Everything ALS

Question 1

What are the H’s and T’s

Answer 1

Hypovolemia
Hypoxia
Hydrogen Ion Excess (Acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
Tension Pneumo
Tamponade - Cardiac
Toxins
Thrombosis (PE)
Thrombosis (MI)

Question 2

TX of Hypovolemic arrest? and potential indications

Answer 2

Early transport (if traumatic), fluid resuscitation, control bleeding (if required).

Indications: Trauma, Gi Bleed, Ruptured AAA

Question 3

TX and indications of Hypoxic Arrest?

Answer 3

2 person BVM -> early intubation, HFNC, Consider peep for a known CHF etiology or profuse blood up ET tube, inline suctioning, MDI ventolin (if indicatied), needle decompression (if indicated). Post Arrest Care: target spo2 of 94%, position at 45 degrees, consider 5cm of peep (unless copd)

Indications: Asthma, COPD, CHF, Anaphylaxis, Tension Pneumo

Question 4

Tx and indications of acidosis in cardiac arrest?

Answer 4

Sodium Bicarb, Calcium, Fluid bolus (500 mL), Vent strategy at 14-16/min. Post Arrest: Prioritize ventilation, consider detaching BVM from ETT if rapid underlying RR, Secure ETCO2 and O2.

Indications: DKA, Sepsis, Post-Workout

Question 5

Tx and indications of Hyperkalemia in cardiac arrest?

Answer 5

Calcium, Sodium Bicarb, Fluid Bolus (500mL) Post Arrest Care: Consider ventolin, consider tx consult, do not give atropine in bradycardia

Indications: AKI, pressure sores, crush injury, burns

Question 6

Tx and indications of Hypothermia in Cardiac Arrest?

Answer 6

Early Transport (EPOS consult?), Consider ECMO facility, 1mg epi MAX, 1 defib MAX, Ventilation strategy 8-10/min, longer pulse checks, no rewarming if less than 30 degrees. PRE/POST Care: Gentle handling, delay intubation to avoid stimulus, supine position, if above 30 degrees passive rewarming, if below prevent further heat loss.

Indications: Found on flood, cold weather, submersion.

Question 7

TX and indications of Tension Pneumo in Cardiac Arrest?

Answer 7

Needle decompression, gentle ventilation, avoid peep. PRE/POST Care: Watch BP, monitor for retensioning.

Indications: Trauma, COPD, Asthma, Marfan’s

Question 8

Tx and indications of Tamponade in Cardiac Arrest?

Answer 8

Early transport (if traumatic), fluid bolus (500mLs). Pre/Post Arrest: Upright position to optimize drainage.

Indications: Post cardiac surgery, Infectious (Pericarditis), IVDU, Trauma

Question 9

Tx and indications of toxins in Cardiac Arrest?

Answer 9

Appropriate antidote (note narcan no longer used intra arrest), Poison control for suggestions, consider early transport (consult). Pre/Post Arrest: Gather pills, consider Tango or CCT for cyanide antidote

Indications: Ingestion, Injection, Inhalation, decreased excretion (Kidney)

Question 10

TX and indications of PE (thrombosis) in Cardiac Arrest?

Answer 10

Recognize, early transport, fluid bolus 250 mLs,
Pre/ Post Arrest: Rapid transport, conservative fluid

Indications: Sudden death, IVDU, Pregnancy, Fxs, recent flights, bed rest, cancer.

Question 11

TX and indications of thrombosis (MI) in cardiac arrest

Answer 11

Standard ACLS

Pre/Post Arrest: Rapid transport, pads on pre-arrest patient, 12 lead 10 mins post ROSC

Indications: Sudden death, cardiac HX.

Question 12

What is narrow complex PEA a result of?

Answer 12

Tamponade, Pneumothorax, Mechanical Hyperinflation, PE, Acute MI. Narrow QRS indicates a mechanical or RV problem.

Question 13

What are the ETC02 targets in head injury?

Answer 13

Normal ranges of 35-40mmhg

Question 14

Indications for Valsalva Maneuvre?

Answer 14

Hemodynamically stable SVT

Question 15

Contraindications for Valsalva?

Answer 15

Hemodynamic instability (immediate cardioversion)
Hypotension
AF/AFL
Aortic Stenosis
Recent MI (last 3 months)
Glaucoma
Retinopathy
3rd Trimester Pregnancy

Question 16

How does the valsalva work?

Answer 16

Initially when the patient strains on the syringe there is an increase in intrathoracic pressure, when the strain is released the acute decrease in intrathoracic pressure leads to an increase in venous return causing a sudden increase in CO and BP, this increase may trigger a reflex bradycardia that will terminate the SVT (hopefully)

Question 17

What is the maximum allowable attempts of the valsalva maneuvre?

Answer 17

3

Question 18

What other differentials should you consider in a patient with pinpoint pupils and respiratory depression?

Answer 18

Pons bleed, other toxins.

Question 19

BP targets in TBI?

Answer 19

Map of great or equal to 80

Question 20

Sp02 targets in TBI?

Answer 20

94% or greater

Question 21

Hallmarks of venous drainage in TBI?

Answer 21

Head of the bed 30 degrees
promote venous drainage (collars, loose thomas tube holder or tube ties, no PEEP)
Maintain neck neutrality

Question 22

When creating ventilation strategies what is important to remember?

Answer 22

The ventilation of the patient prior to intervention, the etiology of the presenting complaint and what they may require, not to hypo or hyperventilate a patient. Have targets in mind and explain them to the team.

Question 23

Why do we employ a nitrogen washout in pre intubation? “NODESAT”

Answer 23

Nitrogen washout of the lungs allows for an increase in the alveolar oxygen reservoir, allowing an extension of the safe apneic time of a patient during intubation.

Question 24

7 pieces needed for intubation?

Answer 24

Pillow, King Vision head, channeled blade, mucogel, syringe, thomas tube holder, tube.
Can interchange king vision and channeled blade, with laryngoscope and bougie.

Question 25

What does WHIPS stand for and when do you use it?

Answer 25

W- Worst you’ve ever had?
H- Hospitalizations
I- Intubation/Infection - Have you ever had a breathing tube down your throat? Any cough cold or flu?
P- Puffers? Did you use them? Did they help? Have you needed to use them alot recently?
S- Steroids - do I see any in the house or do they use them?

Use them in a respiratory assessment. Specifically for asthma or COPD.

Question 26

Why is it critical to identify AF with WPW in a patient in regards to adenosine?

Answer 26

Most AP impulses have a shorter refractory period than the AV node due to this ventricular rate can be more rapid if conduction is preferential to the AP when an AV nodal blocker is used. Also when there is conduction via AV and AP these impulses connect and fuse in the ventricles. Conduction through the AV node is a brake on AP conduction causing it to terminate in ventricles. If Adenosine was used this would take out the brake and the impulse could wreak havoc through the ventricles and possibly go into VF or VT.

Question 27

What must be investigated in patients that present with tachycardia and hypotension?

Answer 27

All shock states IE
Obstructive
Distributive
Cardiogenic