ALS/emergencies

Question 1

VT

Answer 1

1. amiodarone 300mg IV
2. if ineffective requires synchronised DC cardioversion

Question 2

sVT

Answer 2

1. IV adenosine 6 -> 12 -> 18mg
2. If ineffective consider verapamil or BB
3. If unsuccessful for synchronised DC cardioversion

Question 3

bradycardia

Answer 3

1. IV atroprine 500mcg
2. If ineffective repeat up to 3mg (6x500mcg boluses)
3. If unsuccessful for transcutaneous pacing
4. If unsuccessful for transvenous pacing

Note can also use: isoprenaline or adrenaline instead of atropine

Question 4

anaphylaxis

Answer 4

IM adrenaline (1 in 1000) 500 micrograms

Question 5

Other drugs to consider in unstable bradycardia

Answer 5

• aminophylline
• dopamine
• glucagon if overdose of CCB or BB
• glycopyrrolate instead of atropine

Question 6

Refractory anaphylaxis

Answer 6

After 2 doses of IM adrenaline

IV 0.9% sodium chloride bolus
Set up IV adrenaline infusion (continue boluses until this is ready)

Question 7

Adrenaline infusion

Answer 7

1 mg (1 mL of 1 mg/mL [1:1000]) adrenaline in
100 mL of 0.9% sodium chloride

Question 8

DKA

Answer 8

1. Fluids (with K+)
2. Insulin 0.1 units/kg/hour
3. Once glucose <14mmol/l 10% dex should be started at 125mls/hr + 0.9% NaCl

Question 9

Hyperkalaemia

Answer 9

1. Calcium gluconate (stabilises the cardiac membrane)
2. Insulin/dex infusion or salbutamol (shifts extracellular K+ intracellularly)
3. Calcium resonium (moves potassium out of the body by absorption in the gut)

Question 10

Medications to reduce potassium in the body

Answer 10

Loop diuretics
Dialysis
Calcium resonium

Question 11

Hypoglycaemia management

Answer 11

1. Oral glucose 10-20g should be given in liquid, gel or tablet form
2. If unconscious should give IM or IV glucagon
   - IM 1mg glucagon (up to 3mg)
   - IV 10% glucose in 100mls

Question 12

Status epilpeticus

Answer 12

IV lorazepam 4mg or PR diazepam 10mg

Question 13

When is adenosine CI

Answer 13

In asthmatics, use verapamil

Question 14

Medication CI in those that take cocaine and why

Answer 14

BB as can cause coronary artery spasm therefore causing vasoconstriction, should use a CCB/nitrate instead

Question 15

Monophasic defib for VT joules

Answer 15

Monophasic defib: 360J

Question 16

Diphasic defib for VT joules

Answer 16

150-200J

Question 17

Shockable rhythms

Answer 17

pulesless VT
VF

Question 18

Non-shockable rhythmns

Answer 18

asystole
PEA

Question 19

Cardiac arrest management

Answer 19

1. Start CPR 30:2
2. Shockable: give one shock and return to CPR
3. Unshockable: continue CPR

Question 20

How often do you give adrenaline in CPR

Answer 20

Every 3-5 minutes

Question 21

When do you give amiodarone in CPR

Answer 21

After 3 shocks