Questions and Answers
What is a primary indication for the use of Amiodarone?
Which of the following is NOT a common adverse reaction of Lidocaine hydrochloride?
When administering Adrenaline for shockable rhythms, after which cycle should it first be given?
What is the main role of Calcium chloride/gluconate in cardiac arrest?
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Which adverse reaction is most commonly associated with Atropine?
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What is the maximum total dosage of Atropine that can be administered during cardiac arrest?
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In which scenario would you consider using Lidocaine over Amiodarone?
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Which condition is an indication for the use of Calcium chloride/gluconate?
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In what circumstance should a shock strategy of three shocks be implemented?
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What is the purpose of pacing in emergency situations?
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Which arrhythmia is characterized by a hidden P wave in the T wave?
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What monitoring is necessary when using Adrenaline due to a potential adverse reaction?
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What is the initial dosing regimen for Amiodarone in cardiac arrest?
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Which type of heart block is characterized by a prolonged PR interval but is not permanently blocked?
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Study Notes
Advanced Cardiac Life Support (ALS)
Adrenaline
- Stimulates alpha and beta adrenergic effects increasing cardiac output.
- Enhances cerebral and coronary perfusion pressure, peripheral vasoconstriction.
- Raises diastolic pressure, improving defibrillation success and myocardial blood flow during CPR.
- Indicated for asystole/PEA (non-shockable) and VT/VF (shockable) rhythms.
- Used for symptomatic bradycardia unresponsive to atropine.
- Adverse reactions include tachycardia, hypertension, peripheral vasoconstriction, and possible tissue necrosis if extravasation occurs.
- Dosage: 1:10,000 concentration (1mg in 10ml), followed by a 30ml flush.
Amiodarone
- Prolongs action potential duration and refractory period across cardiac tissues.
- Increases coronary blood flow and decreases cardiac oxygen requirements without negative inotropic effects.
- Slows atrioventricular conduction and acts as a vasopressor to aid defibrillation.
- Indicated for pulseless VT/VF, conscious VT, atrial fibrillation (AF), flutter, and supraventricular tachycardia (SVT).
- Adverse reactions: hypotension, bradycardia, and heart blocks.
- Dosage: 300mg IV/IO after 3rd shock, then 150mg every second cycle; must use PVC free-line.
Lidocaine Hydrochloride
- Acts as a membrane stabilizing agent and reduces ventricular cell automaticity.
- Indicated for VF/pulseless VT, hypersensitivity to amiodarone, and prophylaxis for recurrent VF/VT.
- Adverse reactions: hypotension, bradycardia, CNS disturbances (e.g., seizures), respiratory depression.
- Dosage: initial 1mg/kg bolus after the 3rd shock, additional 0.5mg/kg up to 200mg; can also be administered via ETT if IV/IO access is unavailable.
Calcium Chloride/Gluconate
- Essential for nerve impulses and cardiac muscle contractions.
- Increases myocardial excitability and contractility.
- Indicated for hypocalcemia.
- Adverse reactions: alkalosis, hypernatremia, cerebral edema, potential tissue necrosis.
- Dosage: 1mmol/kg over 2-3 minutes, follow with adequate ventilation and CPR; caution against giving with adrenaline in the same IV line.
Atropine
- Reduces parasympathetic effects, increasing heart rate by blocking vagus nerve actions.
- Indicated for symptomatic bradycardia, heart blocks, HR < 40 bpm, and SBP < 90 mmHg.
- Adverse reactions: tachyarrhythmias, hypertension, confusion, urinary retention, hyperthermia in large doses.
- Dosage: rapid IV bolus of 500-600mcg, maximum total dose of 3mg; not recommended for infusion.
Cardiac Rhythms
- Ventricular Tachycardia (VT): Prolonged QRS complex, regular rhythm.
- Ventricular Fibrillation (VF): No organized rhythm, irregular frequency, no palpable pulse.
- Asystole: Absence of electrical activity.
- Pulseless Electrical Activity (PEA): May arise from conditions like massive pulmonary embolism or cardiac tamponade.
Heart Blocks
- First Degree Heart Block: Prolonged PR interval.
- Second Degree Heart Block - Mobitz Type 1 (Wenckebach): Progressively longer PR intervals until a beat is dropped.
- Second Degree Heart Block - Mobitz Type 2: Dropped beats without progressive lengthening.
- Third Degree Heart Block: Complete dissociation between atrial and ventricular activity.
Pacing
- Indications include symptomatic bradycardia, complete heart block, and malfunctioning pacemakers.
- Pacing aims to produce sustainable cardiac output; defibrillator pads placed anterior/posterior or anterior lateral.
- Ensure proper skin preparation for pad placement; replace pads regularly.
- Set pacing rate around 70-80 bpm, adjust current for effective electrical and mechanical capture; monitor continuously.
- Plan for transfer to OR for permanent pacemaker insertion if needed.
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Description
This quiz covers the essential concepts of Advanced Life Support (ALS), specifically focusing on the role of adrenaline in cardiac resuscitation. Participants will explore how adrenaline stimulates alpha and beta effects, its indications, and potential adverse reactions during critical situations. Test your knowledge on the practical application of ALS techniques and medications.
