Life support quiz

The actual correct sequence is Danger Response Send for help Compressions Airway Breathing. The ‘S’ was added in 20101 but unfortunately the ‘ABC’ sequence was not changed in the acronymn did not chang from DRSABC as this was thought to be potentially confusing for people already familiar with the ‘ABC’ sequence.

2 breaths should be given initially. Previous BLS guidelines advocated 5 initial breaths.

Depth of compression should be 5 – 6cm (>1/3 of the thoracic diameter). Ventilation compression ratio should be 2:30. The compression rate should be 100-120/min.

The pulse can be palpated as often as you like during CPR, however stopping CPR to perform a rhythm and pulse  check should only occur 2 minutes after each intervention in ACLS, and not at all in BLS. The pulse should be felt for no longer than 10 seconds in normothermic patients during a rhythm  check.

Early intubation is most likely harmful as some interruption of CPR is usually required. It is best deferred until the patient fails to respond to initial CPR and defibrillation attempts or demonstrates ROSC. Chest compressions should only be ceased at the time the intubator is about to insert the laryngoscope into the patient’s mouth and intubation should be achieved within 10 seconds. The initial dose of adrenaline is 1mg, repeated every 2 minutes.

Initial defibrillation should be attempted at any temperature, but if unsuccessful, active core rewarming techniques should be used until body temperature exceeds 30 degrees then recommence defibrillation as required

Post mortem Caesarian section should be commenced at 4 minutes during an arrest, with delivery achieved by 5 minutes. The risk of pulmonary aspiration increases with increasing gestational age. Apart from re-positioning, CPR technique is the same as for non pregnant patients.

Effective cardiac compression to maintain coronary perfusion is the most important of the choices given. Oxygenation is important, however coronary perfusion of poorly oxygenated blood is still better than no coronary perfusion of highly oxygenated blood. Ventilation is usually only required to maintain oxygenation, whilst restoration of normal acid base status is probably of no benefit and possibly harmful. Hypothermia may have a role to play following ROSC from ventricular fibrillation, but is never an initial priority.

A 10-20% reduction in compression depth occurs by 90 sec., despite operators not necessarily feeling fatigued. This is the reason that changing operators at least every 2 minutes (usually at the time of pulse check) is required.