The ALS Algorithm

Purpose of the ALS Algorithm

ED Patients Entering the Algorithm

Monitored and Unmonitored Areas

Shockable Rhythm Arm of The ALS Algorithm

Shockable Rhythm Arm of The ALS Algorithm – Further Issues

3 Topics

Which Anti-arrhythmic drugs?

Paddle position in resistant VF

Fine VF or Asystole?

Non-shockable Rhythm Arm of The ALS Algorithm

Non-shockable Rhythm Arm of The ALS Algorithm – Reversible Causes of PEA

Non-shockable Rhythm Arm of The ALS Algorithm – Further Issues

3 Topics

The ALS Algorithm

The ALS Algorithm

The ALS Algorithm The ALS Algorithm

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Question 1 of 10

1. Question
1 point(s)
Which of the following is the only intervention proven to improve survival to hospital discharge after cardiac arrest?
- Effective CPR and early defibrillation
- Early defibrillation and amiodarone
- Early defibrillation and adrenaline
- Intubation and effective CPR
- Intubation and early defibrillation
Question 2 of 10

2. Question
1 point(s)
Which one of the following statements regarding CPR is false?
- Chest compressions should briefly pause to allow ventilation if the patient is not intubated
- Adrenaline should be given about every 4 minutes
- If a shock appears to have successfully converted ventricular fibrillation on the monitor, check the pulse
- Chest compressions will not induce ventricular fibrillation
- A 15:2 compression/ventilation ratio plays no part in the current ALS algorithm
Question 3 of 10

3. Question
1 point(s)
All of the following statements regarding drugs and fluids in cardiac arrest are true except one.

Which one is false?
- There is no evidence that vasopressin is superior to adrenaline as a vasopressor
- Sodium bicarbonate should be reserved for the treatment of tricyclic antidepressant overdose
- 5% dextrose should be avoided as the fluid agent of choice in hypovolaemia
- 10% calcium chloride is preferable to 10% calcium gluconate as it provides a higher available calcium dose
- CPR should be continued for at least 60 minutes if thrombolysis is given for suspected massive pulmonary embolus
Question 4 of 10

4. Question
1 point(s)
All of the following statements regarding intubation are true except one.

Which one is false?
- Intubation attempts should take no longer than 60 seconds
- Intubation can be deferred until return of spontaneous circulation if ventilation via bag-mask appears adequate
- Laryngeal mask airway and laryngeal airway are both acceptable alternatives to the tracheal tube
- Successful tracheal tube placement enables continuous chest compressions during CPR
- End-tidal CO2 analysis is required to exclude oesophageal intubation
Question 5 of 10

5. Question
1 point(s)
A 50-year-old man with an inferior myocardial infarction has been thrombolysed in the resuscitation room. He is awaiting a coronary care bed when he is witnessed to groan, turn pale and become unconscious. His rhythm shows ventricular fibrillation.

Which is the most appropriate next move?
- Start CPR
- Check his pulse
- Deliver a precordial thump
- Defibrillation
- Intubation
Question 6 of 10

6. Question
1 point(s)
An 80-year-old woman is presented in cardiac arrest by the paramedics. She originally complained of breathlessness and was hypotensive on paramedic arrival. She has a history of hypertension, atrial fibrillation and ischaemic heart disease. Her medicines include warfarin, bendrofluazide, a statin and a beta blocker. The crew have secured an IV cannula and given her high flow oxygen. She has received basic life support for PEA for 10 minutes. Bag-mask ventilation appears effective. Her heart rate reads 55 bpm.

Which of the following interventions is the least appropriate during the first 2 minutes in the resuscitation room?
- Atropine 1 mg
- Magnesium 2 g
- A 500 ml saline bolus
- A venous blood gas analysis
- Intubation
Question 7 of 10

7. Question
1 point(s)
All of the following statements regarding end-tidal carbon dioxide analysis are true except one.

Which one is false?
- The value is likely to change following sodium bicarbonate administration
- It may identify any return of spontaneous circulation before pulses are palpated
- A value less than 3 kPa indicates poor quality CPR
- Levels may be undetectable in massive pulmonary embolus
- A positive reading confirms that tracheal tube placement lies below the cords
Question 8 of 10

8. Question
1 point(s)
Which of the following statements regarding defibrillation is false?
- Placement of the paddles on the lateral chest walls (one on the left, one on the right) is an acceptable alternative to the standard position
- Defibrillation is best avoided in fine ventricular fibrillation
- If a monophasic defibrillator is used, the initial energy selected should be 360 J
- Immediate defibrillation is advised if ventricular fibrillation is spotted during the pauses for ventilation in CPR
- Repeated shock should be avoided until core temperature is greater than 30°C in hypothermic patients
Question 9 of 10

9. Question
1 point(s)
Which of the following statements regarding shock resistant ventricular fibrillation is the most appropriate?
- Amiodarone 150 mg intravenously is the drug of choice
- Lignocaine 100 mg intravenously is a suitable drug
- Magnesium 2 mg intravenously should be given if there is a history of ischaemic heart disease or renal disease
- Adrenaline 1 mg should be given before each shock
- A precordial thump is worth trying
Question 10 of 10

10. Question
1 point(s)
Which of the following statements regarding patients in cardiac arrest is false?
- A 2 mg IV bolus of glucagon may benefit those in PEA routinely prescribed a beta blocker or calcium channel blocker
- Elevation of the patient's legs by 20° is likely to improve venous return and thereby coronary and cerebral perfusion
- The ALS manual recommends following each IV drug with at least 20 ml saline and arm elevation
- The intraosseous route is preferred to the tracheal route for drug delivery if peripheral venous cannulation has failed
- Ventilation at 15 bpm allows correction of the patient's mixed acidosis and is recommended once the patient's airway is secured

8 Comments

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Peter John David Gerard November 20, 2017 at 6:52 pm

Good study. Will update my knowledge of ALS logarithm

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barnesch June 7, 2018 at 11:04 am

Loved this thank you

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Dr. Tirtha Taposh Saha Roy August 25, 2021 at 10:47 am

Quite in-depth application of ALS knowledge

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Dr Rubia Sultana May 20, 2022 at 3:09 pm

Excellent resource for ALS

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Dr Adrian Boyle December 23, 2022 at 12:59 pm

Excellent, thank you

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Dr. Chenthil Selvi Kadarkarai January 15, 2023 at 9:32 pm

A quick recap of ALS.very useful.

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Dr Syed Shahbaz Ahmer February 27, 2023 at 12:37 pm

Great learning session

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Dr Sarah Anderson January 25, 2024 at 11:32 am

Thanks, great module and consolidation questions.

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