Adult - Cardiac Flashcards
Withholding Resuscitation in a Traumatic cardiac arrest
1- Asystole on initial rhythm interpretation.
2- Transportation time greater than 15 MIN ( may take response time, stand by time, and info from bystanders, dispatch and first responders into account for decision to initiate resuscitation.
Pregnant Trauma patient considerations
Greater than 20 Weeks Gestation
Tile back board 20-30 degrees to the patients left to use manual left uterine displacement in cases where there is CPR in progress
Fluid resuscitation are significantly greater
Trauma Pt Saftey Considerations
Spinal Restriction must not lead to delay on- scene and can be done enroute if required
SMR and C-Collar application are contraindicated in cases of isolated penetrating trauma
S/S of poor tissue perfusion
Altered LOC
Dyspnea
Tachycardia
Peripheral and or central cyanosis
Ischemic Chest pain
Cardiogenic Shock
Failure of the heart to pump effectively due to impaired left ventricular function
Usually occurs after MI causing substantial left ventricular impairment and in ROSC
Obstructive Shock
Physical obstruction of the heart or great vessels
May be caused by tension pneumothorax, pulmonary embolism, or cardiac tamponade
Hypovolemic Shock
Hemorrhagic: Diminished intravascular volume secondary to blood loss
non- hemorrhagic: Diminished intravascular volume from fluid losses such as GI sources, Renal, Skin ( burns) and third spacing
Distributive shock
Decrease in peripheral vascular resistance, can be caused by:
Anaphylaxis- Histamine release causes peripheral vasodilation and a fluid shift from intravascular spaces into the interstitial space
Neurogenic- Spinal cord injury results in unopposed vagabond tone
- Characterized by bradycardia and hypotension with warm dry skin
- Sepsis
-Endocrine
- Drug/ Toxin
Hs and Ts - Hs
1- Hypovolemia
2- Hypoxemia
3- Hydrogen Ion ( acidosis)
4- Hypokalemia
5- hypothermia
Hs and Ts - Ts
1- Tablets/ Toxins
2- Tamponade
3- Tension Pneumothorax
4/5- Thrombosis coronary/ pulmonary
Transport without ROSC criteria
- patient with LVAD left ventricular assist device
- patients with high index of suspicion for pulmonary embolus
- patients with persistent ventricular tachycardia (VT storm) despite multiple shocks
- traumatic cardiac arrest
-hypothermic cardiac arrest
ideal / ROSC End Tidal CO2 range
30-35 mmHg
Facilities with ECMO capabilities
Alberta Children’s Hospital ( pts less than 15 ) - Calgary
Foothills Medical Centre ( Pts over 15 ) - Calgary
University of Alberta hospital- Edmonton
Unstable Pt in V Tach
- Altered LOC
- SBP less than 80
-Ischemic Chest Pain
-Significant SOB and or evidence of CHF
Adult Traumatic Cardiac Arrest Fluid Resuscitation rate
20 Mg/kg
None Competent PTs that cannot refuse transport
- likely to cause harm to themselves
-likely to cause hard to others
-Significantly disabled due to acute illness or injury - Intoxicated due to drugs or alcohol
Fluid bolus for excited delirium
1000 ml
Life threatening causes of abdominal pain
-Aortic aneurysm
-Peritonitis
-Uncontrolled GI Hemorrhage
-Acute MI
Indications for withholding Resuscitation
- Valid goals of care designation order is present
- Cardiac arrest in mass casualty incident ( exception is electrocution )
- Obvious non-survivable conditions: Decapitation/ Dependent lividity
Rigor Mortis
Incinerated
Enviscerated
Decomposition
Frozen Solid - Situation where initiating resuscitation would place practitioner at risk, ensure safety before initiating resuscitation
Use Caution with fluid administration for the following PT’s
Head Injury
CHF
Elderly
Nausea and Vomiting Fluid Rate
20 mg/kg to a MAX of 1000 mL
Common causes of Autonomic Dysreflexia
1) Pounding Headache
2) Sweating above level of injury
3) Bradycardia
4)Flushing of the skin
5)Goose bumps below level of injury
6)Blurred Vision and or nasal congestion
7) Feelings of apprehension or anxiety
8) Pale and or coolness below level of injury
Interventions of Autonomic Dysreflexia
- Sit pt upright 90 degrees
- Loosen tight clothing/ zippers or restrictive devices
- Assess bladder for distension / bladder infection
- Assess all body areas to ensure pt isn’t in contact with a hard surface
- Assess bowls and GI
- Assess skin and feet for wounds/ pressure sores
- Assess for any infections
- Assess for pain
Hemophilia and Von Willebrand Disease considerations
- DO NOT delay transport to complete wound packing
- Administer clotting factor if the pt has it on them
NSTEMI
Non ST elevated MI
A partial occlusion of the coronary artery or a combination of coronary artery spasm with a thrombus, can cause infarction or cell death to some of the heart tissue supplied by that artery
ECG interpretation shows ST-segment depression or dynamic T- wave inversion, transient ST-segment elevation of less than 20 min is also included in this syndrome
STEMI
ST elevated MI
Death of the heart tissue due to a complete occlusion of coronary artery preventing blood flow to the area of the heart
Patients most likely to present with atypical symptoms of MI
- Elderly
- Women
- Diabetics
- Young adults who abuse Cocaine or other sympathomimetic drugs ie speed
O2 consideration for MI patients
Patients experiencing an MI should no receive O2 unless sp02 > 90 %
Titrated to improve sp02 no greater than 92%
How to calculate MAP
Diastolic x 2 + Systolic
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