Adult (Non-traumatic)

Question 1

What are the clinical features of a non-traumatic adult cardiac arrest?

Answer 1

1. No signs of life:
   - Unresponsive
   - Inadequate respirations
   - Carotid pulse cannot be confidently palpated within 10 sec
2. Signs of inadequate perfusion:
   - Unresponsive
   - Pallor or central cyanosis
   - Pulse less than 40

Question 2

Outline the important information regarding early airway management.

Answer 2

• In patients who present with a patent airway, clear of vomitus and secretions, it is reasonable and appropriate to consider the early insertion of an i-gel device instead of providing ventilations with a BVM
• Once inserted, ventilations through an i-gel should occur at a rate of 10/min (one breath every 6 sec)

Question 3

Outline the important information regarding refined drug pharmacology prioritisation.

Answer 3

• In patients in non shockable rhythms, adrenaline (1mg IV) should be administered as soon as feasible
• In patients that present in a shockable rhythm, adrenaline should be withheld until 3 shocks have been delivered
• Patients in a shockable rhythm that is refractory to 3 shocks should be administered amiodarone (300mg IV) as a priority over adrenaline
• All drugs administered during cardiac arrest should be followed by a 10-20 mL flush of sodium chloride
• The routine use of large doses of normal saline should be avoided

Question 4

Outline the protocol for non-traumatic adult resuscitation.

Answer 4

Suggested medical aetiology OHCA

Is there a potential airway obstruction?
If yes, manage as per FBAO CPG

If no,
- Commence continuous chest compressions & apply defib pads

• Initiate rhythm analysis (1st analysis in AED mode)

Shockable rhythm (VF/pulseless VT)

1. Deliver single 200 J DCCS
2. Resume chest compression for 2 minutes
3. If refractory to 3 DCCS, consider:
   - IV/IO access
   - Amiodarone (300mg IV)
   - If STEMI identified, contact QAS consult line
   - Adrenaline (1mg IV)
   - Alternate pad position
   - MCCD application

Question 5

Outline the treatment protocol for non-traumatic adult resuscitation.

Answer 5

Suggested medical aetiology OHCA

Is there a potential airway obstruction?
If yes, manage as per FBAO CPG

If no,
- Commence continuous chest compressions & apply defib pads

• Initiate rhythm analysis (1st analysis in AED mode)

Shockable rhythm (VF/pulseless VT)

1. Deliver single 200 J DCCS
2. Resume chest compression for 2 minutes
3. If refractory to 3 DCCS, consider:
   - IV/IO access
   - Amiodarone (300mg IV)
   - If STEMI identified, contact QAS consult line
   - Adrenaline (1mg IV)
   - Alternate pad position
   - MCCD application
   - Special circumstances
4. If refractory to 5 DCCS, consider:
   - Amiodarone, 2nd & final dose (150mg IV)

Non-shockable rhythm (PEA/asystole):

1. Resume chest compressions for 2 min
2. Consider:
   - Adrenaline (1mg IV)
   - Reversible causes
3. If refractory to standard resus measures, consider:
   - IV/IO access
   - MCCD application
   - Contact the QAS consult line
   - Special circumstances

Manage as per ROSC or ROLE

Question 6

What are the reversible causes for an adult cardiac arrest?

Answer 6

1. Hypoxia
2. Hypothermia
3. Hypokalemia/hyperkalemia
4. Hydrogen ion (acidosis)
5. Toxins
6. Thrombus