ALS

Question 1

Shockable rhythms

Answer 1

• Ventricular fibrillation

- Pulseless ventricular tachycardia

Question 2

Unshockable rhythms

Answer 2

• Asystole/pulseless-electrical activity (PEA)

- E.g. sinus rhythm on monitor but not pulse on patient

Question 3

Chest compressions

Answer 3

• Ratio = 30:2

Question 4

Defibrillation

Answer 4

• Single shock for VF/pulseless VT followed by 2 mins of CPR
• If arrest is witnessed in a monitored patient –> three quick successive (stacked) shocks rather than 1 shock followed by CPR

Question 5

Drug routes

Answer 5

• IV access attempted as first line

- If not –> intraosseous

Question 6

Drugs that can be used

Answer 6

Adrenaline

• Non-shockable rhythms: 1 mg asap (start CPR first)
• VF/pulseless VT: adrenaline 1 mg after 3 shocks and chest compressions have restarted
• Repeat adrenaline every 3-5 mins

Amiodarone

• VF/pulseless VT 300 mg after 3 shocks
• Further 150 mg if VF/pulseless VT after 5 shocks
• Lidocaine = alternative

Thrombolytics

• If PE suspected
• If given –> CPR should be given for extended period of 60-90 minutes

Question 7

Reversible causes of cardiac arrest

Answer 7

H’s

• Hypoxia
• Hypoglycemia (hypokalaemia, hyperkalaemia, hypocalcaemia, acidaemia)
• Hypothermia
• Hypovolaemia

T’s

• Thrombosis (coronary or pulmonary)
• Tension pneumothoraxx
• Tamponade - cardiac
• Toxins