ALS.txt

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

300mg before 4th shock in shockable rhythm

only in non shockable rhythm if HR<60, give 3mg ONCE ONLY

• 1. tracheal deviation away
• 2. hyperresonant percussion
• 3. absent breath sounds on affected side

• thoracocentesis
• large bore cannula in 2nd ic space
• decompress tension
• now its normal PT
• put chest drain in

potassium up to 40mmol in 100ml of 0.9% NaCl as SLOW INFUSION

• when there is NO DEFIBRILLATOR
• must have an ECG monitor to say its VF or pulseless VT
• must have a witness

• 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

• 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

• 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

electrical alternans, low voltage QRS

5th or 6th ic space do pericardiocentesis

• 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