Intermediate life support Flashcards
reversible causes of cardiac arrest can be remembered by
5Hs and 5Ts
5 Hs
Hypovolaemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypokalemia
Hypothermia
5Ts
Tamponade
Toxins
Tension pneumothorax
Thromosis (pulmonary)
Thrombosis (coronary)
signs and treatment of: Hypovolaemia
Signs
- rapid heart rate
- narrow QRS
- blood loss
Management
- obtain IO/IV access
- administer fluids/blood
- use fluid challenge
- high flow oxygen if required
signs and treatment of: hypoxia
Signs
- slow heart rate
- cyanosis
Treatment
- ensure airway is open
- ventilate
- ensure oxygen supply is adequate
signs and treatment of: Hydrogen ion excess (acidosis)
Signs
- low amplitude QRS
Management
- ABG
- provide adequate ventilations
- sodium bicarbonate
signs and treatment of: hypo/hyperkalamaeia
Signs
- Hypokalemia - flattened T waves and U wave
- Hyperkalemia- peaked T waves and widened QRS
Management
- Ventilate (resp)
- Sodium bicard (metabolic)
signs and treatment of: Hypothermia
Signs
- shivering
- previous exposure to cold temp
Management
- active warming measures
signs and treatment of: Tamponade
Signs
- rapid heart rate
- narrow QRS
- jugular vein distension
- no pulse
- muffled heart sounds
Management
- pericardiocentesis
- thoracotomy
signs and treatment of: toxins
Signs
- prolonged QT interval
Management
- based on overdose agent
- supportive care
signs and treatment of: tension pneumothorax
Signs
- slow heart rate
- narrow QRS
- unequal breathing
- JVD
- tracheal deviation
Management
- Needle decompression
- Insertion of a chest tube
signs and treatment of: Thrombosis (pulmonary)
Signs
- rapid heart rate
- narrow QRS
- shortness of breath
- decreased oxygen
- chest pain (pleuritic)
Management
- embolectomy
- fibrinolytic therapy
- anticoagulant therapy
signs and treatment of: thrombosis (coronary)
Signs
- abnormal ECG
- cardiac sounding chest pain
Management
- MONA
- angioplasty
- stent placmeent
- coornary bypass surgery
how can rhythms be classified in ILS
Shockable vs non-shockable
non- shockable rhythmas
- Asystole
- Pulseless electrical activity
briefly summarise managemet of non-shockable cardiac arrest
- 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
describe this rhythm strip
Asystole
outline ILS management of Asystole
1) Recognise as asystole
2) Continue CPR and chassess rhythm every 2 minutes
3) Establish IV or IO access
4) Immediately administer 1mg:10,000 adrenaline IV
5) Repeat every 3-5 minutes whilst patient remains in cardiac arrest
6) Consider reversible causes of cardiac arrest e.g. hypovolaemia give fluids
describe this rhythm
Pulseless electrical activity (PEA)
what is PEA
patient does not have a pulse, however they do have rhythm normally associated with cardiac output
(can resemble many recognizable rhythms)
outline ILS management of PEA
1) Recognise as PEA
2) Continue CPR and chassess rhythm every 2 minutes
3) Establish IV or IO access
4) Immediately administer 1mg:10,000 adrenaline IV
5) Repeat every 3-5 minutes whilst patient remains in cardiac arrest
6) Consider reversible causes of cardiac arrest e.g. hypovolaemia give fluids
shockable cardiac rhythms
- Ventricular fibrillation
- Pulseless ventricular tachycardia
brief summary of management of shockable rhythms
- When shockable rhythm established immediately give 1st shock at 200 joules
- Continue CPR immediately after
- Reassess the rhythm every 2 mins
- Deliver 2nd shock at 300 joules
- After 2 further minutes of CPR give 3rd shock at 360 joules
- Give all subsequent shocks at 360 joules
- After 3rd shock administer 1mg 1:10,000 adrenaline and 300mg amiodarone with big flushes
o IV adrenaline can be given every 3-5 mins
o Amiodarone only given once
describe this rhythm
ventricular fibrillation
recongising VF
VF can be caorse or fine. Electrical activity observed as “chaotic” with random frequency and amplitude and with no recognisable QRS complexes
ILS management of Ventricular fibrillation
1) VF is not compatible with life sop requires immediate initial 1st shock at 200 joules
2) Carry on CPR in between shocks
3) Reassess the rhythm every 2 minutes. If patient remains in VF deliver a 2nd shcok at 300 joules
4) After a further 2 minutes of CPR and if patient remains in VF deliver 3rd shock at 360
5) All subsequent shcoks delivered at 360 joules
6) Immediately after 3rd shock give 1mg:10,000 adrenaline IV and 300mg amiodarone IV- both followed by a large flush
describe this rhythm
pulseless ventricular tachycardia
pulseless ventricular tachycardia
ventricular tachycardia is recogised by regular broad comples QRS generally greater than 180 bpm
- can be compatible with life
- in cardiac arrest siutatio it is essential to check that the patien tdoes not have a pulse to confirm the rhythm is a pulseless ventiruclar tachycardia
ILS management of pulseless ventricular tachycardia
1) VT is not compatible with life sop requires immediate initial 1st shock at 200 joules
2) Carry on CPR in between shocks
3) Reassess the rhythm every 2 minutes. If patient remains in VF deliver a 2nd shock at 300 joules
4) After a further 2 minutes of CPR and if patient remains in VF deliver 3rd shock at 360
5) All subsequent shcoks delivered at 360 joules
6) Immediately after 3rd shock give 1mg:10,000 adrenaline IV and 300mg amiodarone IV- both followed by a large flush
order of shock strength
200j
300j
360j ,360j, 360j……..
