Advanced Life Support

Front 1

Targeted temperature management

ROSC temperature

ILCOR recommendation

Back 1

36'

Front 2

paediatric arrest, lone provider

Back 2

1m CPR

then get help

Front 3

CPR with trismus

Back 3

use NPA

if no NPA mouth:nose respiration

Front 4

adult arrest, lone provider

Back 4

place in recovery position

get help

start CPR

Front 5

ETT size in newborn ID

Back 5

3-3.5mm

Front 6

paed ALS shock strength j/kg

Back 6

4j/kg

Front 7

why should you avoid asynchronous breaths without a cuffed tube below the vocal cords?

Back 7

raises intrathoracic pressure -> decreases coronary artery perfusion

increases aspiration risk

Front 8

length of tube to tip of incisors formula...

Back 8

tube size - ID; internal diameter x 3

Front 9

commonest rhythm in primary arrest

Back 9

pulseless electrical activity

Front 10

TBI MAP And CO2 targets

supine

30' head up BP

CO2 stable

CO2 herniating

Back 10

supine >60mmHg

30' head up >90mmHg

TBI/ICH pCO2 35-40mmHg

cerebral herniation 30-35mmHg

Front 11

paediatric arrest adrenaline dose

Back 11

10microg/kg

Front 12

percentage of patients that show a clinical deterioration prior to cardiac arrest

Back 12

80%

Front 13

ventilation rate during arrest

Back 13

6-10 breaths/minute

Front 14

expired air ventilation FiO2

Back 14

15-18%

Front 15

percentage survival rate in paediatric hypoxic progression to slow idioventricular rhythm and asystole

Back 15

5%

Front 16

amiodarone dose in paediatric arrest

Back 16

5mg/kg

Front 17

what percentage of pre-arrest CO is generated by good quality CPR

Back 17

20-30%

Front 18

4 H

Back 18

hypoxia

hypovolaemia

hypothermia

hypo/hyper K/Glu/Ca

Front 19

4T

Back 19

thrombus

tension

toxins

tamponade

Front 20

maximum acceptable time for compression interruption during CPR for ETI

Back 20

20 seconds

Front 21

how long should you look, listen, feel for during initial assessment

Back 21

10 seconds

Front 22

how much does the chance of successful defibrillation drop by each minute from time of arrest

Back 22

80% initial chance

10% minute by minute

Front 23

hyperventilation in cardiac arrest

Back 23

increases intrathoracic pressure

decreases coronary artery pressure

Front 24

what diastolic pressure is needed for coronary artery perfusion

Back 24

30-40mmHg

Front 25

what is the ultimate aim of CPR

Back 25

to preserve brain function

Front 26

calcium in arrests

Back 26

use calcium chloride

10ml of 10% CaCl = 1g

3x greater concentration of Ca2+ ions to gluconate

Front 27

amiodarone in arrests

Back 27

300mg after 3rd shock in shockable rhythms

class III antiarrythmic

further 150mg may be given in refractory arrests

(after 5th shock)

Front 28

indications for atropine in ALS

Back 28

anticholinergic - blocks vagal stimulation to heart

bradyarrythmias

500microg aliquots max dose 3mg

Front 29

indications for calcium in cardiac arrest

Back 29

hypocalcaemia

hyperkalaemia

arrest due to Ca channel blocker OD

Front 30

cardiac arrest fluids

Back 30

use hartmanns

saline if not available; caution hyperchloraemic acidosis and large sodium load

Front 31

lignocaine in ALS

Back 31

local anaesthetic

sodium channel blocker

class 2b antiarrythmic

1mg/kg

Front 32

lignocaine indications in ALS

Back 32

used as antiarrythmic when amiodarone cannot be used

Front 33

magnesium in arrest

Back 33

MgSO4

20mmol in 10ml vial

standard dose for ALS e.g. TdP = 8mmol/2g

Front 34

indications for MgSO4 in arrest

Back 34

hypomagnasaemia

hypokalaemia

torsades de pointes (8mmol)

digoxin toxicity

sotalol toxicity

refractory VF/VT

Front 35

potassium on arrest trolley

Back 35

10mmol in 0.29% saline

Front 36

sodium bicarbonate on arrest trolley

Back 36

sodium bicarbonate 8.4% in 50ml

1mmol/ml

adult dose -> 1-2 vials (50-100mmol)

Front 37

indications for sodium bicarbonate in ALS (3)

Back 37

hyperkalaemia

TCA overdose

severe pre-existing metabolic acidosis

Front 38

goals of care of ALS (3)

Back 38

RHYTHM CONTROL

OXYGENATION OF HEART AND BRAIN

REVERSING CONTRIBUTING CAUSES

Front 39

what is the next most appropriate course of action after delivering a shock

Back 39

continue CPR for a further 2 minutes and assess pulse with rhythm at the next check

Front 40

indications for pacing

Back 40

only in a patient with a pulse

bradyarrythmia where an increase in rate may improve cardiac output

Front 41

electrical pacing sequence

Back 41

attach pads including monitoring pads

press pacer button

set rate to 60

dial up current start at 40mA

look for electrical capture

check pulse to look for mechanical capture

set at 10% above threshold

Front 42

naloxone arrest dose

Back 42

400microg IV push

Front 43

alteplase dose for suspected arrest due to PE

Back 43

alteplase 50mg bolus

continue CPR for minimum 20 minutes

Front 44

ALS modification in hypothermia (4)

Back 44

no drugs until temp >30

three shocks then no more until temp >30

double interval between drug doses between 30-35'

continue resuscitation until temp >30'

Front 45

assessing a patient with VADs in collapse

Back 45

there is a continuous connection from LV to Ao

if screen shows flow >2L/m circulation is present

seek and treat other causes of collapse

Front 46

stepwise management for VAD patient collapse

Back 46

Check response, send for help, ABC

-check the VAD

-ensure driveline connected to controller

-look at screen for alarms

-press scroll button to check alarm information

continue normal A-E assessment

Front 47

why shouldn't you do CPR in VAD patient

Back 47

valveless connection from LV to Ao

CPR will cause retrograde flow back to LV

risk of trauma due to pump location and outflow graft to Aorta - catastrophic bleeding

Front 48

how long to check pulse for in hypothermia

Back 48

60s as may be markedly bradycardic