14. Pre-hospital cardiac arrest

Question 1

Where should a chest drain be inserted?

Answer 1

5th intercostal space mid-axillary line

Question 2

What rate of mortality increase is associated with every minute delay in defibrillation?

Answer 2

Every minute delay is associated with increased mortality by 10%

Question 3

What is the rate of VF recurrence after successful termination?

Answer 3

1. 50% within 2 minutes
2. 75% during entire cardiac arrest

Question 4

After how long attempting to gain IV vascular access should IO be considered?

Answer 4

1. After 2 unsuccessful attempts
2. After 2 minutes

Question 5

Under what circumstances should CPR not be attempted?

Answer 5

1. When patient has valid DNACPR
2. When patient has condition associated unequivocally with death:
   * decapitation
   * massive cranial/cerebral destruction
   * hemicorporectomy (or similar massive injury)
   * incineration (>95% full thickness burn)
   * decomposition/putrefication
   * rigor mortis or hypostasis

Question 6

What factors are associated with better CPR outcomes?

Answer 6

1. Young age
2. MI
3. Reversible cause of cardiac arrest (e.g. PE, hypothermia)

Question 7

What should target oxygenation and PaCo2 levels be after ROSC?

Answer 7

1. 94-98% SpO2
2. 4.6 - 6kPa PaCO2