giving amiodarone and adrenaline in caridac arrest
For shockable rhythms
- 300mg IV Amiodarone (only give once during cardiac arrest)
- 1mg:10,000 IV Adrenaline (given every 3-5 minutes after initial dose for the duration of the cardiac arrest)
DKA
- Rapid A to E
- IV access, bloods
- ECG
- IV fluid resus: IV 0.9 NaCL
- Fixed rate insulin infusion (FRII) at 0.1 units/k/h
- Potassium replacement if needed
Myocardial infarction
- Bloods
- IV access
- Morphine
- Oxygen
- Nitrates
- Aspirin
Pneumothorax
- > 2cm -> aspirate via needle decompression
- If no reduction insert chest drain
Anaphylaxis
- A to E
- Remove triggers e.g. stop any infusion
- Lie patient flat
o If pregnant- left lateral position - IM adrenaline in anterolateral aspect 1:1000 500 mg
- Give high flow oxygen
o Monitor: pulse oximetry, ECG, BP - If no response repeat adrenaline after 5 mins
- IV fluid bolus (500ml over 15 mins)
- If no improvement in breathing or circulation despite 2 doses of adrenaline -> commence CPR
Choking
- Encourage person top cough
- If cough becomes ineffective give 5 back blows
o Lean person forward
o Between shoulder blades with heel of hand - If back blows ineffective give 5 abdominal thrusts
- If chocking not relieved after 5 abdominal thrusts, continue alternating between 5 BB and % AR until relived
- If person becomes unresponsive start CPR
Seizure
- Support airway and breathing
- Gain IV/IO access
- Give benzodiazepine (buccal, IV or IO)
- If 2 staggered benzos failure give either:
o Phenytoin or levetiracetam - If the above fails -> thiopentol for rapid induction
major haemorrhage protocol
How to activate Major Haemorrhage Protocol
Phone 2222 and say “Major Haemorrhage, Children’s Hospital” stating location of patient (i.e. ward / department).
Blood Bank will call the ward
Porter will go to the Blood Bank.
General response
- Control bleeding
- Venous access
- Avoid hypothermia - warm fluids
- Take appropriate blood tests and send urgently to appropriate Laboratory
Immediate blood tests
- FBC
- Crossmatch
- Coagulation screen (including Fibrinogen)
- Biochemistry (including Calcium
- Blood gases (if appropriate).
Information required by Blood Bank
- Urgency of the situation
- Patient details:
- Conscious patient – forename, surname; DOB; gender; CHI number.
- Unconscious/unidentified patient – minimum of gender and CHI number.
- Whether cross match has been sent
- Location of Patient
- Contact number – need to establish clear lines of communication
- Patient diagnosis
-Nominate one person to liaise with Blood Bank
Blood component availability
Factor in time for samples to reach Blood Bank and any blood product to be delivered from Blood Bank.
- Immediate – Group O Negative blood
(4 units available in Paediatric theatres fridge) - 15 minutes – group specific blood (ABO + RhD grouping)
- 35 minutes – fully cross-matched blood.
- Platelets – Platelets supplies are limited so these may be delayed.
- Fresh Frozen Plasma (FFP) and Cryoprecipitate – allow up to 20 minutes for thawing (plus delivery time)
