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Cardiovascular Week 5 2016/17 > 5: Managing cardiac arrest > Flashcards

5: Managing cardiac arrest Flashcards

1
Q

What is a cardiac arrest?

A

Effective cessation of the heart (no blood flow –> oxygen delivered due to pump stopping)

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2
Q

What does a patient in cardiac arrest look like?

A

Unresponsive

Not breathing normally

No pulse

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3
Q

Which arrhythmias are common in most cardiac arrests

A

Ventricular fibrillation

Ventricular tachycardia

(shockable rhythms)

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4
Q

The majority of cardiac arrests are ___.

A

reversible

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5
Q

Cardiac arrests due to arrhythmias other than VT/VF tend __ to be shockable.

A

not

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6
Q

Most cardiac arrests are preceded by ___ in a patient’s condition.

A

deterioration

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7
Q

What are some examples of deteriorations which occur before a patient goes into cardiac arrest?

A

Hypoxia

Hypotension

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8
Q

If it is inappropriate to resuscitate a person in cardiac arrest, a ___ order will have been put on them.

A

DNAR (do not attempt resuscitation)

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9
Q

An important part of preventing cardiac arrest deaths is ___ ___ of what is occurring.

A

early recognition

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10
Q

Why do patients go into cardiorespiratory arrest?

A

ABC

i.e problems with oxygen delivery

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11
Q

What does D stand for in ABCDE?

A

Disability

i.e neuro problems

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12
Q
  1. Assess effects of treatment
  2. Initial assessment
  3. Reassessment
  4. Treat life-threatening problems

Arrange 1-4 in the correct order

A

2, 4, 1, 3

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13
Q

Before commencing ABCDE, make sure someone has called for ___

A

help

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14
Q

How are a patient’s vital signs recorded by ABCDE in a hospital setting?

A

NEWS score

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15
Q

What is the gold standard test for measuring a patient’s SaO2?

A

ABGs

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16
Q

How is a patient’s [Hb] measured in hospital?

A

Full blood count

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17
Q

Why can a patient’s tongue block their airway?

A

CNS depression

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18
Q

How can a patient’s disability be measured?

A

AVPU

Glasgow Coma Score (look for difference in pupils)

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19
Q

What should be given to a patient through a cannula as part of disability in ABCDE?

A

Glucose (if hypoglycaemic)

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20
Q

What are the three criteria for someone to be in cardiac arrest?

A

Unresponsive

Not breathing

No pulse

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21
Q

What is the difference between someone in respiratory arrest and someone in cardiac arrest?

A

Respiratory arrest - unresponsive, not breathing, have a pulse

Cardiac arrest - unresponsive, not breathing, no pulse

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22
Q

Respiratory arrest tends (to last a long time / not to last very long).

A

doesn’t last long

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23
Q

A patient in respiratory arrest, if untreated, will go into ___ ___ soon after.

A

cardiac arrest

24
Q

Which pulse should be taken while you check for breathing?

A

Carotid pulse

25
Q

Which type of breathing may be seen in cardiac arrest?

A

Agonal breathing

26
Q

In a hospital setting, if a cardiac arrest has been confirmed, who should be called?

A

Resuscitation team

27
Q

When swapping over with a partner while doing CPR, delay in restarting chest compressions should be no more than _ seconds.

A

5

28
Q

What should be used to monitor heart rate in advanced life support?

A

ECG

29
Q

Which types of arrythmia are shockable?

A

Ventricular fibrillation

Ventricular tachycardia

30
Q

Which arrhythmias are non-shockable?

A

Asystole / PEA

31
Q

Which rhythm is this?

How can you tell?

Is it shockable?

A

Ventricular fibrillation

Irregular, no recognisable QRS complexes, random frequencies and amplitudes

Yes

32
Q

Which rhythm is this?

How can you tell?

What are the two classifications?

Is it shockable?

A

Ventricular tachycardia

Rapid rate, constant QRS

Monomorphic and polymorphic (varies more)

Yes

33
Q

What should be done if you know a patient is in VF/VT cardiac arrest and a defibrillator is not available?

A

Precordial thump

34
Q

What is defibrillation?

A

Use of electrical current to “reset” the heart and restore sinus rhythm

35
Q

After a shock, CPR should be (continued / discontinued) unless the patient shows signs of life.

A

continued

36
Q

What should be reassessed after a shock has been delivered?

A

Cardiac rhythm

37
Q

When should adrenaline be given in advanced life support?

A

After 3rd shock, then every alternate shock after that (5th –> 7th…)

38
Q

Apart from adrenaline, what other drug should be given after the 3rd shock?

A

Amiodarone

39
Q

What rhythm is this?

How can you tell?

Is it shockable?

What else should you do?

A

Asystole

Pretty much a straight line

No

Give adrenaline IV every 2 cycles of CPR

40
Q

What rhythm is this?

How can you tell?

Is it shockable?

How do you reverse it?

A

Pulseless electrical activity (PEA)

There is ECG activity but no pulse (heart is not contracting or CO is very low)

No

Treat reversible causes and IV adrenaline every 2 CPR cycles, 3-5 mins

41
Q

What dose of adrenaline should be given in a cardiac arrest?

A

1 mg

42
Q

Why does adrenaline help during a cardiac arrest?

A

Vasoconstriction (increases BP)

Positive inotrope (increases heart rate)

43
Q

What dose of amiodarone should be given during advanced life support?

A

300 mg

44
Q

What are the four Hs (reversible causes)?

A

Hypoxia

Hypovolaemia

Hypo- anything (metabolic)

Hypothermia

45
Q

What are the four Ts (reversible causes)?

A

Thrombosis

Tension pneumothorax

Cardiac tamponade

Toxins

46
Q

What is cardiac tamponade?

A

Fluid in the pericardial space, doesn’t allow the heart to contract properly

47
Q

Does resuscitation stop after return of spontaneous circulation (ROSC)?

A

No

48
Q

What approach should be taken to look after a patient after ROSC?

A

ABCDE

49
Q

What treatment can actually improve outcomes (e.g limiting brain damage) in a person who is recovering from cardiac arrest?

A

Hypothermia (i.e cooling them down)

50
Q

What is the name for the syndrome encompassing post-cardiac arrest brain injury, myocardial dysfunction or ischaemia?

A

Post-cardiac arrest syndrome

51
Q

What is the target SpO2 range in a patient recovering from cardiac arrest?

A

94-98%

Unless T2 resp. failure - 88-92%

52
Q

How does the body regulate CO2 concentration in the blood if you have hypercapnia?

A

Hyperventilation (to blow off CO2)

53
Q

What is the name given to ‘normal CO2 concentration’ i.e that aimed for in patients recovering from cardiac arrest?

A

Normocapnia

54
Q

What is the target systolic BP in patients recovering from cardiac arrest?

A

> 100 mmHg

55
Q

Which drug can be used to elevate a patient’s heart rate and improve oxygen delivery?

A

Atropine

56
Q

What does PEA stand for?

A

Pulseless electrical activity

Cardiovascular Week 5 2016/17 (5 decks)

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