ADVANCED LIFE SUPPORT| 38 QUESTIONS AND ANSWERS

ALS - early drugs - Adrenaline - dose and dilution? 1mg 10ml of 1:10,000 1ml of 1 in 1,000 ALS - early drugs - drug A for thrombolysis for suspected or proven cardiac arrest due to PE Tenecteplase 500 - 600 mcg/kg IV by bolus TeN CuT PLeaSe ALS - early drugs - adrenaline in shockable rhythm 1mg IV • Given after 3rd shock when compressions have been resumed • Repeat every 3 to 5 mins • Do not interrupt chest compressions ALS - early drugs - adrenaline in non shockable rhythms 1mg IV • give as soon as circulation access obtained • Repeat every 3-5 mins • Give without interrupting chest compressions ALS - early drugs - IV fluids Use 0.9% sodium chloride or Hartmann's solution • Avoid colloid • Avoid Dextose ALS - early drugs - adrenaline in shockable rhythm 1mg IV • Given after 3rd shock when compressions have been resumed • Repeat every 3 to 5 mins • Do not interrupt chest compressions ALS - early drugs - drug B for thrombolysis for suspected or proven cardiac arrest due to PE Altephase 50mg IV ALS - early drugs - adrenaline in non shockable rhythms 1mg IV • give as soon as circulation access obtained • Repeat every 3-5 mins • Give without interrupting chest compressions ALS - how long to continue CPR in suspected or actual PE Continue CPR for 60 to 90 minutes in PE ALS - how long to continue CPR in suspected or actual PE Continue CPR for 60 to 90 minutes in PE ALS - early drugs - drug B for thrombolysis for suspected or proven cardiac arrest due to PE Altephase 50mg IV ALS - early drugs - IV fluids Use 0.9% sodium chloride or Hartmann's solution • Avoid colloid • Avoid Dextose ALS - early drugs - adrenaline in non shockable rhythms 1mg IV • give as soon as circulation access obtained. !!DIFFERENT!! • Repeat every 3-5 mins - alternate loops • Give without interrupting chest compressions ALS - early drugs - drug B for thrombolysis for suspected or proven cardiac arrest due to PE Altephase 50mg IV a LaTe PHaSe ALS - early drugs - calcium used when? ONLY in non shockable rhythms from >> Hyperkalaemia >> Hypocalcaemia >> OD of Ca channel blockers ALS - early drugs - calcium risks May • Harm ischaemic myocardium • Impair cerebral recovery ALS - early drugs - calcium used when? ONLY in non-shockable rhythms from • Hyperkalaemia • Hypocalcaemia • OD of Ca channel blockers ALS - early drugs - calcium dose 10ml of 10% calcium chloride IV (6.8mmol Ca++) ALS - what is Amiodarone • Membrane stabilising anti-arrhythmic drug • Increases the duration of the action potential and refractory period in atrial and ventricular myocardium ALS - early drugs - calcium risks May • Harm ischaemic myocardium • Impair cerebral recovery ALS - early drugs - calcium dose 10ml of 10% calcium chloride IV (6.8mmol Ca++) ALS - Amiodarone in PEA Not indicated ALS - Amiodarone usage in VT 300mg bolus IV • Given after the 3rd shock (when compressions resumed) • Further dose of 150mg if VF/VT persists. ALS - early drugs - what is Amiodarone • Membrane stabilising anti-arrhythmic drug • Increases the duration of the action potential and refractory period in atrial and ventricular myocardium ALS - Amiodarone non availability alternative • Lidocaine 100mg for VF/VT refractory to 3 shocks • 1 to 1.5 mg per kg ALS - Amiodarone usage in VT 300mg bolus IV • Given after the 3rd shock (when compressions resumed) • Further dose of 150mg if VF/VT persists. ALS - Amiodarone non availability Lidocaine usage after initial dose • Additional dose of 50mg • Max dose 3mg/kg in first hour ALS - early drugs - calcium dose 10ml of 10% calcium chloride IV (6.8mmol Ca++) ALS - Amiodarone in PEA Not indicated ALS - Amiodarone non availability alternative • Lidocaine 100mg for VF/VT refractory to 3 shocks Dose = 1 to 1.5 mg per kg ALS - Amiodarone non availability Lidocaine usage after initial dose • Additional dose of 50mg • Max dose 3mg/kg in first hour ALS - Magnesium action in cardiac arrest • Facilitates neurochemical transmission • Decreases acetylcholine release • Reduces motor end plate sensitivity ALS - Magnesium action in cardiac arrest • Facilitates neurochemical transmission • Decreases acetylcholine release • Reduces motor end plate sensitivity ALS - early drugs - cardiac arrest sodium bicarbonate; indications x2 Arrest associated with • Hyperkalaemia • Tricyclic overdose Too much KaTie ALS - early drugs - cardiac arrest sodium bicarbonate dose 50ml of 8.4% solution IV. (50mmol) ALS - early drugs - what NOT to give with sodium bicarbonate? Do not give IV calcium through same route ALS - adrenaline - what are the alpha adrenergic effects ... Causes systemic vasoconstriction ... which rises coronary artery pressure ALS - adrenaline - what are the BETA adrenergic effects ... Inotropic Chronotropic