Advanced Cardiac & Special Circumstances

Question 0

What are the 4 H’s in reversible causes of cardiac arrest?

Answer 0

Hypoxia
Hypovolaemia
Hyperthermia/hypothermia
Hyper/hypokalaemia

Question 1

What is agonal breathing?

Answer 1

Abnormal pattern of breathing/ last dying breaths

Question 2

Describe ways to correct Hypoxia as a cause of cardiac arrest.

Answer 2

Ensure good airway management
Oxygenation
Ventilation

Question 3

Describe how to correct hypovolaemia as a cause of cardiac arrest

Answer 3

Bolus of 20ml/kg of saline IV/IO

Question 4

Describe how to correct hypo/hyperkalaemia calcaemia (metabolic disorder) as a cause of cardiac arrest

Answer 4

2.5ml/kg of 10% IV Dextrose to a maximum of 100ml

Question 5

Describe how to correct hypo/hyperthermia as a cause of cardiac arrest

Answer 5

Commence passive warming or cooling

Question 6

What are the 4 T’s in relation to correctable causes of cardiac arrest?

Answer 6

Tamponade
Tension pneumothorax
Toxins
Thrombosis

Question 7

Describe corrective measures of tension pneumothorax in CA

Answer 7

Bilateral chest decompressions (thoracocentesis) in the presence do asthma and chest trauma

Question 8

Which causes of cardiac arrest need to be managed at the hospital

Answer 8

Tamponade- mechanism of injury/history
Toxins- mechanism of injury/history
Thrombosis- as above

Question 9

Resuscitation attempts need to be modified for special circumstances in cardiac arrest. Name the 5 circumstances

Answer 9

Hypothermia
Drowning
Asthma
Anaphylaxis
Pregnancy

Question 10

What is management for a patient in CA due to hypothermia?

Answer 10

Remove from cold environment
Commence with passive warming
Handle patient with care to prevent VF
Temp 30.
Double intervals between dose until temp reaches 35.
Defibrillation is unlikely or be successful in the hypothermic heart.

Question 11

Cardiac arrest in drowning occurs secondary to hypoxia/hypothermia. Describe how to manage.

Answer 11

Initial resuscitation
Consider c spine precautions 
O2 and fluid therapy
Consider regurgitation following resusc and maintain airway
Consider hypovolaemia and manage

Question 12

Pre hospital cardiac arrest in asthmatics is usually due to hypoxia as a result of severe bronchospasm and mucous plugging or bilateral pneumothorax. How to manage?

Answer 12

Moderate ventilation at 4-6 breaths per minute.
If chest hyper inflating during ventilations consider chest compressions to relieve trapped air.
Consider (paramedic) bilateral needle chest decompression if suspected tension pneumothorax are the cause for arrest.
Patient often hypovolaemic- treat with fluid therapy.

Question 13

Anaphylaxis can lead to death from respiratory arrest, due to airway compromise and distributive shock. Describe treatment for anaphylaxis cardiac arrest

Answer 13

Remove allergen.
Due to possible airway obstruction, early cricothyrotomy may be indicated.
Adrenalin dosages should not be altered if IM adrenalin has already been administered.

Question 14

How to modify resuscitation for a woman over 20 weeks pregnant?

Answer 14

Left lateral tilt is required.
Likelihood of regurgitation is increased, so secure airway required.
Chest compressions should be performed higher on the sternum due to upward displacement of the diaphragm and the abdominal contents.
Ventilation volumes may need reducing because of the mother’s elevated diaphragm.