1. CPR Flashcards
PCAS
Post cardiac arrest syndrome
Chain of survival
1) Early recognition and call for help
- to prevent cardiac arrest
2) Early CPR
- to buy time
3) Early defibrillation
- to restart the heart
4) Post CPR therapy
- to restore quality of life
Call CPR team - say
1) Your name
2) What happened (ongoing cpr)
3) Where you are
- how to get there
Detailed (building, floor, corridor)
CPR team devices
- Defibrillator
- CPR equipments
High quality chest compressions
- At least 100/min (not over 120/min)
- At least 5 cm deep (not over 6 cm)
- Release pressure totally
- Minimize interruptions (communication)
CoCPR
Compression only CPR
AED
Automated external defibrillator
- Cheap, easy, safe
ABCDE
A: Airways B: Breathing C: Circulation D: Neurological disability E: Environment/event
OMV
Oxygen, monitor, vein
SBAR
- Request/recommendation
- Assessment
- Background
- Situation
DNAR (BLS)
-
ALS - when to shock
Assess rhythm every 2 minutes (shockable vs non-shockable)
Shockable rhythm
Pulseless VT and VF
Non-shockable rhythms
PEA and asystole
Chest compressions during shocking patient
- Chest compressions during charging
- Pause max 5 sec
What energy of shock?
1) According to description on device!
2) If unknown;
- Biphasic defibrillator: 200J+360J (or max)
- Monophasic: all shocks 360J
Max time allowed to pause chest compressions when using defibrillator
5 sec
Chest compressions with advanced airway in place
Continuous
Medications to give during ALS
- Adrenaline every 3-5 min
- Amiodarone after 3 shocks
Reversible causes of heart arrest
4 Hs and 4 Ts
1) Hypoxia
2) Hypovolemia
3) Hypo/hyperkalemia + metabolic
4) Hypo/hyperthermia
1) Thrombosis
2) Tension pneumothorax
3) Tamponade (cardiac)
4) Toxins
Correction of hypokalemia
Mg + K
Correction of hyperkalemiaa
Ca2+
How to recognize ptx
Auscultation
CPR devices
- LUCAS
- AutoPulse
IV during ALS
- Peripheral first if not established yet
- Central line best if already established
Peripheral venous access - which veins to avoid
Distal of cubitalis or diaphragm
Intraosseous devices
- FAST (hedgehog)
- BIG (gun)
- EZ-IO (drill)
When and how much drug to give during ALS
Shock #3
- 1 mg epinephrine
- 300 mg amiodarone
Shock #5
- 1 mg epinephrine
- 150 mg amiodarone
Shock #7
- 1 mg epinephrine
NTS
Non-technical skills
- e.g team work, communication
RoSC
Return of spontaneous circulation
PCAS / post cardiac arrest treatment (6)
1) ABCDE
2) Aim for O2 of 94-98 %
3) Aim for normal PaCO2
4) 12-lead ECG
5) Treat precipitating cause(s)
6) Targeted temperature management
Severity of PCAS is related to
- degree of ischemia
- cause of cardiac arrest
- patient´s condition before cardiac arrest
Ventilation numbers
- etCO2: 35-40 mmHg
- paCO2: 40-45 mmHg
Spontaneous breathing activity =
Does NOT equal «adequate breathing»
Visible breathing =
Respiratory insufficiency (when ventillation makes WOB cease = adequate treatment)
With intubation we bypass
- The warming and moisturing function (nose)
- The auto-PEEP (3-5 cmH20)
- The mucociliary clearance of airways
With intubation we increase:
- Airway resistance (R~I; R~1/r^4) «straw»
- WOB (work of breathing)
Target MAP
65-90 - (-100) mmHg
Target Tcore
32-36 degrees (celcius)
Post cardiac arrest temperature control duration
24 hours
Methods of temperature control in post cardiac arrest pts
- 30 ml/ttkg
- 4 degr celcius crystalloid
- (1,5 degr celcius / 30min)
Use of Mg in maintenance of normothermia
Decreases shivering treshold
Maintenance of normothermia
- Sedation +/- neuromuscular blockade
- Mg (decrease shivering-treshold)
