im a doctor :) > ALS > Flashcards

ALS Flashcards

(59 cards)

Study These Flashcards
1
Q

WHEN DO YOU DO AN ADRENALINE INFUSION

WHEN DONT YOU WANT TO SYCHRONISE CARDIOVERSION

A
  1. ANAPHYLAXIS-REFRACTORY PATHWAY
  2. BRADYCARDIA

WITH THE T WAVE- VF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DOSE FOR BRADYCARDIA ADRENALINE INFUSION

BROAD COMPLEX TACHYCARDIA MANAGEMENT

A

2-10 mcg min iv

ADVERSE SIGNS- CARDIOVERSION

IF STABLE IS IT REGULAR OR IRREGULA R

REULAR (vtach), (svt withbbb)- 300 amiodorone - after you may cardiovert but seek help

Irregular - A FIB with BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

adrenaline infsuion dose for anaphylaxis

A

1ml in 1mg adrenaline 1:1000 in 100ml saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

some of the drugs we can use in vtach WITH A PULSE !

A

lidocaine - 1–1.5 mg/kg IV (max 3 mg/kg)
amiodorone 1st line - 300 mg IV over 20–60 minutes, then 900 mg over 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when do you give 3 stacked shocks in succession

what is biventrucalr pacing

A

patient has a witnessed arrest in cath lab and it coutns as one

used in heart failure for inotropic rather than bradycardiv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when to do precordial thump

A

only for pvtach, and if it was a witnessed in house cardia arrest and a defib is not availlable

  • not effectetive for v fib- ALS BOOK SAYS OTHWISE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why should we consider higher shock energies in asthma cardiac arrest

A

Hyperinflation increases thoracic impedance. Higher energies should be considered if the first shock fails.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what can vf be confused as sometimes

A

very fine vf can be mislead as asystole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if someoe has an ICD wherre to put the pads

how to treat torsdades

A

Pads should be placed at least 10-15 cm from the ICD or alternatively in the antero-posterior position.

  1. stop any agent thats prolonging
  2. correct electrolytes
  3. mg 204 over 10 mins
    4.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if the rhythm changes from asystole to VF during the 2 min cycle, a shock should be given.

A

NO FINISH THE CYCLE AND THEN GIVE THE SHOCK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CI FOR THROMBOLYISS

A

major surgery past 3 months
Previous haemorrhagic stroke (at any time)
* Ischaemic stroke within the past 6 months
* Intracranial malignancy, AV malformation, or aneurysm
* Significant head injury or recent intracranial surgery (<3 week
bleeding diatheis , known bleeding disoder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in a metabolic acidosis what is the BE

do vagal maneouveres work?

A

NEGATIVE

valsaver/carotid will terminate a quarter if not working could be atrial tachycardia/flutter OR ggiven to slow OR peripheral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

IN A METABOLIC ALKALOSIS WHAT IS BE

A

POSTIVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

IN A RESPIRTATORY ACIDOSIS WHAT IS BE

A

PSOTIVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A RESPIRTATORY ALKALOSIS WHAT IS BE

A

NEGATIVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

VENTRICULA RSTANDSTILL ECG

what does a synchronized shock do

A

JUST SEE P WAVES , NO QRS COMPLEXES

coincides with R WAVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when to do transcutaneous pacing

A

brady, atropine not worked,
same process as pads - set to pace mode its temprory before actual pace maker is inserted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

max dose of atropine in bradycardia

what to do in cardiac arrest and someone has ICD

A

3mg so 6 DOSES

it should terinate the shock but if not, continue cpr as normal, attach pads far away, if it keeps shocking and interrutpting deactivate it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

stepwise appraoch to bradycardia

A

500 atropine - give up to 6 every 3- 5 UP TO 3 MG!!! mins
doesnt work
do transcutabeous pacing
doesne twork
adrenaline infusion 2-10 mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mobtitz type 2 treamtment

A

its always pathological
pacing!!
immediate admission of cardiac monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

WHEN DO WE USE ADENOSISNE

who is more likely to have adverse features in a tachyarrythmia?

