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Advanced Life Support Flashcards

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1
Q

What is the Chain of Survival?

A
  1. Early Recognition
    - to prevent Cardiac Arrest
  2. Early CPR
    - to buy time
  3. Early Defibrillation
    - to restart the heart
  4. Post Resus Care
    - to restore quality of life
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2
Q

Infant

A

Under 1 year

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3
Q

Child

A

1-8 year old

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4
Q

Adult

A

9+ year old

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5
Q

BLS

A

CPR and use of AED

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6
Q

CPR

A

Chest compressions combined with rescue breathing

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7
Q

ALS

A

BLS with more advanced techniques.

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8
Q

Symptoms of Cardiac Arrest

A

Chest pain
SOB
Nausea and Vomitting
Dizziness

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9
Q

DRSABCD

A 
Danger
Responsive
Send for help
Open airway
Normal breathing
CPR
Defib
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10
Q

List 4 of Adult Compressions

A
  1. 30:2
  2. 100-120bpm
  3. 1/3 of front-back dimension = 5+cm
  4. Mid lower half of sternum at nipple line
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11
Q

2 results of chest compressions

A
  1. Produce CO2 by generalised ^intrathoracic pressure and direct pressure on the heart.
  2. Release of compressions allows blood flow back to heart
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12
Q
  1. Early Recognition and Call for Help
A
  1. Signs of collapse and impending cardiac arrest

2. 111 in response to chest pain, SOB or sudden collapse

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13
Q
  1. Early CPR
A
  1. ^2-3 times survival rate when CPR began by bystanders

2. Risk of NOT doing CPR on someone who NEEDS it, outweighs the the risk of doing CPR on someone who does NOT.

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14
Q
  1. Early Defib
A
  1. Common cause of CA is VF

2. AED and BLS ^survival

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15
Q

Interval between CA and Defib in Metropolitian Areas?

A

4mins or less

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16
Q

Interval between CA and Defib in Hospital?

A

3mins or less

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17
Q
  1. Post Resus Care
A

After ROSC

  1. Re-evaluate ABCDE
  2. ECG
  3. Treat precipitating causes
  4. Re-evaluate O2 and ventilation
  5. Targeted temperature management
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18
Q

List 3 of Child Compressions

A
  1. 2:15
  2. 100-120bpm
  3. Approx 5cm depth
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19
Q

How much does survival decrease every minute Defib is delayed?

A

10%

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20
Q

Where are Pads positioned for Adults?

A

Anterior-Lateral

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21
Q

If the person has a PPM or ICD, how far away do the Defib Pads need to be positioned?

A

8cm away from device

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22
Q

Where are Pads positioned for Paediatrics?

