ABCD of Emergency Cardiovascular Care (Chapter 1) Flashcards
Nonmodifiable (fixed) risk factors for cardiovascular disease (CVD)
Age, gender, heredity, race
Modifiable risk factors for CVD
Diabetes, elevated serum cholesterol levels, high BP, metabolic syndrome, obesity, physical inactivity, tobacco use
Contributing risk factors for CVD
Alcohol, inflammatory markers, psychosocial factors, stress
What does contributing risk factors mean?
Thought to increase risk, but exact role not yet known
Sudden loss of effective blood flow that is caused by cardiac and/or peripheral vascular factors
Cardiovascular collapse
Absence of cardiac mechanical activity
Cardiopulmonary (cardiac) arrest
How do you confirm cardiac arrest
Absence of pulse, unresponsiveness, apnea or agonal, gasping breathing
ECG shows a wide, regular QRS complex at a rate faster than 120 beats/min
Pulseless vtach
Irregular chaotic deflections that vary in shape and height on ECG but no coordinated ventricular contraction
Vfib
No cardiac electrical activity present
Asystole
Electrical activity is present on ECG, but central pulses are absent
Pulseless electrical activity (PEA)
Shockable rhythms
Vfib and Vtach
Nonshockable rhythms
Asystole, PEA
Links in the chain of survival
Early recognition and activation Early CPR Early defibrillation Effective advanced life support Integration of post-cardiac arrest care
Most common S&S of MI
Chest pain or discomfort, pain or discomfort in the arms or shoulder, SOB
Components of basic life support
Recognize signs of cardiac arrest, MI, stroke, foreign body airway obstruction (FBAO)
Relief of FBAO
CPR
Defibrillating with an AED
Two components of the driving pressure through coronary arteries
Aortic BP and RA pressure; remember, veins drain into the RA so if the pressure is high in the RA, blood flow through the coronary arteries will decrease
Determinants of vascular resistance in the coronary vessels
BV radius and degree of external pressure caused by myocardial contraction and relaxation
When does most coronary blood flow occur
Diastole
Blood pressure range maintained by autoregulation of coronary vessels under normal conditions
60-180 mm Hg
Systole and diastole correspond to what during CPR
Systole when you are compressing the chest and diastole is when you release
2 most crucial components to neurologically normal survival during cardiac arrest.
Maintenance of coronary and cerebral perfusion
Limiting factor in delivery of O2 to tissues in cardiac arrest
Blood flow; arterial oxygen content is normally adequate to perfuse tissues
After you determine that CPR is indicated, what should be the initial action performed?
Chest compressions (yes, even before opening airway or giving ventilations)
This enables the delivery of O2 that is already present in lungs to brain and heart
CO compared to normal during CPR
25-33%
How far should you push in a victims chest during CPR
2 inches in children and adults, 1.5 inches in infants
What is the appropriate compression rate for CPR
100 compression/min
Likelihood of successful resuscitation during cardiac arrest determined by what
Speed with which CPR and defib are performed
Did placing an AED in homes improve overall survival?
Not really
How long should you check for a pulse?
10 seconds
Where should you check for a pulse in an infant
Brachial a.
Where should you check for a pulse in a child
Carotid or femoral aa.
Where should you check for a pulse in an adult
Carotids
Compression:ventilation ratio for infants and children if one rescuer
30:2
Compression:ventilation ratio for infants and children if 2 rescuers
15:2
Compression:ventilation ratio for adults
30:2
What to do if an infant is choking
5 back blows (slaps) followed by 5 chest thrusts in rapid sequence
3 phases of cardiac arrest due to vfib
Phase 1 (electrical phase): Onset-5 minutes Phase 2 (circulatory phase or hemodynamic phase):5-15 minutes Phase 3 (metabolic phase): 5 minutes and beyod
During which phase of cardiac arrest due to vfib is defibrillation most important
Phase 1 (electrical phase)
High quality CPR compressions are most important during which phase of cardiac arrest due to vfib
Phase 2 (circulatory phase)
When are low-quality CPR compressions most important?
When you want the patient to die
What can you do to improve perfusion pressures during vfib cardiac arrest
Give vasopressors
What can excessive ventilation in vfib cardiac arrest do?
Increase the intrathoracic pressure and decrease venous return to the heart
What should you do to comatose survivors of cardiac arrest?
Cryogenic stasis (therapeutic hypothermia)
Therapeutic hypothermia important during which phase?
Metabolic (Phase 3)
Cardiocerebral resuscitation (CCR) consists of what
High quality, minimally interrupted chest compressions, delayed active ventilation, early epinephrine administration
Ratio of chest compressions to shock in CCR
200:1
When do you intubate the pt in CCR
After 3 cycles of chest compressions
What is the best CCR song
Fortunate Son
ABC’s of general impression
Appearance, Breathing, Circulation
Rapid hands-on assessment that takes less than 60 seconds
Primary survey
ABCDE’s of primary survey
Assess responsiveness Airway Breathing Circulation Defib and Disability Exposure
AVPU; what does it stand for and what does it assess
Alert, Verbal stimuli (responds to), Painful stimuli (responds to), Unresponsive
During what part of the primary survey would you obtain a Glasgow score
Defib and disability
Use what technique to open the airway
Head tilt-chin lift
Use what technique to open the airway if trauma is suspected
Jaw-thrust
When should you repeat the primary survey
Sudden change in pt condition Interventions don't appear to be working Vital signs are unstable Before any procedures Change in rhythm on cardiac monitor
ABCDEF’s of 2ndary survey
Obtain vital signs, SAMPLE history Reassess Airway Reassess Breathing Reassess Circulation Differential diagnosis/Diagnostic procedures Evaluate interventions, pain management Facilitate family presence
