Q: How soon must defibrillation be provided to alter outcome in cardiac arrest?
A: Within 12 minutes

Q: What is the overall survival for OOHCA?
A: Up to 20%

Q: What is the overall survival for OOH shockable arrest?
A: Up to 35%

Q: What is the overall survival for OOH PEA arrest?
A: 5-10%

Q: What has better outcomes, OOHCA or in hospital arrest?
A: OOHCA

Q: What is the probability of ROSC if absent cardiac activity on echo?
A: <5%

Q: What is the probability of ROSC if cardiac activity is evident on echo?
A: 80%

Q: What proportion of sudden cardiac death is due to cardiac causes and electrical causes?
A: 80% vs. 20%

Q: What did the CAST I trial find?
A: In patients with recent MI who had frequent PVC's, Class I anti-arrhythmics increase risk of sudden death.
Class III and beta-blockers may provide some protection

Q: In whom are ICD's indicated?
A: Known significant CAD, depressed LVEF, spontaneous, life-threatening and/or inducible ventricular dysrhythmias

Q: What are the components of the chain of survival?
A: Early call for help
Early CPR
Early defibrillation
Early ACLS

Q: What proportion of cardiac arrests show initial VF?
A: 25%

Q: What is the risk of SCD in HOCM per year?
A: 1% per year

Q: What is ALCAPA?
A: Anomalous left coronary artery from pulmonary artery syndrome

Q: What does ECG look like in Brugada?
A: Type I - Coved ST elevation >2mm in >1 of V1-3 with inverted T wave
Type II - >2mm saddleback ST elevation
Type III - Either of above patterns but <2mm ST elevation

Q: What is the incidence of ventricular dysrhythmia in Brugada?
A: 1.5% per year and overall 50% in lifetime

Q: Which patients with early repolarisation need referral to Cardiology?
A: Young adult with syncope of no clear cause and those with FHx of sudden cardiac death

Q: What proportion of the population have BER?
A: 1-2%

Q: What is the BLS algorithm?
A: Danger?
Responsive?
Send for help
Open airway
Normal breathing?
Start CPR 30:2
Attach AED
Continue CPR until responsiveness or normal breathing return

Q: What age children need neutral head position?
A: <1yo

Q: Choking algorithm
A: Continue effective cough
If not -
5 chest thrusts, 5 back blows repeatedly
Start CPR if loses consciousness

Q: Under which hip does wedge go for pregnant females?
A: Right hip

Q: What depth of compression is targeted in CPR?
A: 1/3 chest AP diameter
>5cm in adults, 5cm in children, 4cm in infants

Q: Target rate of CPR?
A: 100-120

Q: How far from implantable device do pads go?
A: >8cm

Q: Should patients in puddles be moved prior to defibrillation?
A: If possible, move to dry area

Q: Who can compression only CPR be performed on?
A: Adult witnessed OOHCA, <4min duration, shockable rhythms if low confidence with rescue breaths

Q: How long do you run water over chemical burns?
A: 1 hour or until stinging ceases

Draw the ALS algorithm

Q: Features that suggest arrhythmic syncope?
A: Sitting, supine syncope
No preceding symptoms
Chest pain
During or after exercise
Repetitive episodes
FHx of SCD
Palpitations
Seizure (nocturnal and resistant)

Q: What proportion of usual cardiac output can CPR provide?
A: 20-30%

Q: How long should attempts to secure airway take?
A: <5 seconds

Q: Where do pads go on chest?
A: Right 2nd ICS parasternal
Left 6th ICS midaxillary line

Q: When are stacked shocks recommended?
A: Witnessed shockable rhythm if defib possible within 20 seconds

Q: When is praecordial thump advised?
A: Pulseless VT if delay to defib attachment only

Q: How can etCO2 be used to predict outcome in CPR?
A: etCO<10 after intubation or 20 min of CPR associated with low likelihood of survival
etCO2 >10 after intubation or 20 min of CPR may be predictor of ROSC
etCO2 >20 after intubation or 20 min of CPR may be predictor of survival to dc
Sudden increase by 10 is 95% predictive of ROSC

Q: Energy levels recommend in shockable rhythm
A: 200 - 360 - 360

Q: What proportion of PEA is due to primary cardiac event?
A: 50%

Q: What are causes of PEA?
A: Tamponade, tension PTX, PE, hypovolaemia, severe acidosis, drug toxicity, electrolyte disturbance

Q: What did the ALPS study show?
A: No benefit of amiodarone or lignocaine vs. placebo in achieving survival to discharge or neurological outcome in OOHCA

Q: Which drugs can be given via ET?
A: Adrenaline, lignocaine and atropine only

Q: What is the target SpO2 in paraquat poisoning?
A: 88-92%

Q: How long should CPR be continued for after thrombolysis in suspected massive PE?
A: 60-90 minutes

Q: What is the PE triad in arrest?
A: Witnessed, <65yo and PEA initial rhythm

Q: What is the PPV of RV > LV for PE on FOCUS?
A: 88%

Q: What is McConnell's sign?
A: Mid-RV wall hypokinesis with apical sparing. 100% Specific

