Advanced life support algorithm chapter 6 Flashcards
What is the sequence of treatment for VF/pVT?
1) confirm cardiac arrest
2) call the resuscitation team
3) perform uninterrupted chest compressions while applying the defibrillator pads
4) plan actions before pausing CPR and communicate with team
5) stop chest compressions, confirm VF/pVT from the ECG - this pause should be less than 5 seconds.
6) resume chest compressions immediately - everyone else to stand clear apart from person performing CPR
7) designated person selects correct energy on the defibrillator, and presses charge button.
8) ensure rescuer giving the compressions is the only person to be touching the patient
9) once defibrillator is charged, tell the rescuer to “STAND CLEAR”, when clear give shock
10) after shock delivered, re-commence CPR
11) continue CPR for 2 mins, the team leader should prepare for the next pause in CPR
12) pause briefly to check the monitor
13) if remains in VT/VF - repeat above to deliver 3rd shock. After the 3rd shock, give 1mg adrenaline + 300mg amiodarone
14) give further adrenaline 1mg IV after alternate shocks (approx 3-5 mins)
15) continue - if ROSC achieved start post-rests care
15) if PEA/asystole - switch to non-shockable rhythm pathway
when can further amiodarone be given in VT/VF?
150mg further amiodarone can be given, after the 5th shock if VT/VF persists
when is pericardial thump recommended to be given?
if there is significant delay in bringing the defibrillator
how is pericardial thump given?
ulnar edge of tightly clenched fist, deliver sharp impact to the lower half of the sternum from a height of around 20cm, then retract immediately
what is the sequence of resuscitation in Cath lab if a patient has VT/VF?
1) identify rhythm
2) give up to three successive shocks (stacked)
3) start chest compressions and continue CPR for 2 minis the third shock is not successful
Pathway of resuscitation for PEA or asystole?
1) start CPR 30:2
2) give adrenaline 1mg IV as soon as IV accesss achieved
3) continue CPR until airway secured
4) recheck rhythm after 2 mins
5) if remains in non-shockable rhythm, continue CPR for further 2 mins
6) re-check after 2 mins
7) give further adrenaline 1mg IV every 3-5 mins, during alternate 2 cycles of CPR
what is the criteria for high quality chest compressions?
depth of 5-6cm
rate of 100-120bpm
ensure full recoil of chest in between each compression
as soon as airway is secured, continue chest compressions without pause
switch individual giving CPR every 2 mins or less
which is the preferable method of ventilation during resuscitation if airway trained staff not available?
I-gel (supraglottic airway) or bag-mask
once inserted- give CPR continuously
what is the number of breaths that should be given via SGA in resuscitation?
10 breaths per min
Name some ways of monitoring during CPR?
clinical signs of life- breathing efforts, movements and eye opening
pulse checks
monitoring heart rhythm
end tidal carbon dioxide monitoring with waveform capnography
blood sampling/blood analysis
art line
what is the end tidal CO2?
partial pressure of CO2 at the end of the exhaled breath - it reflects cardiac output and pulmonary blood flow and ventilation minute volume
normal range of end tidal CO2?
4.3-5.5kpa
describe the end tidal CO2 waveform?
baseline indicates the end of inspiration, as the curve starts to rise it indicates start of expiration, the expired air initially does not contain any CO2 as it has come from the dead space, then reaches plateau which represents the gas from alveoli and once maximal CO2 reached this is the end tidal CO2
where are the three sites of IO access?
proximal humerus
proximal tibia
distal tibia
what are contraindications to IO access?
trauma infection prosthesis recent IO access (within 48hrs) previous failed attempt
