ILS Course - A to E Training & Solutions Ltd > ALS Algorithm > Flashcards

ALS Algorithm Flashcards

(51 cards)

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1
Q

What is the advantage of using the ALS algorithm?

A
  1. Rx to be delievered expediently
  2. Without protracted discussion
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2
Q

Key actions to improve survival in cardiac arrest:

A
  1. Early, high quality, uninterrupted chest compressions
  2. Early defibrillation for shockable rhythms
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3
Q

What is the ALS algorithm?

A
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4
Q

Recognition of cardiac arrest - Step 1:

A
  1. HAZARDS - Ensure the environment is safe; approach the pt.
  2. HELLO - Check for a response - Shake the pt’s shoulders & ask loudly: “Hello, Are you alright?”
  3. HELP - If they do not respond shout for help/pull the emergency buzzer & proceed to Step 2.
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5
Q

Recognition of cardiac arrest - Step 2:

A
  1. Assess for breathing & signs of life (take ≤ 10s).
  2. Turn the pt. onto their back
  3. Open airway - head tilt & chin lift
  4. Determine if the pt. is breathing normally:
  5. LOOK - chest movement
  6. LISTEN - breath sounds
  7. FEEL - air on your cheek
  8. Assess for a carotid pulse simultaneously
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6
Q

Recognition of cardiac arrest - Step 3 - If help has arrived:

A
  1. Start CPR
  2. Instruct the helper to the call resuscitation team (2222 if in-hospital, 999 if out-of-hospital)
  3. Helper to get the resuscitation equipment
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7
Q

Recognition of cardiac arrest - Step 3 - If help has NOT arrived & you’re alone:

A
  1. Leave pt. to get help
  2. Get resus equipment
  3. Return ASAP to start CPR
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8
Q

Performing CPR - Step 1:

A
  1. Place the heel of 1 hand in the centre of the chest with the other hand on top.
  2. Interlock your fingers
  3. Keep your arms straight
  4. Position shoulders vertically above the pt’s chest
  5. Compress to a depth of 5-6 cm.
  6. Allow the chest to recoil after each compression.
  7. Repeat at a rate of 100-120 min-1.
  8. Continue with a ratio of 30 chest compressions to 2 breaths
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9
Q

When to change person doing compressions to avoid fatigue?

A
  1. Change every 2 min
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10
Q

How to do compressions when airway secured/advanced airway in place?

A
  1. Continuous compressions wihtout pausing during ventilations

Ventilate at 10 breaths/min

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11
Q

What is the role of waveform capnography during CPR?

A
  1. Ensuring correct ETT placement
  2. Monitoring ventilation rate & avoiding hyperventilation
  3. ID ROSC during CPR - increase in end-tidal CO2
  4. Prognosticate during CPR
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12
Q

Monitoring during CPR:

A
  1. Clinical signs - breathing, eye opening, movements
  2. Pulse checks
  3. Heart rhythm
  4. End-tidal CO2 with waveform capnography
  5. Bloods - avoid finger pricks
  6. Invasive cardiac monitoring
  7. Focused US/echo
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13
Q

What principles to remember during CPR?

A
  1. Good quality compressions
  2. ID & Rx reversible causes
  3. Secure airway
  4. IV access
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14
Q

Performing CPR - Step 2:

A
  1. Attach the defibrillator ASAP
  2. Apply the self-adhesive pads beneath the R clavicle and the L-MAL.
  3. Minimise interruptions to chest compressions.
  4. As soon as the defibrillator is attached, perform a rhythm check.
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15
Q

Rhythm assessment - How to perform Rhythm check with AED?

A
  1. Follow the prompts
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16
Q

Rhythm assessment - How to perform Rhythm check with manual defibrillator:

A
  1. Pause chest compressions
  2. Observe the rhythm on the defibrillator screen
  3. Determine if shockable or non-shockable
  4. Take no longer than 5 s to do this
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17
Q

What are the shockable rhythms?

A
  1. VF
  2. Pulseless VT
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18
Q

What are the non-shockable rhythms?

A
  1. PEA
  2. Asystole
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19
Q

Characteristics of VF:

A
  1. Bizarre, irregular waveform
  2. No recognisable QRS complexes
  3. Random frequency & amplitude
  4. Uncoordinated electrical activity

Exclude artefact - movement/electrical interference.

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20
Q

Characteristics of pulseless VT:

A
  1. Broad complex rhythm
  2. Rapid rate
  3. Constant QRS morphology

check for a pulse.

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21
Q

Characteristics of PEA:

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A
  1. Clinical features of cardiac arrest
  2. ECG normally associated with a palpable pulse
22
Q

Conditions ass. w/ PEA:

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A
  1. Hypovolaemia
  2. Tamponade
  3. Tension pneumothorax
  4. Massive PE
23
Q

Characteristics of Asystole:

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A
  1. Absent QRS
  2. Atrial activity (P waves) may persist
  3. Rarely a straight-line trace

Completely straight line - monitoring lead disconnected

24
Q

Mx of shockable rhythms - AED:

