3. Recognising deterioration and preventing cardiorespiratory arrest

Question 1

Survival after in-hospital cardiac arrest is more likely if the arrest is witnessed and monitoring, if the rhythm is (1), if the primary cause is (2), and the patient is successfully defibrillated immediately

Answer 1

1) VF/ pVT
2) myocardial ischaemia

Question 2

Patients often have slow and progressive physiological deterioration prior to arrest, particularly what two signs?

Answer 2

hypoxia and hypotension

Question 3

causes of airway obstruction?

Answer 3

CNS depression, blood, vomitus, foreign body, direct trauma to face/ throat, epiglottitis, pharyngeal swelling, laryngospasm, bronchospasm, bronchial secretions, blocked tracheostomy

Question 4

what are the main respiratory muscles?

Answer 4

the diaphragm and the intercostal muscles (the latter are innervated at the level of the their respective ribs and may be paralysed by a spinal cord lesion above this level)

Question 5

Spontaneous breathing cannot occur with severe cervical cord damage above what level?

Answer 5

C3 (because diaphragm innervated by C3,4,5)

Question 6

what is the commonest cause of sudden cardiac death?

Answer 6

an arrhythmia caused by either ischaemia or myocardial infarction

Question 7

drug causes of VF?

Answer 7

antiarrhythmic drugs, TCAs, digoxin

Question 8

what features indicate a high probability of arrhythmic syncope?

Answer 8

occurs in supine position, during or after exercise, with no/ brief prodrome, repeated episodes unexplained syncope, in individuals with a FH of SCD/ inherited cardiac condition