A

IN SVT

in normal people with normal hearts - less likely if <150 bpm so cardioversion less benefit howver people with problems can develop signs around 120 and so cardiversion is of benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CI ADENOSISE

A

ASTHA/COPD
2ND/3RD AV BLOCK WITHOUT PACING
SICK SINUS SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MANAGEMENT OF SVT with doses

A

IF STABLE
1. valsava
2. adenosine 6 12 18
3. if fails give verapamil (ONLY IF THEY DO NOT TAKE A BB) or metoprolol (2.5-5mg slowly over 2 mins maximum is 15 mg ) if needed repeat every 5 minutes. IF NOT WORKING THEN SYNCHRONISED CARDIOVERSION

unstable
synchroised cardioversion
can also consider amiodarone after but should not delay cardioversion 300 mg IV over 10–20 min, then repeat cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to do valsava

Study These Flashcards
A

blow through syringe 15 secs
flip down with legs up 15 secs
get back to nromal postion

25
msot common arrythnias associated with stemi
vf, v tach, sudden cardiac death
26
brugada syndrome do all pacing devices also defibrillate
inherited in AD pattern a lot of people aysomtomatic ecg v1 and v2 high in south east asia o high risk of Vfib and sudden cardiac death treat fevers promtptly may need ICD NO - this is why if it onlyc paces better to use AP so you can used ocnventional placement for defib
27
loading doses for PCI
300 ASPIRIN 300 CLOPIDOGREL /600 60 PRASUGREL < 75 years and <60 kg TICAGROLER 180 then you give an anticoagulant during the actuall prciedure
28
if receiveing thrombolyisis what to give for stemi
300 aspirin 180 ticagrelor or if high bleeding risk give 300 aspirin and clopidogrel and a LMWH HEPARIN, unfractionated heparing
29
how do we know if thrombolyis has failed only exception to als non shcoakable algorithm
failure on the ecg for the st elevation to improve by 50% so now you have to transfer them for a PCI 'resuce pci' SOMEONE IS OS TACHY THEY DONT HAVE A PULSE - its giiving PEA but you a sychronised shco
30
how to treat an NSTEMI
300mg aspirin or clopidogrel 300mg if pci is planned ( ticagrelor 180 loading or prasugrel 60mg) and an anticoagulant like ondaparinox 2.5mg once daily need a coronoary angio within 72 hours
31
secondary prevention after MI
clopidogrel 75 aspirin 75 ticagrelor 90bd prasugrel 20mg *ace inhibitor * bb *statin *htn
32
whats an accelerated iodventriuclar rythm
after repurfusion via pci or thrombolysis
33
spironolcatone PROBLEMS WITH DEFNITVE PACEMAKER
Kk sparing dieuetic helps in heart failure as allows you to loose water but keep K+ helps in remodelling the heart, preveniting fiborosis and damge usually started when EJ <40% 1. lead displacement (more likley first few days, less likely 4 weeks in 2 fracture afater a fall
34
what electrolyte abnormality is most associated with torsades 3 things to check wave form for
hypoklameia quality of cpr tracheal iintubation prognostication
35
examples of non invasive pacing methods WHEN TO STOP CPR
transcutaneous percussion pacing - ulnnar fist aystole >20 mins and all 4hts pea - bit more difficult still 20 mins but involve a senior and also can consider cardiac ultrasound
36
parameters of the grace score (8 variables)
1. age 2. bp 3. heart rate 4. killip class, increased jvp, crackes, 4.creatinine 5. cardiac arrest at admission 5. ecg0 st changges 6. troponin
37
echg printouts
BETTER TO LOOK AT FOR RTYM AS FO ST CHANGES BETTER TO HAVE THE MONITOR
38
HOW TO MANAGE AN ADULT WITH TACHYCARDIA WITH ADVERSE SIGNS POST ROSC CARE
SYNCHRONISED DC SHOCK UP TO 3 ATTEMPTS IF FAILES THEN AMIORDONE 300MG OVER 10-20 MINS, REPEAT SHOCK THEN 24 HOUR AMIORODONE INFUSION
39
NEWS MONITORING WHAT IS CAPTURE
0 - EVERY 12 HOURS 1-4- every 4-6 hours 5-6 (or 3 in any parameter) - every hour 7- continuous, or every 30 mins when you pace someone and you get a response you see an immediate qrs complex - you need to correlate with pulse
40
chain of survival
early recognition and call for help cpr early defibrillation rosc the chain is only as strong as its weakest link
41
WHAT IS RSPECT USE FOR how to use pacemeaker