A

Paediatric Pads = Anterior-Lateral

Adult Pads = Anterior - Posterior

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23
Q

SEVERE CHOKING + Responsive

A

Ineffective Cough

  1. Send for help
  2. 5 BACK BLOWS
  3. 5 CHEST THRUSTS
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24
Q

SEVERE CHOKING + unresponsive

A

Ineffective Cough

  1. Send for help
  2. CPR
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25
MILD CHOKING
Effective Cough 1. Encourage coughing 2. Continue to check 3. Send for help
26
What is Anaphylaxis?
Serious allergic reaction that is rapid in onset and may cause death.
27
Anaphylaxis with UNKNOWN allergen.
ACUTE onset and SKIN/MUCOSAL of at least one: 1. RESP compromise 2. LOW BP
28
Anaphylaxis with LIKELY allergen.
2 or more in mins or hours 1. SKIN/MUCOSAL 2. RESP 3. LOW BP 4. GI symptoms
29
Anaphylaxis with KNOWN allergen
1. LOW BP
30
What % of anaphylaxis has SKIN involvement?
90%
31
List 4 common allergens for anaphylaxis
1. STINGS 2. FOOD - shellfish, nuts, dairy 3. MEDICATIONS - abx, NSAIDS 4. OTHER - latex, chlorhex, contrast
32
Initial Treatment for signs and symptoms of anaphylaxis
1. Remove trigger 2. Send for help 3. Assess ABCD 4. Lie flat
33
List 3 complications of Anaphylaxis
1. SHOCK 2. UPPER AIRWAY OBS 3. LOWER AIRWAY OBS
34
Difference between Upper Airway OBS and Lower Airway OBS (ADULTS)
UPPER AIRWAY = stridor and tongue/laryngeal swelling. LOWER AIRWAY = wheeze
35
Difference between Upper Airway OBS and Lower Airway OBS (CHILD)
UPPER AIRWAY = Stridor + RESP distress LOWER AIRWAY = Wheeze + RESP distress
36
Treatment for Anaphylaxis (Adults)
0. 5mg IM Adrenaline (0. 5ml of 1,1000) Upper putter thigh Repeat in 5mins if no improvement
37
Following treatments for anaphylaxis (Adults)
2. IVF 0.9% NaCl 1000ml, Hiflo O2, monitoring
38
Following treatments if no resolution of anaphylaxis (Adult)
Consider x3 dose of IM Adrenaline | 0.5ml of 1:1000
39
Treatments for complications of anaphylaxis (Adults) 1. Shock 2. UAO 3. LAO
1. IVF or INOTROPES 2. Neb Adrenaline 3. Neb Salbutamol
40
Resolution of Anaphylaxis (Adult and child)
1. Observe ABC | 2. Antihistamine or Prednisone
41
Treatment for Anaphylaxis (Child)
10mcg/kg IM Adrenaline (0.01ml/kg of 1:1000) Repeat in 3-5mins If no improvement 0.9% NaCl 20ml/kg
42
No resolution for anaphylaxis (Child) 1. Shock 2. UAO 3. LAO
1. IVF or Adrenaline INF 2. Neb Adrenaline or Adrenaline INF 3. Neb Salbutamol or Adrenaline INF
43
List 5 things DURING CPR
1. Airway adjuncts = LMA/ETT 2. O2 3. Waveform capnography 4. IV/IO access 5. Plan actions before interrupting CPR
44
4 Hs and 4 Ts
1. Hypoxia 2. Hypovolaemia 3. Hypo/perthermia 4. Hypo/perkalaemia 1. Tamponade 2. Tension Pneumothorax 3. Toxins 4. Thrombosis - coronary/pulmonary
45
ACLS DRUGS SHOCKABLE
1mg/10ml IV ADRENALINE after 2nd shock (then every 2nd look/4mins) 300mg/6ml IV AMIODARONE BOLUS after 3rd shock
46
ACLS DRUGS NONSHOCKABLE
1mg/10ml IV ADRENALINE IMMEDIATELY | Then every 2nd loop/4mins
47
What is the rate for VENTILATION
6-10/min
48
What is an LMA?
Laryngeal mask
49
What is an ETT?
Endotracheal Tube
50
Why is overventillation harmful?
Gas trapping
51
What 4 things is WAVEFORM CAPNOGRAOHY used for?
1. Assess Airway PATENCY 2. Confirm intubation of TRACHEA 3. Assess ADEQUACY of CO during CPR 4. To detect ROSC
52
What does Waveform Capnography measure?
End-Tidal CO2 (ETCO2)
53
What is adequate CO of ETCO2?
30-40mmHg
54
What is an alternate drug to use in CA after Amiodarone?
1mg/kg IV LIGNOCAINE
55
Compression:Ventillation Ratio | Adult/Child
30: 2 (Adult) 2: 15 (Child)
56
List 4 ways to Ventilate
1. Bag via Mask 2. LMA 3. ETT 4. Tracheostomy
57
How many cycles of ventilation (Adult/Child)
5 in 2mins Adult 5 in 1min Child
58
How many compressions/min (Adult)
75
59
How many compressions/min? (Child)
75
60
How many breaths/min (Adult)
5
61
How many breaths/min (Child)
10
62
Why is hyperventilation harmful?
1. ^intrathoracic pressure 2. Dec coronary and cerebral perfusion 3. Dec ROSC and survival rate
63
Why do you need to beware of Gas Trapping?
^intrathoracic pressure cause NO VENOUS RETURN = No CO
64
What is the BAG MASK O2 flow rate?
10-15ml/min
65
What is ETCO2 rate meaning ineffective CPR?
<10mmHg
66
What does Adrenaline do?
Peripheral VASOCONSTRICTION Increases coronary perfusion ``` ASYSTOLE = overcome cholonergic induced Brady PEA = improve cardiac contractility ```
67
What dose of Adrenaline for Child CA?
10mcg/kg of 1:10,000 | 0.1ml/kg 1:10,000
68
What does of Amiodarone for Child CA?
5mg/kg
