1. Cardiac Arrest & Post Cardiac Arrest Care

Question 1

For CPR quality we want greater or equal than _____ inches of movement and fast compressions greater or equal to ______/ min.

Answer 1

For CPR quality we want greater or equal than 2 inches of movement and fast compressions greater or equal to 100/ min.

Question 2

We rotate compressors every ______ min.

Answer 2

2

Question 3

In capnography, if PET-CO2 is less than ___ mm Hg or if intra-arterial diastolic pressure is less than ___ mm Hg we need to improve CPR quality.

Answer 3

In capnography, if PET-CO2 is less than 10 mm Hg or if intra-arterial diastolic pressure is less than 20 mm Hg we need to improve CPR quality.

Question 4

What are the 3 things that must occur for ROSC to exist?

Answer 4

1. pulse and BP return
2. abtrupt sustained PET-CO2 greater or equal to 40
3. spontaneous arterial pressure waves with intra-arterial monitoring

Question 5

For shock energy, a ______ shocker uses an initial dose of 120-200 J. Second and subsequent doses should be equivalent and higher doses may be considered.

A ______ shocker uses 360 J.

Answer 5

For shock energy, a biphasic shocker uses an initial dose of 120-200 J. Second and subsequent doses should be equivalent and higher doses may be considered.

A monophasic shocker uses 360 J.

Question 6

Epinephrine is given _____-_____ min, 1mg IV/IO.

Vasopressin IV/IO 40 units can _____ first or second dose of epi.

Amiodarone first dose is _____ mg bolus and second dose is 150 mg.

Answer 6

Epinephrine is given 3-5 min, 1mg IV/IO.

Vasopressin IV/IO 40 units can replace first or second dose of epi.

Amiodarone first dose is 300 mg bolus and second dose is 150 mg.

Question 7

An advanced airway consists of:

1) a ________ advanced airway or ________ intubation
2) Waveform ________ to confirm and monitor ET tube placement
3) ________ -________ breaths per minute with continuous chest compressions

Answer 7

An advanced airway consists of:

1) a supraglottic advanced airway or endotracheal intubation
2) Waveform capnography to confirm and monitor ET tube placement
3) 8-10 breaths per minute with continuous chest compressions

Question 8

What are the 5 H’s of reversible causes:

Answer 8

Hypovolemnia

Hypoxia

Hydrogen ion–acidosis

Hypo or Hyperkalemia

Hypothermia

Question 9

What are the 5 T’s of reversible causes:

Answer 9

Tension pneumothorax

Tamponade, cardiac

Toxins

Thrombosis, pulmonary

Thrombosis, coronary

Question 10

If I suspect a cardiac arrest in a patient what do I do before I determine if the rhythm is shockable?

Answer 10

Try to arouse the patient

See if he is breathing or if there are pulses

Shout for help & activate the emergency response system–get an AED

Start CPR

Give oxygen

Attach monitor/ defibrillator

Question 11

What do I do if the rhythm is not shockable?

Answer 11

The rhythm must be either Asystole or pulseless electrical activity.

Do CPR for 2 min

Seek IV or IO access

Give epinephrine, 1mg IV or IO, every 3 - 5 min

Consider advanced airway capnography

Question 12

If a rhythm coninues being not shockable after already seeing it once, what do I do?

Answer 12

Same as before:

The rhythm must be either Asystole or pulseless electrical activity.

Do CPR for 2 min

Seek IV or IO access

Give epinephrine, 1mg IV or IO, every 3 - 5 min

Consider advanced airway capnography

Question 13

If an unshockable rhythm becomes shockable, what do I do?

Answer 13

We must either be in V fib or V tach so we need to:

shock

do CPR for 2 min

Give Epi every 3-5 min OR give amiodarone

Treat reversible causes

Consider an advanced airway or capnography

Question 14

We give Epi after the _____ shock in a shockable rhythm (so after shock#_____).

Answer 14

We give Epi after the second shock in a shockable rhythm.

Question 15

In a shockable rhythm, after we give Epi, we give the next shock, what do we do?

Answer 15

Give amiodarone 300 mg bolus (150 mg for second dose)

Treat reversible causes

Question 16

After giving amiodarone, if the rhythm is shockable what series of events occurs?

Answer 16

Shock

Epi

Shock

Amiodarone

Question 17

If I start CPR and the AED says there is a shockable rhythm, what do I do?

Answer 17

We must either be in V fib or V tach so we need to:

shock

Do CPR for 2 min

Shock

Epi

Shock

Amiodarone

circle back

Question 18

If from a cardiac arrest, I have determined ROSC, what is my first step?

Answer 18

Optimize ventilation and oxygenation–do 10-12 breaths per min so breathe for patient every 5 - 6 seconds.

maintain oxygen sat at greater or equal to 94%

consider advanced airway and waveform capno (get PET-CO2 to 35-40 mm Hg)

do not hyperventilate

Question 19

What step follows the first step in ROSC?

Answer 19

Treat hypotension (get Systolic BP to greater than 90 mm Hg)

IV/IO bolus; 1-2 L normal saline or lactated Ringers

Vasopressor infusion: epi, NE, DA

Consider treatable causes

12-lead ECG

Question 20

What are the doses of Epi, NE, & DA in ROSC?

Answer 20

Epi is .1 - .5 mcg/kg/min

NE: .1 - .5 mcg/kg/min

For Epi & NE the dose is 7 - 35 mcg/ min in a 70Kg male.

DA: 5 - 10 mcg/kg/min

Question 21

After we treat for hypotension, what do we check for?

Answer 21

We check to see if the pt can follow commands.

Question 22

If the patient cannot follow commands, what do we do?

Answer 22

We do induced hypothermia with 4 C saline.

After this, we consider if there is high suspicion of an acute MI or a STEMI.

Question 23

If the patient cannot follow commands, what do we do?

Answer 23

We consider if there is high suspicion of an acute MI or a STEMI.

Question 24

If there is a suspicion of an acute MI or a STEMI, what do we do?

Answer 24

Coronary reperfusion

Question 25

If there is NO suspicion of an acute MI or a STEMI, what do we do?

Answer 25

Advanced critical care