Q: When is pre-hospital termination of CPR appropriate?
A: Need all of:
Non-witnessed arrest
No bystander CPR
No pre-hospital defibrillation
Failure to achieve ROSC

Q: Target BP post-arrest?
A: SBP >100 or usual BP for patient

Q: Target glucose post-arrest?
A: 4-10

Q: What did the TTM trial show?
A: No difference in outcomes between 33 and 36 degrees targeted temperature management in comatose OOHCA

Q: How long should TTM be continued?
A: At least 28 hours and control of fever recommended after that

Q: What proportion of patients with acute coronary occlusion causing arrest have STEMI on ECG?
A: 2/3 so 1/3 do not show this but need PCI at some stage

Q: Favourable features that suggest PCI of benefit (in non-STEMI)
A: Witnessed
Early CPR
Short time of CPR
Good perfusion
<85yo

Q: What proportion of survivors of OOHCA have ICH?
A: Up to 10% in one series

Q: What are unfavourable factors re: PCI post-arrest?
A: Unwitnessed
Non-VF/VT initial rhythm
No bystander CPR
CPR >30 minutes
Ongoing CPR
pH <7.2
Lactate >7
Age >85
ESRF

Q: Atropine dose in bradyarrhythmias
A: 500mcg q3-5min up to 3mg

Q: Amiodarone loading and infusion doses
A: 300mg over 10-20min hour then 900mg over 24 hours

Q: Magnesium dose for TdeP
A: 5mmol bolus q10 min then 20mmol over 4 hours
Same as children
0.1mmol/kg bolus then 0.075mmol/kg/hr infusion

Q: Adenosine dose in SVT
A: 6/12/12mg

Q: Verapamil dose in SVT
A: 2.5-5mg IV over 2 min

Q: Hydrocortisone doses in anaphylaxis by age
A: >12yo: 200mg
6-12yo: 100mg
6mo to 6yo: 50mg
<6mo: 25mg

Q: Target SBP in traumatic arrest
A: >90mmHg (or >110mmHg if head injury)

Q: ICC output that warrants thoracotomy
A: 1L immediately, >200mL/hr for next 2-4 hours

Q: When is adrenaline recommended in traumatic arrest?
A: Only after control of external haemorrhage, opening airway, commencement of volume resuscitation and decompression of chest if indicated

Q: What do you do if an LVAD has flow <1.5L/min?
A: Check all connections, start CPR (incl. defib if indicated), connect VAD to AC power and consider ECMO

Q: What do you do if LVAD has flow 1.5-2.5L/min?
A: Do not start CPR. Give 250mL N/saline bolus and start adrenaline infusion

Q: What causes an increased etCO2?
A: Fever, sepsis, seizure, bicarb, reduces ventilation, malignant hyperthermia, hyperthyroidism, increased CO (e.g. ROSC)

Q: What causes a decreased etCO2?
A: Increased ventilation, arrest, decreased temp, increased sedation, paralysis, PE

Q: When can extubation be performed w.r.t. train of 4?
A: Once >0.9

Q: What is the dose of adrenaline in paediatric ALS?
A: 10mcg/kg

Q: What is the dose of amiodarone in paediatric ALS?
A: 5mg/kg

Q: What age gets adult ALS?
A: 9 years old and up

Q: Who gets neonatal resuscitation?
A: Newborns and first hours of life only

Q: What proportion of paediatric cardiac arrest presents in VF?
A: 10%

Q: When should single rescuer get help first for paediatric arrest?
A: If witnessed sudden arrest

Q: What is the approximate weight of a newborn?
A: 3.5kg

Q: What is the approximate weight of a 1 year old?
A: 10kg

Q: What is the weight formula for under 9's?
A: Age x 2 + 8

Q: What is the weight formula for over 9's?
A: Age x 3.3kg

Q: What is the adrenaline infusion dose for paediatrics?
A: 0.05-0.5mcg/kg/min

Q: What is the atropine dose for paediatrics?
A: 20mcg/kg IV q5min up to 3mg total dose

Q: Dose of glucose for hypoglycaemia in children?
A: 2.5mL/kg of 10% dextrose or 0.5mL/kg of 50% via CVL

Q: Dose of Mg in paediatrics for TdeP
A: 0.1mmol/kg IV followed by 0.075mmol/kg/hr infusion

Q: Dose of K for hypokalaemia in paediatrics?
A: 0.05mmol/kg IV slow push followed by 0.3mmol/kg/hr infusion if critically low

Q: Dose of adenosine in paediatric SVT
A: 0.1 / 0.2 / 0.3mg/kg up to 12mg

Q: Cuffed tube size in newborns >3kg and <1yo
A: 3.0mm

Q: Cuffed tube size in 1-2yo
A: 3.5mm

Q: Cuffed tube size formula
A: Age /4 + 3.5

Q: Can IO be used for VBG?
A: pH, Na and Bicarb only

Q: Target BP post-ROSC in paediatrics
A: 5th centile for SBP
= 70 + Age x 2

Q: What is the dose of adrenaline in neonatal resus?
A: 10-30mcg/kg (0.1-0.3mL/kg of 1:10 000)