69
How many Jouls to shock a child?
4J/kg
70
What does a Precordial Thump do?
Mechanical stimulation by producing a myocardial depolarisation to covert VT to SR.
71
When should Precordial Thump only be used?
Person who is monitored, when a Defib is not immediately available and when the onset of VT is witnessed.
72
How to do Precordial Thump?
Hold cleaned fist April 25-30cm above the sternum. Bring fist down sharply. Immediately start CPR after.
73
Where does an Oropharyngeal airway sit?
Tip sits at the back of the pharynx keeping the tongue forward and airway open.
74
How to measure OPAs?
Distance from persons earlobe to corner of the mouth from the mid-incisor to angle of the jaw. Size 3,4 for Adults
75
How to insert OPA?
1. Open mouth 2. Imager OPA upsidedown 3. Once behind the tongue, rotate 180deg to final position.
76
What is a CE grip?
Place thumbs over top of mask. Place index fingers over the bottom of the mask. Provide head tilt-chin lift with middle and ring fingers. Ensure little finger is behind the angle of the jaw and provide jaw thrust with little finger and seal the mask to face.
77
How to do alternate CE grip?
Place heels of both hands firmly into the sides of mask. Place all four fingers behind the angle of the jaw. Apply very firm jaw thrust with all four fingers to seal the mask to face.
78
What is an LMA?
Has in inflatable cuff that sits above the vocal cords.
79
What advantages of LMA?
Opens airway when OPAs are insufficient. Maintains open airway without ongoing airway manoeuvres. Insertion while compressions continue. When ETT is difficult. Stops aspiration.
80
How do you insert an LMA?
1. Test the cuff - with 30ml syringe. 2. Lubricate back of cuff. 3. Hold LMA with line facing towards you. 4. Hold LMA like a pen and insert directly backwards following the HARD PALATE. 5. Press LMA backwards and downwards around the corner until it goes no further. 6. Inflate cuff with cuff size x 10.
81
Does LMA protect against regurgitation?
No. Aspiration is less common than with ORO or NASO
82
Crisis Resource Management (CRM 15)
1. Know Environment 2. Anticipate and Plan 3. Call for Help early 4. Leadership and Followership 5. Distribute Workload 6. Mobilise available resources 7. Communicate effectively 8. Use all available information 9. Fixation errors prevention and manage 10. Double check 11. Cognitive AIDS 12. Re evaluate 13. Teamwork 14. Allocate attention wisely 15. Set priorities dynamically
83
What is CRM for?
Coordinate and utilise and apply all available resources to optimise patient safety and outcomes
84
1. Know environment
Equipment, resources and personnel. Weekends, nights, how long. Reduces stress.
85
2. Anticipate and plan
Plan for each possible difficulty and expect the unexpected. Avoids surprises and reduces stress.
86
3. Call for help early
Knowing limitations. Alone - dangerous and inappropriate Shows safety respect and responsibility
87
4. Leadership
Take command, distribute tasks and collect all info. Coordinating and planning using clear communication.
88
4. Followership
Listening to leader and doing what needed. Assertive and ensure leader is aware of concerns
89
5. Distribute workload
Leader remain free of manual tasks. Quality control from leader.
90
6. Mobilise all available resources.
Everyone and everything that can help. Technology and people. Skills and weaknesses are important resources.
91
7. Communicate effectively
Everyone on the same page. Close the loop!!
92
8. Use all available information
``` Complete picture: Clinics impression Vital signs History Trends ```
93
9. Prevent and manage fixation errors.
Managing is getting a NEW view of situation not biased. Second opinion by someone NOT involved and don’t infect them. Change perspective and step back to look at bigger picture.
94
10. Double check
Correlating what we already know from different sources. Making sure what you remember you perceived is what you actually perceived.
95
11. Cognitive aids
Checklists and algorithms. Look things up!
96
12. Re-evaluate
Don’t stick to initial decisions. Things change in medicine and monitor trends!!
97
13. Teamwork
Respect members and weaknesses. Team players should always think about what the other person will need next.
98
14. Allocate attention wisely
Not good at multitasking. ABC sequence. Don’t get fixated.
99
15. Set dynamic priorities.
Don’t stick to decisions. After evaluation it may need new priorities and goals. Ask for other views and opinions.
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