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what dose of adrenaline do you give in cardiac arrest and how often?
1mg, 1:10,000 iv every 3-5 mins. first dose before 3rd shock if shockable or asap if non shockable and every 3-5mins
when, what dose of amiodarone do you give in cardiac arrest?
300mg before 4th shock in shockable rhythm
when what dose of atropine do you give?
only in non shockable rhythm if HR<60, give 3mg ONCE ONLY
what are the signs of tension pneumothorax? (3)
- 1. tracheal deviation away
- 2. hyperresonant percussion
- 3. absent breath sounds on affected side
what is the treatment of tension pneumothorax?
- large bore cannula in 2nd ic space
- decompress tension
- now its normal PT
- put chest drain in
what is the treatment of hypokalaemia?
potassium up to 40mmol in 100ml of 0.9% NaCl as SLOW INFUSION
when do you give precordial thump?
- when there is NO DEFIBRILLATOR
- must have an ECG monitor to say its VF or pulseless VT
- must have a witness
Describe VF and how to confirm it is VF?
- bizarre irregular waveform
- no recognisable QRS complex
- random freq and amplitude
- uncoordinated electrical activity
- must exclude movement and artefact
- if monomorphic:
- broad complex QRS
- rapid beats
- constant QRS shape
- polymorphic: torsades de pointes
describe asystole (4)
- 1. absent ventricular activity i.e. no QRS
- 2. may be some P waves
- 3. not flat line, but wavily line
- 4. treat fine VF as systole
what are 3 features of cardiac tamponade?
- sudden fall in art BP on insp by > 10mmHg i.e. pulsus paradoxus
- increasing JVP as increased venous pressure - see distended neck veins
- decreased HS as fluid in pericardium
what are ECG signs of cardiac tamponade?
electrical alternans, low voltage QRS
how do you treat cardiac tamponade?
5th or 6th ic space do pericardiocentesis
whats the differential diagnosis for tamponade and how do you differentiate?
- constrictive pericarditis: pt has Kussmaul sign which is increased JVP on inspiration and on echo there is no effusion, just a thickened pericardium
- rapid y descent on JVP waveform
- ecg: saddle shaped ST elevation
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