14. Pre-hospital cardiac arrest Flashcards
how long should you remain on scene for at an arrest until you transport the pt to hospital
ideally until ROSC achieved or until skills/ interventions only possible in a hospital environment are encountered
team approach to OHCA?
Position 1: airway at head of pt
Position 2: chest compressions + defib if needed at left side of pt
Position 3: chest compressions and access at pts right side
Position 4: team leader stands back and oversees only becoming involved if required
T/F: evidence suggests survival from OHCA is improved if tracheal intubation is achieved
false - no evidence for this
simple techniques e.g. bag-mask, SGA produce as good if not better outcomes
T/F: cricoid pressure should be used if tracheal intubation is being undertaken during CPR
false - do not routinely use, many pts have already aspirated and cricoid pressure can make intubation more difficult
what sized laryngoscope blade is appropriate for most adults
size 4 MAC
secure the tracheal tube at roughly what length?
approx 22cm
possible complications of tracheal intubation?
hypoxaemia (oxygenate between intubation attempts)
unrecognised oesophageal intubation (use waveform capnography to exclude)
endobronchial intubation (insert tube no more than the appropriate length, listen to breath sounds in both axillae, monitor tube position)
other sites that an oxygen probe can be placed it pt has cold extremities?
toes, nose, ear lobe, tongue or lip
T/F: SGAs minimise the risk of gastric distention compared to bag-masks
true
where is a chest drain for a tension pneumothorax usually inserted
5th IC space mid-axillary line
in patients receiving positive pressure ventilation with a tension pneumothorax, what treatment is preferred pre-hospital
thoracostomy (5th IC space midaxillary line) - it is less invasive, quicker and avoids complications associated with the chest drain itself
hypocarbia induced by ventilation (excess tidal volumes, RR, or both) can cause excessive cerebral vaso____
vasoconstriction and ischaemia
T/F: defibrillation is one of the few interventions that improves outcome from sudden cardiac arrest
true
application is time critical
mortality increases 10% for every minute’s delay
when attending OHCA as a solo responder, what should take priority: immediate rhythm assessment and defibrillation or airway and breathing interventions
immediate rhythm assessment and defibrillation
VF recurs in ___% of pts within 2 mins of successful termination and ____% of pts during the entire cardiac arrest
50
75
(give amiodarone after 3 defib attempts, irrespective of whether those episodes are concurrent or separate)
following any IV/IO drug given in cardiac arrest by a flush of what?
at least 20ml saline to facilitate drug delivery to the central circulation
T/F: mechanical chest compression devices are superior to manual chest compressions
false - routine use is not superior
examples of scenarios where mechanical chest compressions are needed?
acute MI and VF/ pVT refractory to 5 shocks where a decision is made to transport during arrhythmia to access PCI
hypothermic pt where prolonged resuscitation is considered
roles of waveform capnography?
monitor tracheal tube placement
early indication ROSC
ensuring high quality CPR
helping prognostication
criteria when it is appropriate to not start CPR in a cardiopulmonary arrest? (recognition of life extinct)
decapitation
massive cranial and cerebral destruction
hemicorporectomy
incineration (>95% full thickness burns)
decomposition/ putrefaction
rigor mortis and hypostasis
valid DNACPR in place
if, following ALS interventions, the pt has been persistently and continuously asystolic for ___ mins and all reversible causes have been identified and corrected, resuscitation may be discontinued
20
where practical, pts with what rhythms on ECG should be taken to the nearest cardiac arrest centre with ongoing CPR, minimising time on scene
VF/ pVT - because further treatment e.g. PCI may be successful
T/F: you should allow relatives to be present during the resuscitation attempt
true - providing they do not interfere with the clinical care
treat hypotension following ROSC with what
boluses of 250ml saline, repeated as necessary
following ROSC, in the event of severe haemodynamic instability unresponsive to atropine and/ or fluids and/ or pacing, consider what intervention?
inotropic support > boluses of adrenaline 0.05-0.1mg IV/IO titrated against BP and repeated as necessary
aim for initial SBP >100
during ventilation following ROSC, aim to maintain SpO2 at ___-___% and the end-tidal CO2 at ___-___kPa (values may be lower in pts with poor cardiac output)
94-98
4.6-6
T/F: if pt is pyrexial post-ROSC, using rapid high-volume cold IVF immediately
false - associated with increased incidence of re-arrest and pulmonary oedema
use passing cooling (do not cover with blankets, keep ambulance temperature no higher than ambient)
management of the combative pt post-ROSC (may be cerebrally irritated)
exclude hypoglycaemia
incremental doses of IV diazepam or IV midazolam may be indicated
anaesthetic support once in hospital
T/F: should aim to achieve ROSC on scene rather than transporting pt with ongoing resuscitation attempts
true - resuscitation in a moving ambulance is likely to be suboptimal
in those who achieve ROSC, or those who have not achieved ROSC in 20 mins but in whom resuscitation is being continued, aim to leave the scene ASAP
when transporting the pt to the hospital following ROSC, what position should they be in to optimise cerebral perfusio?
supine
feet first when coming down stairs
head up about 30 degrees
structured method to handover information during a pre-alert?
ATMIST
- age
- time of onset
- medical complaint/ mechanism of injury
- investigations/ injuries
- vital Signs
- treatment
Finish with ETA
