ILS Training Flashcards
How can the reversible causes of cardiac arrest be remembered?
5Hs
5Ts
What are the 5Hs?
reversible causes of cardiac arrest
Hypovolaemia
Hypoxia
Hypokalemia
Hypothermia
Hydrogen ion excess
What are the 5Ts?
reversible causes of cardiac arrest
Toxins
Tension pneumothorax
Tamponade
Thrombosis - pulmonary thrombosis
Thrombosis - coronary thrombosis
What are signs of hypovolaemia?
- tachycardia - racing HR
- narrow QRS on an ECG
- blood loss
How is hypovolameia managed?
- get IV access or IO access
- give fluids and/or blood
- fluid challenge
- high flow oxygen (if sats are low) - 15L high flow oxygen through non-rebreathe max then titrate down
What are signs of hypoxia?
- bradycardia
- cyanosis - can be peripheral or central.
How is hypoxia managed?
- check airway is patent
- ventilation
- oxygen supply - check it is adequate.
What are signs of hypokalaemia and hyperkalaemia on an ECG?
- hypo = flattened T waves and U waves, long PR and long QT
- hyper = tall tented T waves and widened QRS
How is hyperkalaemia managed?
Hyper
* ventilation
* sodium bicarbonate
Hypo
* saline with pot chloride (40mmol)
* ventilate
* continuous ECG
What are signs of hypothermia?
shivering, and Hx of exposure to cold temp
How is hypothermia managed?
active warming
what are signs of hydrogen in excess i.e. acidosis?
low amplitude QRS
How is hydrogen ion excess managed?
ABG
Ventilate
sodium bicarb
What are signs of tamponade?
How is it maanged?
Signs:
* tachycardia
* narrow QRS
* raised JVP
* no pulse
* muffled heart sounds
Managed:
* pericardiocentesis
* thoracotmoy
What are signs of toxin/overdose?
How is it managed?
signs = long QT, pinpoint pupils, resp depression
Management - based on drug, need supportive care. See table from Sas
What are signs of tension pneumothorax?
How do we manage tension pneumothorax?
Signs:
* slow HR/brady,
* narrow QRS,
* unequal rise and fall of chest,
* raised JVP,
* tracheal deviation
Managed:
* needle decompression
* insert chest tube
What are signs of pulm thrombosis?
How is it managed?
Signs:
* tachycardia
* narrow QRS
* SOB
* low O2 sats
* pleuritic chest pain
Managed:
* emblectomy
* anticoag therapy
* fibrinolytic therapy
What are signs of coronary thrombosis?
How is it managed?
signs = abnrmal ECG, cardiac chest pain
management = MONA, angioplasty, stent, coronoary bypass
What are non-shockable rhythms?
aystole and PEA
How is a non-shockable cardiac arrest managed?
taken from Sas
- Continue CPR and recheck rhythm every 2 mins
- Establish IV or IO
- Administer 1mg 1:10,000 adrenaline IV
- Repeat every 3-5 mins whilst patient remains in cardiac arrest
- Consider reversible causes e.g. 5Hs and 5Ts
what do 1, 2 and 3 show?
1 = asystole
2 and 3 = PEA
How is asystole managed?
taken from sas
- Recognise as asystole
- Continue CPR and re assess rhythm every 2 minutes
- Establish IV or IO access
- immediately administer 1mg:10,000 adrenaline IV
- Repeat every 3-5 minutes whilst patient remains in cardiac arrest
- Consider reversible causes of cardiac arrest e.g. hypovolaemia give fluids
What is PEA?
pulsless elec activity - they have a rhythm on ECG but no pulse when you check
How is PEA managed?
taken from Sas
- Recognise as PEA
- Continue CPR and chassess rhythm every 2 minutes
- Establish IV or IO access
- Immediately administer 1mg:10,000 adrenaline IV
- Repeat every 3-5 minutes whilst patient remains in cardiac arrest
- Consider reversible causes of cardiac arrest e.g. hypovolaemia give fluids
What rhythms in ILS are shockable?
VT (pulseless VT)
VF
How to carry out managmenet for shockable rhythm?
- once you know it is shockable = 1st shock 200J
- go back to CPR straight after
- reassess rhythm every 2 mins
- 2nd shock 300J
- 2 mins CPR
- 3rd shock 360J –> after this shock = give 1mg 1:10,000 adrenaline and 300mg amiodarone with flush
- all shocks from this point = 360J
Note: IV adrenaline can be given every 3-5 mins
Amiodarone is only given ONCE
What is this?
VF
Note:
can be coarse (deep valleys and taller peaks) or fine (waves are short and shallow)
you cant see any identifiable P, QRS or T
How is VF managed?
Needs shock - as it is NOT compatible with life
1. shock 200J
2. CPR
3. reassess 2 mins
4. if still in VF = shock 300J
5. CRP and assess 2 mins
6. if still in VF = shock 360J
7. give 1mg 1:10,000 adrenlaine and 300mg IV amiodarone, followed by flush of saline.
8. can give adrenaline every 3-5mins
9. continue cpr and shocks 360J
What is this?
what do you need to check with this rhythm?
- pulseless V tachycardia
- need to check pt does NOT have pulse to confirm it as PULSELESS VT = so can shock
How do you manage pulseless VT?
Needs shock
1. shock 200J
2. CPR
3. reassess 2 mins
4. if still in VF = shock 300J
5. CRP and assess 2 mins
6. if still in VF = shock 360J
7. give 1mg 1:10,000 adrenlaine and 300mg IV amiodarone, followed by flush of saline.
8. can give adrenaline every 3-5mins
9. continue cpr and shocks 360J
