5. Adult Resus Flashcards
Cardiac arrest with rhythm of VF or pVT often from what source?
heart
Nontraumatic cardiac arrest: List 4 cardiac causes
cad
cardiomyopathy
structural abnormality
valve dysfunction
Nontraumatic cardiac arrest: List 8 respiratory causes
Hypoventilation: cns dysfunc, nm disease, toxic and metabolic encephalopathies
upper airway: cns dysf, fb, infection, trauma, neoplasm
pulmonary dysf: asthma, copd, pulmonary edema, pe, pneumonia
Nontraumatic cardiac arrest: List 7 circulatory
mechanical obs: tension pneumo, tamponade, pe
hypovolemia: hemorrhage
vascular tone: sepsis, neurogenic
Nontraumatic cardiac arrest: List 4 metabolic causes
lyte abnorm: hypo or. hyperk, hypermag, hypo mag, hypoca
Nontraumatic cardiac arrest: List 8 toxic causes
- prescription meds: anti dysrh, digoxin, beta blockers, ccb, tca
- drug use: cocaine, heroin
- toxins: co, cyanide
Nontraumatic cardiac arrest: List 4 environmental causes
lightning
electrocution
hypothermia or hyperthermia
drowning or near drowning
Key hx of cardiac arrest - bystander q:
event
pt doing
drug ingestion
cpr
initial cpr
ecg
interventions
pmhx SAMPLE
PE of cardiac arrest
General, airway, neck, chest, lung, heart, abdo, rectal, extremities, skin
Goal of CPR
maintain perfusion until ROSC achieved
CPR important qualities adults
100-120 comp per min, depth 5-6cm, chest compression fracture at least 80% ie performed 80 out of 100 of pulseless interval
full recoil between
in hosp 30:2 ventilation
PEA 2 further characterizations:
1)
2)
1) electromechanical dissoc (no Myoc activity)
2) pseudo EMD (myoc contraction occurs but is inadequate, no pulse palpable)
distinguish by echo
Causes of pseudo EMD
cardiac: pap m and myocardial wall rupture
hypovol, PE, PTX, tamponade
A mnemonic “4 H’s and 4 T’s” is often referenced to aid in rapidly identifying reversible etiologies of PEA arrest: hypoxia, hypovolemia, hypo/hyperkalemia, hypother- mia, thrombosis (pulmonary embolism), tamponade (cardiac), toxins, and tension pneumothorax.
**
vF or pVT refractory to defib 2 meds and doses
(first dose: 300 mg IV/IO; second dose: 150 mg IV/IO) or lidocaine (first dose: 1 to 1.5 mg/kg IV/IO; second dose: 0.5 to 0.75 mg/kg IV/IO)
Magnesium sulfate dose in Torsades
2-4g IV
NaBicarb in TCA OD
1-2mEq/kg
List 5 indicators of inadequate blood flow during CPR
- carotid/fe pulse not palpable
- coronary perfusion pressure <15mmhg
- arterial relax/diastolic press ,20-25
- PETco2 <10
- CVO2 <40%
At what etco2 should compressors work harder?
<10 = bad
What is SVO2?
oxygen remaining in blood after systemic extraction
Because oxygen consumption remains relatively constant during CPR, as does arterial oxygen saturation (Sao2) and hemoglobin, changes in Scvo2 reflect changes in oxygen delivery by means of changes in __ __
cardiac output.
Common complications of ECMO
coagulopathy, hemorrhage, limb ischemia, vascular injury, renal replacement therapy, and stroke
Pt with STEMI findings post ROSC?
asa, antiplt
cath
Goals post ROSC from cardiac arrest
ecg
maintain o2 - 94-98%
maintain bp - map 70-100, cvp 10-15
hbg >/70
lact <2
temp 36
u/o
- Which of the following statements regarding the epidemiology of out-of-hospital cardiac arrest is true?
a. Most patients have an automated external defibrillator applied
prior to emergency medical services (EMS) arrival.
b. Most patients receive bystander CPR.
c. Most surviving to hospital discharge will not have major per-
sistent neurologic deficits.
d. Only 2% of EMS-treated out-of-hospital cardiac arrests survive
to hospital discharge.
c
. It is estimated that 180,000 patients are treated for out-of-hospital cardiac arrest each year in the United States. The number of patients receiv- ing bystander cardiopulmonary resuscitation (CPR) remains low, averag- ing 40%. The proportion of emergency medical services (EMS)–treated cardiac arrest patients with an initial shockable rhythm has declined over time to 18% in recent US studies. Automated external defibrillators are applied in a minority of cases prior to EMS arrival. Recent epidemiologic data from cardiac arrest registries indicate the survival rate to hospital dis- charge for EMS-treated, out-of-hospital cardiac arrest is about 10%. Of patients surviving to hospital discharge, independent of neurologic status on presentation, 79% have good neurologic function.
Which of the following statements regarding hypothermic targeted temperature management (HTTM) in comatose survivors of car- diac arrest is true?
a. Gradual rewarming should occur over 4 hours.
b. Pregnancy is an absolute contraindication.
c. Prolonged pharmacologically induced paralysis without seda-
tion is often required to control shivering.
d. Target core body temperature should be 32° to 36°C.
d
- A 75-year-old man presents with return of spontaneous circulation
(ROSC) after 2 minutes of ventricular fibrillation and successful defibrillation by EMS. The patient is unresponsive to verbal and pain- ful stimuli. Vital signs on arrival are pulse, 120 beats/min; blood pres- sure, 130/70 mm Hg; respiratory rate, 10 breaths/min; temperature, 36°C (96.8°F); and oxygen saturation, 94%. The patient has intrave- nous access. The next most appropriate examination or procedure is: a. Anteroposterior (AP) chest radiograph
b. Arterial blood gas (ABG)
c. Comprehensive neurologic examination d. Electrocardiography
d
- For end-tidal pressure of carbon dioxide (PETco2) to be a reliable indicator of cardiac output during cardiac arrest, which of the fol- lowing must be present?
a. Mechanical chest compressions must be performed.
b. The patient must be in asystole.
c. The patient must be normothermic
d. The patient must have relatively constant minute ventilation
d
- Which chest compression/ventilation ratio is recommended during adult resuscitation efforts performed by health care professionals before placement of an advanced airway?
a. 10:1
b. 20:1 c. 20:2 d. 30:2
d
