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*Medicine: Anaesthesia and ITU > Life Support > Flashcards

Life Support Flashcards

1
Q

For adult basic life support, how do you assess the unconscious patient?

A

DRS ABCD

  • Danger → check around pt + environment
  • Response → question, shake + command
  • Shout → ‘help, help help’
  • Airway → head-tilt/chin-lift or jaw thrust, look/remove obstructions
  • Breathing → assess for up to 10s by listening + feeling w/ ear, while watching chest movements and palpating carotid
  • CPR + Call ambulance → if not breathing, start CPR; ask helper to call 999, if no helpers then you must call 999
  • Defibrilator → find AED, attach pads to pt’s bare chest, continue CPR while attaching electrodes, follow prompts
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2
Q

What is involved in CPR for BLS?

A
  • 30:2 chest compressions to resuce breaths
  • 30 chest compressions → perform at 100-120/min, depth 5-6cm
  • 2 rescue breaths
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3
Q

Adult Advanced Life Support (ALS) follows the same DRS ABCD assessment as BLS. What is the algorithm for ALS?

A
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4
Q

How are chest compressions given in ALS?

A
  • 30:2 chest compressions to ventilations (until airway secure)
  • Perform at rate 100-120/min (ie 2/s)
  • Depth of 5-6cm
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5
Q

When should chest compressions be stopped?

A
  • 5 second rhythm checks
  • Electrical shocks
  • When giving 2 rescue breaths (before airway is secure)
  • Ask person doing compressions to tell airway person each time 30 are complete
  • Switch CPR provider during rhythm check every 2 mins (or earlier if they tire)
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6
Q

When should chest compressions be continuous?

A

Once the airway is secured with either a supraglottic airway or endotracheal tube

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7
Q

How do you set up defibrilation?

A
  • Work around person performing compressions
  • Place two pads: under right clavicle + over cardiac apex
  • Shave/dry chest
  • Leave jewellery on but move it out of way
  • If pacemaker → move pads >8cm away
  • Connect pads to defib and set monitoring trace to ‘pads’
  • Delegate someone to manage timing + say when 2 min cycles are up, remember cycle number
  • Cycle 1 starts when defib is connected
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8
Q

When should rhythm checks be performed?

A
  • Perform rhythm check +/- shock every 2 mins
  • When pads in place and defib on, ask for CPR to be stopped for 5s rhythm check
  • Determine if rhythm shockable vs non-shockable
  • If rhythm compatible w/ pulse during check, also feel for central pulse and stop compressions if present
  • Then immediately continue CPR
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9
Q

What are the shockable vs non-shockable rhythms?

A
  • Shockable → VF + pulseless VT
  • Non-shockable → PEA + asystole
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10
Q

What happens next if a shockable rhythm is identified?

A
  • Select correct energy level for device, if unsure then give highest energy level shock
  • Ask for O2 to be removed
  • Everyone (except compression person) to move away
  • Compressions continue until you alert them to move away
  • Charge defib and then move hand away from machine
  • Once charged, ask compressions to stop and shout “everybody stand clear”
  • Check area is clear (incl oxygen)
  • Deliver shock by pressing ‘shock’
  • Immediately restart CPR
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11
Q

What are management options for airway?

A
  • Face mask w/ bag (30:2) → consider also placing oropharyngeal / nasopharyngeal airway under mask if struggling
  • Supraglottic airway (laryngeal mask, i-gel) → once placed, ventilate every 6 seconds with continuous compressions, providing seal is good
  • Intubation w/ ET tube (gold standard) → once placed, ventilate every 6 seconds w/ continuous compressions
  • Attach 15L/min O2
  • Attach end-tidal CO2 monitoring (i-gel or ET)
  • Avoid hyperventilation
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12
Q

ALS: When is IV access needed?

A
  • Obtain IV access + drugs ready
  • After 2 IV attempts → intraosseous access via head of humerus / tibial tuberosity
  • Take bloods from cannula → VBG, FBC, U+Es, Mg, G+S
  • Give IV fluids
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13
Q

Which drugs are important to give during CPR?

A
  • Adrenaline 1mg IV (10ml of 1:10,000)
    • Shockable → give after 3rd shock (during CPR) + flush
    • Non-shockable → give as soon as IV established + flush
    • causes peripheral vasoconstriction + maximises cardiac blood flow
    • repeat during every other CPR cycle thereafter
  • Amiodarone 300mg IV
    • if shockable rhythm only
    • give once after 3 shocks have been administered (during CPR)
    • is given to stabilise myocardium in VF and T
    • usually single dose, but further 150mg bolus may be given
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14
Q

What are the reversible causes of cardiac arrest?

