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ALS notes
SBAR
– I am calling about Mx who currently has (condition)
– They are X years old, presenting with (condition) On a background
of (PMHx)
– He looks ? ABCDE
– I am currently (action), could you (request)
Airway
– Head tilt + chin lift
– Jaw thrust
Insertion of:
– Oropharyngeal airway/guedel
upside down + readjust
– Nasopharyngeal (R)
– iGel
+++++ consider suctioning !!
CONDITIONS TO CONSIDER
– STRIDOR? 2222
– ANAPHYLAXIS? (ADRENALINE 1:1000 IM, REPEAT 5MINS,
CONSIDER BOLUS)
Breathing
– ^ RR?
– 02 levels (non-rebreathe 15L?)
– Use of accessory muscles
– Positioning
– Chest movement
– ABG?
– Auscultate
– Wheeze?
– Crackles? (Fine/course?)
– Stridor?
– Rhonchi?
– Friction rub?
https://www.youtube.com/watch?v=i6khX2gwuBs
Circulation
– CRT
– Pulse (rate, rhythm, character)
– BP
– Temp
– Look at them
– ECG
– Bloods + IV access
– Auscultation HS
https://www.youtube.com/watch?v=gohqRFjJOUw
https://www.youtube.com/watch?v=zNHI-l_c-ls
Disability
– AVPU
– Alert, Voice, Pain, Unresponsive
– Pupils
– Drugs + Allergies
– Hypoglycaemia
Exposure
– Head to toe skin
– Calves
– Bleeding?
Common Clinical Presentations
. Acute Coronary Syndromes
. ECG
. IV ACCESS + BLOODS
. MONA (MORPHINE, O2, NITRATES, ASPIRIN)
. AKI
. IV ACCESS + BOLUS + BLOODS
. STOP NEPHROTOXINS
. CATHETER (IP,OP) + URINALYSIS
. RENAL USS?
. HYPOGLYCAEMIA (<4.0mmol/l)
. Food + drink, glucogel, dextrose
. DKA
. VBG = pH > 7.3 + HCO3 > 15.0 mmol/L + Ketone < 0.6 mmol/L
. BOLUS or 0.9% NaCl
. 10 units soluble insulin (Actrapid)
. IV fixed rate insulin
. ASTHMA
. MODERATE = 02 + salb nebs + Oral/IV steroids
. SEV = ABG, ipatropium neb 500mcg, salb b2b
. FATAL = CXR, ICU, IV aminophylline 5mg/kg loading dose +
. 0.5mg/kg/hr maintenance
BLS
– Response?
– 4 2’s
– 30:2 + bag valve on
– Defibrillator
Pad placement
ALS Algorithm
FOR BOTH VF + VT
– 1ST SHOCK 200J
– 2ND SHOCK 300J
– 3RD SHOCK 360J + ADRENALINE 1MG 1:10,000 + AMIODARONE
300MG
– RPT 360J
VF
VT
SAME AS
THUS
– CONT CPR
– IV ACCESS
– 1MG 1:10,000 ADRENALINE
– RPT 3-5 MINS
Reversible Causes of Cardiac Arrest
– Hypoxia
– Hypovolaemia
– Hypo/hyper kalaemia
– Hypo/hyper thermic
– Thrombosis
– Toxins
– Tension Pneumothorax
– Tamponade
Causes of deterioration and cardiorespiratory arrest
– Airway Obstruction = cerebral or pulmonary oedema, exhaustion,
secondary apnoea, and hypoxic brain injury, and eventually cardiac
arrest