Q: What is the target SpO2 post-delivery at 1 min?
A: 60-70%

Q: What proportion of newborns require resus?
A: 5%

Q: Which babies are recommended for delayed cord clamping?
A: Pre-term babies that do NOT require immediate resuscitation

Q: How should pulse be checked in newborn?
A: Auscultation (then SpO2 monitor)

Q: When is mec suctioning recommended?
A: Never. Not even in non-vigorous newborns with mec-stained liquor

Q: What pressures should be used for PPV in newborns?
A: 30cmH20 (20-25 in preterm)

Q: What PEEP is recommended for newborn resuscitation?
A: 5cmH20

Q: What ventilation rate is used for PPV in neonatal resus?
A: 40-60/min

Q: Indications for intubation in neonatal resus
A: Born without detectable HR, congenital diaphragmatic hernia, extremely LBW, ventilation failing by other means

Q: ET sizing in neonates
A: Gestational age / 10

Q: Blade size for neonates
A: Size 1 for term
Size 0 for <32 weeks

Q: When are APGARs performed?
A: At 1 minute, 5 minutes then every 5 minute

Q: Normal glucose in neonate
A: >2.5

Q: Which neonates get induced hypothermia?
A: 35 weeks or more with moderate-severe HIE. Need all 3 of:
 - Prolonged resus >10 min
 - APGAR <=5 at 10 min
 - pH <7.0 or BE >-12 at or just after birth

Q: Why is it important to fluid resuscitate adequately before vasopressor use in pregnant women?
A: Umbilical arteries must be fully dilated and blood flow is pressure dependent

Q: What makes pregnant females difficult to intubate?
A: Airway oedema
Weight gain
Difficult BVM
Rapid desaturation due to increased MR and decreased FRC
Reduced lower oesophageal tone, increased IAP, reduced gastric emptying

Q: How quickly short perimortem C-S be performed?
A: Within 5 min of maternal death ideally

Q: What are the proven benefits of NIV in APO?
A: Reduced intubation rates
Improves cardiac output
Reduced mortality
Reduced hospital LOS

Q: Does NIV in APO reduce mortality?
A: No short-term mortality benefit proven

Q: What defines electrical capture?
A: Spike, then QRS with consistent ST segment and T wave in opposite direction

Q: What are the effects of dopamine?
A: <5mcg/kg/min: D1 and D2 splanchnic vasodilation
5-10mcg/kg/min: Beta-1 and Beta-2 inotropy
>10mcg/kg/min: Alpha agonist

Q: What receptors does noradrenaline act on?
A: Alpha-1, Beta-1 and minimal Beta-2

Q: What receptors does isoprenaline act on?
A: Non-selective Beta agonist

Q: What are the criteria for DKA?
A: pH <73, HCO3 <15, moderate ketones, BSL >13.8, AG >10

Q: Normal A-a gradient for age
A: Age/4 + 4

Q: How much K to add in DKA?
A: 10mmol/hr if 4-5.2;
30mmol/hr if 3.0-4.0;
40mmol/hr if <3.0

Q: Maximum concentration of K peripherally?
A: 10mmol/100mL minibags

Q: Maximum rate of K without monitoring
A: 10mmol/hr burette or 20mmol/hr infusion pump

Q: When is dextrose added in DKA management?
A: BSL <14

Q: Target BSL in DKA
A: 8.3 - 11

Q: Synchronised DC shock for paediatric SVT
A: 0.5-2J/kg

Q: Changes to resus in hypothermia
A: Cease defib and adrenaline after 3 cycles until >30 degrees
Double dose interval of adrenaline if 30-35 degrees

Q: Calcium dose in CCB toxicity
A: 20mL 10% calcium chloride or 60mL 10% calcium gluconate over 10 min q20min up to 3 doses

Q: Target SBP in head injury trauma
A: >110mmHg in 18-49yo + >70yo
>100mmHg in 50-69yo

Q: Target INR in trauma
A: <1.5

Q: Target fibrinogen in trauma
A: >1.5

Q: Dose of desmopressin for platelet fx
A: 0.3mcg/kg IV

Q: What can IO blood be tested for accurately?
A: Hb ABO Rh
Na, Cl, Glucose, Bili
pH, HCO3
BC

Q: What can IO blood not be tested for accurately?
A: WCC, Plt
pCO2, PO2
K, AST, ALT, ALP

Q: What measures can be performed to prevent reperfusion deterioration in compression injury?
A: Pre-decompression bicarb 1mmol/kg IV, calcium chloride 10mL 10% and fluid resuscitation

Q: Dose of intralipid in LA toxicity
A: 1.5mL/kg then 15mL/kg/hr for 1 hour
Can repeat bolus up to 2 times
Can double infusion rate if hypotensive