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Alberta Protocols > Adult - Cardiac > Flashcards

Adult - Cardiac Flashcards

1
Q

Withholding Resuscitation in a Traumatic cardiac arrest

A

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.

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2
Q

Pregnant Trauma patient considerations

A

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

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3
Q

Trauma Pt Saftey Considerations

A

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

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4
Q

S/S of poor tissue perfusion

A

Altered LOC
Dyspnea
Tachycardia
Peripheral and or central cyanosis
Ischemic Chest pain

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5
Q

Cardiogenic Shock

A

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

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6
Q

Obstructive Shock

A

Physical obstruction of the heart or great vessels
May be caused by tension pneumothorax, pulmonary embolism, or cardiac tamponade

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7
Q

Hypovolemic Shock

A

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

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8
Q

Distributive shock

A

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

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9
Q

Hs and Ts - Hs

A

1- Hypovolemia
2- Hypoxemia
3- Hydrogen Ion ( acidosis)
4- Hypokalemia
5- hypothermia

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10
Q

Hs and Ts - Ts

A

1- Tablets/ Toxins
2- Tamponade
3- Tension Pneumothorax
4/5- Thrombosis coronary/ pulmonary

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11
Q

Transport without ROSC criteria

A
  • 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
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12
Q

ideal / ROSC End Tidal CO2 range

A

30-35 mmHg

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13
Q

Facilities with ECMO capabilities

A

Alberta Children’s Hospital ( pts less than 15 ) - Calgary
Foothills Medical Centre ( Pts over 15 ) - Calgary
University of Alberta hospital- Edmonton

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14
Q

Unstable Pt in V Tach

A
  • Altered LOC
  • SBP less than 80
    -Ischemic Chest Pain
    -Significant SOB and or evidence of CHF
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15
Q

Adult Traumatic Cardiac Arrest Fluid Resuscitation rate

A

20 Mg/kg

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16
Q

None Competent PTs that cannot refuse transport

A
  • 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
17
Q

Fluid bolus for excited delirium

A

1000 ml

18
Q

Life threatening causes of abdominal pain

A

-Aortic aneurysm
-Peritonitis
-Uncontrolled GI Hemorrhage
-Acute MI

19
Q

Indications for withholding Resuscitation

A
  • 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
20
Q

Use Caution with fluid administration for the following PT’s

A

Head Injury
CHF
Elderly

21
Q

Nausea and Vomiting Fluid Rate

A

20 mg/kg to a MAX of 1000 mL

22
Q

Common causes of Autonomic Dysreflexia

A

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

23
Q

Interventions of Autonomic Dysreflexia

A
  • 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
24
Q

Hemophilia and Von Willebrand Disease considerations

A
  • DO NOT delay transport to complete wound packing
  • Administer clotting factor if the pt has it on them
25
Q

NSTEMI

A

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

26
Q

STEMI

A

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

27
Q

Patients most likely to present with atypical symptoms of MI

A
  • Elderly
  • Women
  • Diabetics
  • Young adults who abuse Cocaine or other sympathomimetic drugs ie speed
28
Q

O2 consideration for MI patients

A

Patients experiencing an MI should no receive O2 unless sp02 > 90 %
Titrated to improve sp02 no greater than 92%

29
Q

How to calculate MAP

A

Diastolic x 2 + Systolic
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3

Alberta Protocols (4 decks)

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