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A
  1. Follow the audio/visual instructions from the machine
25
Mx of shockable rhythms - **Manual defibrillator**:
1. **Apply** self-adhesive **pads** while doing compressions 2. **Pause** compressions (< 5 sec) for rhythm check 3. **Resume** **compressions** immediately 4. Warn all **rescuers** to **"stand clear"** expect one doing compressions 5. **Remove O2** as appropriate 6. **Select** the appropriate **energy** on the defibrillator 7. Press the **charge** button 8. Once charged - instruct the rescuer doing chest compressions to **"stand clear"** 9. When **all** rescuers are **clear**, deliver the **shock** 10. **After** the shock - **Immediate CPR** 11. **Do not pause** to reassess the **rhythm** or feel for a **pulse** 12. **Continue** CPR for another **2-min cycle** 13. **Continue** to repeat the 2-min CPR cycle - rhythm check - defibrillation sequence **if VF/pVT persists** 14. Prepare **ADR 1 mg** IV & **Amiodarone 300 m**g IV to be given **after 3rd shock** 15. Give **further ADR 1 mg** IV after alternate shocks (about **every 3-5 min**)
26
What shock energy is needed?
1. **1st** shock - at least **150J** 2. **Subsequent** shocks - **same** or **higher**
27
If electrical activity compatible with a pulse is seen during a rhythm check, or the AED advises no shock is required or check for signs of life - If **no** signs of life are present:
1. Continue **CPR** 2. **Switch** to the **non-shockable side** of the algorithm.
28
If electrical activity compatible with a pulse is seen during a rhythm check, or the AED advises no shock is required or check for signs of life - If **signs of life are present**:
1. Start post-resuscitation care.
29
Mx of non-shockable rhythms - AED: | If the AED advises no shock is required?
1. **Follow** its **prompts** 2. Continue **CPR**.
30
Mx of non-shockable rhythms - Manual Defibrillator: If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life. If **no pulse and/or signs of life**:
1. Continue **CPR** 2. Prepare **ADR 1 mg** IV/IO to be given as soon as access is achieved 3. **After 2-minutes** of CPR, pause chest compressions briefly for **rhythm check**
31
If an organised rhythm is seen during a 2 min period of CPR - What to do?
1. **DO NOT interrupt compressions** to palpate pulse 2. **Only stop** compressions to palpate pulse **when signs of life**
32
If there is any doubt when doing pulse check - what to do?
1.Continue CPR
33
Sites for IO access in adults?
1. Proximal humerus 2. Proximal tibia 3. Distal tibia
34
How to give drugs peripherally during CPR?
1. **Flush** with 20 ml of fluid 2. **Elevate extremity** for 10-20 sec
35
Mx of non-shockable rhythms - Manual Defibrillator: If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life. If **VF/pVT is seen** at the rhythm check, **or the AED advises** to deliver a **shock**:
1. **Switch** to the **shockable** side of algorithm
36
Reversible causes of cardiac arrest - 4 Hs and 4 Ts
**4Hs:** 1. Hypoxia 2. Hypovolaemia 3. Hypothermia 4. HypoK/ hyperK/ hypoglycaemia/ hypoCa/ H ion excess (acidaemia) **4Ts:** 1. Thrombosis - coronary / PE 2. Tamponade 3. Tension pneumothorax 4. Toxins
37
Rx - Hypoxia:
1. Ensure **airway** is **patent** 2. **Ventilate** the lungs using a self-inflating bag; 3. Give **high-flow 100% O2** 4. **Don't hyperventilate** - reduces the coronary perfusion pressure and can worsen the outcome
38
Rx - Hypovolaemia:
1. IVF 2. Blood
39
Rx - Hypo/HyperK:
1. HyperK - give calcium chloride followed by insulin/dextrose infusion. 2. HypoK - replace
40
Rx - Hypothermia:
1. Active re-warming techniques 2. Cardiopulmonary bypass may be considered
41
Rx - Coronary Thrombosis:
1. PCI 2. Thrombolysis
42
What is the commonest cause of thromboembolic or mechanical circulatory obstruction?
1. Massive PE
43
Rx - Pulmonary Thrombosis:
1. Fibrinolysis
44
Rx - Tamponade:
1. Needle pericardiocentesis or resuscitative thoracotomy
45
Rx - Toxin OD (inpatients):
1. R/V of the pt's drug chart may be helpful
46
Rx - Tension Pneumothorax:
1. Early needle decompression (thoracocentesis) 2. Followed by chest drain insertion is needed.
47
Signs of ROSC:
1. **Clinical** - breathing, eye opening, movements 2. **Monitoring** - sudden increase end-tidal CO2 or arterial BP waveform
48
What to do after Return of spontaneous circulation (ROSC)?
1. **Reasses** pt. using **ABCDE** approach 2. Aim for **sats** of **94-98%** 3. Aim for a **normal PaCO2** 4. 12-lead **ECG** 5. **Rx** any precipitating **cause**(s) 6. Consider targeted **temp Mx**
49
Who should be the one discussing stopping CPR?
1. Team leader
50
How to Dx death after unsuccessful resus attempt?
1. **Observe** pt. for **5 min** after stopping CPR 2. **Absent mechanical cardiac Fx** - Absent central pulse / absent heart sounds 3. **Absent reflexes** - pupillary / corneal/ motor response to supra-orbital pressure 4. **Supplementary features** - Asystole on ECG/ absent flow on direct intra-arterial pressure monitor (A-line) / absent heart contractions on echo
51
Post resus event tasks to do:
1. Ongoing **care** of **pt.** 2. **Documentation** of resus 3. **Communication** w/ **relatives** 4. Post-resus **debriefing** - immediate & delayed 5. **Restock** equipment & drugs 6. **Audit** forms
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