ACLs/Cardiac Rhythms Flashcards
What is the chain of survival?
- Early recognition: look for signs of a cardiac arrest
- Call for help
- Early defibrillation: COACHED
- Early CPR → instead of ABC during cpr it is CAB
- Post resuscitation care
COACHED
(safe method for defibrillation)
compressions continue, oxygen away, all others clear, charging defibrillator, hands off, evaluating rhythm, defibrillate or disarm
How do we diagnose a cardiac arrest?
→ patient complaints of chest pain, dizziness, shortness of breath, nausea
→ Check pulse
→ ECG to see wave patterns (VF or VT are shockable while PEA and asystole require CPR)
Components of the ACLS algorithm
Start CPR
Attach the defibrillator
Assess rhythm
If it is shockable → shock then continue CPR = if rhythm comes back commence post resus care
If it is non shockable → continue CPR = if rhythm comes back commence post resus care
Describe the 2 shockable rhythms
Ventricular fibrillation (VF) →
- Bizarre irregular waveform
- No recognisable QRS
- Random frequency and amplitude
- Uncoordinated electrical activity
- Coarse/fine
- random
Ventricular tachycardia (Pulseless VT) →
- Monomorphic VT
- Broad complex rhythm
- Rapid rate
- Constant QRS morphology
- Wide = coming from ventricular and fast
- Polymorphic VT
Describe the 2 non-shockable rhythms
Asystole
- Absent ventricular activity
- Atrial activity may persist
- Rarely a straight-line trace
- Adrenaline 1mg IV immediately then every second loop
Pulseless electrical activity (PEA)
- Electrical activity looks like it should have a pulse but doesn’t
- Clinical features of cardiac arrest
- Adrenaline 1mg IV then every second loop
Causes of Cardiac Arrest
JUST 4H’S
HYPOXIA
- Decreased O2 concentration
- Pre-arrest SpO2
- Consider advanced airway
- Avoid hyperventilation (use capnography)
HYPER/HYPOKALAEMIA
- Electrolyte disorders (high and low potassium)
- Possible cause (diuretic use, D+V, kidney disease, medications)
- Latest lab results (medical history, drug chart, fluid input)
HYPOTHERMIA
- Critically ill patients may have disrupted thermoregulation
- Suspect an underlying cause
- Assess the patients core temperature
- Warm IV fluids
- Active rewarming treatment
- Consider cardiopulmonary bypass (ECMO) = warm blood externally
*Commonly caused by respiratory issue
HYPOVOLAEMIA
- Control haemorrhage (internal/external)
- Blood loss (give blood)
- Distributive shock (IV fluids)
Treat cause - (Wounds, Sepsis)
4T’S
TENSION PNEUMOTHORAX
- Air in intrapleural space
- Needle decompression
- Thoracotomy
- Follow up with ICC and chest drain
TAMPONADE (cardiac)
- Blood or fluid in pericardial space
- Needle pericardiocentesis
- Resuscitative thoracotomy
THROMBOSIS (pulmonary/coronary)
- Clot in pulmonary vein - PE
- Often caused by DVT/inactivity (SOB, hypoxia, arrhythmia)
- Fibrinolytic therapy, Percutaneous intervention
TOXINS
-Review medication charts
-Deliberate overdose
-Recreational drugs complicated by purity/polypharmacy
Treatment - naloxone
Post resus care
Re-evaluate ABCDE
- 12 lead ECG
- Treat precipitating causes (4 T’s, 4 H’s)
- Aim for Spo2 94-98%, normocapnia and normoglycaemia
- Temperature management > 32-36, sedation (control shivering)
- Circulation: Blood pressure goals > 100mmHg, fluids
- Injuries from CPR (broken ribs etc.)
- Brain injury (CT scan)
- Rehabilitation
- Cardiac arrest centres
Family/patient wishes
- Legal and ethical considerations (CPR vs. no CPR, organ donation, withdrawal of life support)
- Support
Nursing roles during ACLS
- Primary nurse (knows the pt.)
- Time of arrest call for help
- Commence CPR
- Handover to cardiac arrest team
- Stay with pt. - Second nurse
- Contact team
- Brings trolley - Third nurse
- Assists CPR and medications
- Documents treatment
Team leader, airway management, compressions, defib person, drugs x2 people (drawing up and an administer), scribe, documentation
Non-technical:
Structured communication (closed loop and definite), task management, team working, situational awareness, debrief after event
Common cardiac arrest drugs
(7 of them)
ADRENALINE (first line)
- Potent vasoconstrictor, 1mg IV push every 3 minutes, (VF, Pulseless VT, asystole, PEA) – increases rate and contractility
AMIODORONE
Prolongs action potential and slows sinus rate, IV push 300mg – additional 150mg as needed
(VF, VT, AF, or atrial flutter)
ATROPINE
Parasympathetic antagonist (blocks action of valgus nerve on heart), IV bolus 1mg every 3-5 mins
- For bradycardia
MAGNESIUM
Essential for membrane stability, Bolus dose = 55mmol x 2, Infusion = 22mmol every 4 hrs
- Digoxin toxicity
LIGNOCAINE
Antiarrhythmic sodium channel blocker, Bolus 1mg/kg
(VF, VT)
POTASSIUM
Electrolyte – essential for membrane stability, IV 5mmol bolus
MORPHINE
Vasodilator (reduces oxygen requirements)
