1. Cardiac Arrest & Post Cardiac Arrest Care Flashcards
For CPR quality we want greater or equal than _____ inches of movement and fast compressions greater or equal to ______/ min.
For CPR quality we want greater or equal than 2 inches of movement and fast compressions greater or equal to 100/ min.
We rotate compressors every ______ min.
2
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.
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.
What are the 3 things that must occur for ROSC to exist?
- pulse and BP return
- abtrupt sustained PET-CO2 greater or equal to 40
- spontaneous arterial pressure waves with intra-arterial monitoring
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.
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.
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.
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.
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
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
What are the 5 H’s of reversible causes:
Hypovolemnia
Hypoxia
Hydrogen ion–acidosis
Hypo or Hyperkalemia
Hypothermia
What are the 5 T’s of reversible causes:
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
If I suspect a cardiac arrest in a patient what do I do before I determine if the rhythm is shockable?
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
What do I do if the rhythm is not shockable?
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
If a rhythm coninues being not shockable after already seeing it once, what do I do?
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
If an unshockable rhythm becomes shockable, what do I do?
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
We give Epi after the _____ shock in a shockable rhythm (so after shock#_____).
We give Epi after the second shock in a shockable rhythm.
In a shockable rhythm, after we give Epi, we give the next shock, what do we do?
Give amiodarone 300 mg bolus (150 mg for second dose)
Treat reversible causes
After giving amiodarone, if the rhythm is shockable what series of events occurs?
Shock
Epi
Shock
Amiodarone
If I start CPR and the AED says there is a shockable rhythm, what do I do?
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
If from a cardiac arrest, I have determined ROSC, what is my first step?
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
What step follows the first step in ROSC?
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
What are the doses of Epi, NE, & DA in ROSC?
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
After we treat for hypotension, what do we check for?
We check to see if the pt can follow commands.
If the patient cannot follow commands, what do we do?
We do induced hypothermia with 4 C saline.
After this, we consider if there is high suspicion of an acute MI or a STEMI.
If the patient cannot follow commands, what do we do?
We consider if there is high suspicion of an acute MI or a STEMI.
If there is a suspicion of an acute MI or a STEMI, what do we do?
Coronary reperfusion
If there is NO suspicion of an acute MI or a STEMI, what do we do?
Advanced critical care