FOR COMMUNICATION, STRRUCTURED LEADERSHIP TOOL most pacemakers willbbe set to DEMAND mode where if they sense movement artefact they will stop so try to stop this as much as possible if this is not possible then use FIXED PACING. normal rate to pace if 60-90 but can be lower if there is an av block with an idoventirucla rythm can be as low as 30 or 40 in standstill set to the lowest energy and gradually increase -until you get capture a pacing spike occurring before qrs complex always check for a t wave after qrs cos artefact can confuse you but it definitely wll not have a t wave . always check there is a pulse after each capture as could be PEA if you reach highese setting and sitll no copature conside changing elctrodes
42
INVASIVE PACING TECHNIQUES
transvenous pacing pacemaker
43
spike model
breakingbad news
44
team tool
team Emergency Assessment Measure (TEAM) tool is used as a teaching intrusment and discussion point for both instructor and candidates through face-to-face teaching and during teaching scena
45
ci to io route
fake joint infection around the area trauma recent io acces in the same limb including a failed attempt in the past 48 h failure to identify anatomical landmarks
46
when to we pritotise rythm control over rate
A FIB < 48 hours opt for rtyhm control /propofenone/fleixanide - cant use in heart failure or a prologed qt amiodrone 300mg IV
47
CARIDAC ARRESTS ON THE WEEKENED - WORSER PROGNOSIS OR EVENING studies have shown in-hospital cardiac arrests occuring in the late afternoon, at night or at weekends are more often non-witnessed and have a lower survival rate. Patients discharged at night from ICUs to general wards havean increased risk of ICU readmission and in-hospital death compared wit hthose discharged during the day and those discharged to HDUs.
48
HYPOGLYCEMIA UNCONCIOUS PATIENT WHEN IS PACING AFFECTIVE
10% glucose in 50ml glucose solution can repeat every minute until gains consiousnees or or until a total of 250 has been given EFFECTIVE IF YOU HAVE P WAVES
49
normal range of co2 complications of intubation
4.7-6 1. hypoxia 2. esaphageal intubation - wave from caprnography 3. endobronchial intubation - check both axilla, equal chest expalsntion
50
stop 5 - transcuteanous pacing info percussion pacing
debrief in 5 minutes its non invasive- not very reliable, should quickly find more deifnitve pacing methods PP can be used indtead of cpr, less trauma to chest, do it repeatedly on the left sternal edge , monitor ecg look for QRS complexes, ideally with 2 people, other peson checks for apulse
51
how long to press for capillary refill statistics for VF
5 seconf 50% within 2 mins reocuur and then 75% at one point during the cycle,
52
what cannulae to use infor IV ACCES
14 OR 16
53
ABNORMAL QT INTERVAL is lucas better and when to use
MEN >0.45 WOMEN >0.47 it is not superior to mechanical compressions but obviously if somoen is geting tired its superior. we use if for example after 5 shocks patient is still in vf and we need to transport them or in hypothermia where you have continued compressions
54
normal qt interval shock energies in defib
men - up to 43 women up to 45 120-150 but greater range is 120-360j
55
does all the energy reach the heart in defib
NO DUE TO TRANSTHROACIC IMPEDANCE, as little as 4% and also diverted to non cardiac pathways can also be affected by electrode postion
56
impedence and factors that affect page 118 different postions of placing the pads
current flow is inversely proportional to impedance. there are some clever difbs that can measure the impendence and adjust the energy. postion of electrodes hairy chest - put bi axiallary transdermal drug patch left clavicle left back bi axiallary left mid axiallary (posterior lateral ) then back right side
57
advantage of manual defib over aed energy that an ICD shock s
has other functions like synchronized cardioversion - has pacing abilities - less time off the chest 40 through a pacing wire and then 80 if sc
58
implantable loop during cardiac arrest internal defib
slight risk of damge of device due to energy but not risk during cpr or defib internal defib requires much less energy as using paddles DO NOT EXCEED 50
59
problems with transvenous pacing
1. high threshold ( typically you start with the lowest energy and increase . until you get capture, if not then increase the energy well above threshold 2. lead displacemnt : usually the tip is near the rgith ventricle sometimes it can peforate it,- can cause tamponade very rarely (pea) 3. connection failure most pacing leads are bipolar
im a doctor :)
flashcards
Decks in class (65)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions