarone
Give amiodarone after the 3rd shock regardless of whether or not they are stacked
You witness a patient go into VF/pVT on the monitor but there is no defib, what do you do?
Precordial thump
How would you perform a precordial thump
Take the ulnar edge of a clenched fist to the lower half of the sternum from a height of 2cm and retract first immediately
What is the relationship of CPR interruptions and coronary perfusion pressure
Less interruptions = high coronary perfusion pressure