A
  • 4 Hs + 4 Ts
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15
Q

ABCDE is used for the critically ill patients.

What is involved in assessing‘A’?

A
  • If patient can talk → patent
  • Not patent if:
    • secretions
    • aspirated
    • snoring / GCS < 8
  • Look inside mouth - any obstructions?
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16
Q

How can you manage airway?

A
  • Consider → suction, airway opening manouvres (jaw thrust, head-tilt/chin-lift), oropharyngeal/nasopharyngeal airways, intubation if GCS < 8
  • Cricothyroidotomy required in upper airway obstruction where intubation not possible
  • Treat any evident causes (eg. anaphylaxis, foreign body)
17
Q

How do you assess‘B’?

A
  • Pulse oximetry
  • RR
  • Chest exam → cyanosis, tracheal deviation, chest inspection, accessory muscles, expansion, percussion, auscultation
  • Calves
  • Send for → ABG + CXR
18
Q

How do you manage breathing?

A
  • 15 L/min O2 via non-rebreathe mask
  • Take care in COPD unless in resp distress/critically unwell + need high flow O2, start at 24-28% ie 2-4L venturi, aim for sats 88-92%
  • Consider NIV or invasive ventilation if hypoxic or hypercapnic despite max therapy
  • If resp effort inadequate, must be supported → ventilate with mask
  • Treat evident causes (pneumothorax, astham/COPD exacerbation, opiate OD, PE)
19
Q

How do you assess‘C’ (circulation)?

A
  • Cap refill (central)
  • Pulse rate, rhythm + volume
  • Blood pressure (look at trend)
  • Temperature
  • Auscultate heart, check JVP + look for signs of fluid overload
  • Assess fluid balance + organ perfusion → catheter
  • Place wide-bore IV cannula + take bloods, VBG first if required
  • Apply 3-lead cardiac monitoring + ECG
20
Q

Circulation: How do you manage the hypotensive patient?

A
  • Lay supine and elevate legs
  • Fluid challenge = 500ml 0.9% saline/Hartmann’s solution STAT and monitor by HR, BP + urine output
  • Take care if significant heart failure history (use 250ml challenge)
21
Q

Circulation: How do you manage the patient in shock?

A
  • 2 large bore IV cannulas
  • Fluid challenge → 1L 0.9% saline/Hartmann’s solution STAT
  • Replace blood w/ blood (can give O neg or typing takes 15 mins)
  • If massive blood loss → call 2222/lab and activate massive blood loss protocol to get packed red cells + FFP +/- platelets
22
Q

What is further management of ‘C’ (circulation)?

A
  • Respond fully → give maintenance fluids
  • Responds but BP falls again → more fluids (adequate resuscitation depends on patient and degree of deficit but is usually 20-30ml/kg given quickly)
  • No response → pt is either fluid overloaded (don’t give any more fluids) or v depleted (give lots of fluids)

Treat underlying causes (eg. arrhythmia, sepsis, bleeding)

23
Q

Circulation: What does the patient need if they are hypotensive and overloaded?

A

Inotropes

24
Q

Circulation: What does the patient need if they are still hypotensive despite adequate fluid resuscitation (30ml/kg)?

A

Vasopressors

25
Q

How do you assess‘D’ (disability)?

A
  • Glucose
  • GCS / AVPU
  • Pupils reactivity and symmetry
  • Pain assessment
  • CT brain if intracerebral pathology
26
Q

How can you manage‘D’ (disability)?

A
  • Correct glucose
  • Give analgesia if pain (eg. morphine 10mg in 10ml slow IV injection titrated to pain)
  • Look for + treat causes of low GCS (eg. morphine/sedative use, focal neurology to suggest intracranial pathology, hypercapnia, post-ictal)
27
Q

What can be done in ‘E’ (everything else)?

A
  • Exposure → bleeds, rashes, injuries, drain/catheter putput, lines
  • Examine abdomen
  • Focussed exam of relevant systems
  • Manage any other abnormal findings as appropriate
28
Q

BOXES

ABCDE: Which investigations can be done to find causes of acute illness?

A
  • Bloods → ABG if low sats/GCS, venous bloods (G+S, FBC, U+Es, CRP, LFTs +/- amylase, clotting, troponin, VBG etc), capillary glucose, blood cultures (if pyrexial)
  • Orifice tests → urine dip, urine/sputum/faeces culture, urine b-hCG
  • X-rays/imaging → portable CXR, CT brain (if neurology or low GCS in absence of other causes)
  • ECG → +/- 3-lead cardiac monitoring
  • Special tests → depending on likely cause

*Medicine: Anaesthesia and ITU (8 decks)

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