6. Advanced life support algorithm

Question 1

What percentage of initial monitored cardiac arrest rhythms do VF/pVT account for?

Answer 1

20%

Question 2

How frequently does VF/pVT occur at some point in patients with initial recorded PEA/asystole?

Answer 2

25%

Question 3

What defibillation energy should be chose for first shock?

Answer 3

120-150J

Question 4

What is the adult ALS algorithm?

Answer 4

Question 5

Will all patients have palpable pulses immediately after ROSC?

Answer 5

No, and 25% of patients with ROSC take more than 2 minutes to have palpable pulse

Question 6

What drugs are used as standard in ALS algorithm?

Answer 6

• Adrenaline 1mg IV after 3rd shock and then after every other shock
• Amiodaron 300mg after total of 3 shocks and consider 150mg after 5 shocks
• Consider lidocaine 1mg/kg if amiodarone not available, but do not given once dose of amiodarone given

Question 7

What is the protocol for witnessed/monitored cardiac arrests?

Answer 7

1. 3 stacked shocks
2. Start ALS algorithm if no ROSC as if only first shock has been given
3. When giving adrenaline, treat the 3 shocks as the first shock
4. When giving amiodarone, give immediately after the 3 shocks

Question 8

At what rate should chest compressions and ventilation be delivered during CPR?

Answer 8

Chest compressions - 100-120/min
Ventilation - 10/min

Question 9

What is the normal value of end-tidal CO2?

Answer 9

4.8 kPa (4.3 - 5.5 kPa)

Question 10

In terms of end-tidal CO2 monitoring during CPR, what is considered a poor prognostic factor?

Answer 10

Failure to achieve end-tidal CO2 of >1.33 kPa after 20 mins of CPR

Question 11

What are the common reversible causes of cardiac arrest?

Answer 11

4 Ts
1. Hypovolaemia
2. Hypoxia
3. Hyperkalaemia (and other metabolic disorders)
4. Hypothermia

4 Hs
1. Thrombosis (coronary or pulmonary)
2. Tension pneumothorax
3. Tamponade (cardiac)
4. Toxins

Question 12

How is death diagnosed after stopping CPR?

Answer 12

1. Observe patients for minimum of 5 minutes
2. Absence of mechanical cardiac function (absence of central pulse, absence of heart sounds) along with:
   * asystole on continuous ECG display
   * absence of pulsatile flow on intra-arterial pressure monitoring
   * absence of contractile activity on echocardiogram