Cardiac Arrest Flashcards
Definition of cardiac arrest
Sudden cessation of cardiac output and effective circulation. The prime aim of arrest management is oxygen delivery to the heart and brain via continuous compressions, with defibrillation when appropriate. Compressions deliver oxygen, ventilation replaces oxygen on the haemoglobin and adrenaline confines oxygenated blood to the core and thus coronary/cerebral circulation.
Pathophysiology
- Blood flow to coronary vessels ceases, leading to hypoxia. Hypoxia leads to arrhythmias as a result of anaerobic metabolism and cessation of waste removal.
- Depletion of O2 and glucose to cerebral arteries causes a loss of consciousness, leading to agonal breathing.
- Systemic ischemia
Principles of HPCPR
- 3secs off the chest
- 5cm depth compression
- Clear and quiet working space
- Rate between 100-120
- Complete recoil
- Change every 2 minutes
- Rhythm and pulse check every 2 minutes
Describe AT Macro Drill to cardiac arrest situations
- Monitor is placed L) shoulder.
- CPR commenced immdiently
- Defib pads placed, monitor charged and rhythm analysed.
- Charge monitor at 1:45, and change positions following shock.
- When more people arrive, begin advanced life support.
- Ventilation with iGel: 15:1
Describe AT micro drill for rhythm check
- Clear patient; compressions continue.
- At 1;45: charging to 200J (adult) or 4J/kg (paed).
- Locate carotid pulse (with left hand).
- Stop compressions with tactile response.
- Analysing rhythm (shockable or not).
- Shock or disarm.
- Continue compressions with tactile response.
- Swap rolls.
Reversible causes of cardiac arrest: 4 H’s and 4T’s
- Hypovolaemia
- Hypo-/hyperkaelamia
- Hypo-/hyperthermia
- Hypoxia
- Tamponade
- Thrombus (PE, MI, CVA)
- Toxins
- Tension
Compression to ventilation ratio for intubated and not
Not intubated (OPA/NPA): 30:2; pause for ventilations
Intubated (LMA/ETT): 15:1; or 8-10/min - no pause for ventilation
PEA causes (as per AT CPG)
- Hypoxia
- Anaphylaxis
- PE
- Tension
- FBAO
- Asthma
Newborn baby stabilisation
- Warm, dry and stimulate baby
- 2cm pad under shoulders
- Wrap in cling wrap (if premature)
- Assess tone, breathing and HR
- Commence BVM (no O2) if HR <100
- assess every 30 seconds
- Commence CPR if HR <60 (3:1)
Paediatric compression ratio
15:2 (two operators)
30:2 (one)
What age group does the AT CPG cardiac arrest apply to
<12 years of age who are unresponsive, not breathing normally and:
- Pulseless or
- HR <60bpm (infants)
- HR <40bpm ))children)
Paediatric: compression ratio
15:2
Single responder: 30:2
Effects of EtCO2 in cardiac arrest
- High EtCO2 associated with ROSC
- Decrease EtCO2 may be associated with CPR fatigue
Treatment in paediatrics where PEA arrest where hypokalaemia, anaphylaxis, sepsis or asthma is suspected
NaCL 10ml/kg aliquots up to 40ml/kg
Cardiac arrest: special considerations - Anaphylaxis management
- Adrenaline high priority
- NaCl
Cardiac arrest: special considerations - Asthma meneagament
- Reducing RR with smaller tidal volume and prolonged expiratory time
- Adrenaline
- NaCl
Cardiac arrest: special considerations - Drowning
- Ventilations early
- PEEP consideration (max 5cmH2O)
- Drugs are low priority
Cardiac arrest: special considerations - Hyperkalaemia
- Suspect in patients with renal failure or crush injury
- Sodium bicarb
Cardiac arrest temperature management
- > 32 degrees:
○ Standard cardiac arrest guideline- 30-32 degrees:
○ Double dosing intervals for medication (adrenaline and amiodarone) and defib
○ Do not rewarm >33 degrees if ROSC - <30 degrees:
○ Rewarm until temp >30 degrees
○ One defib shock
One dose of adrenaline and amiodarone
- 30-32 degrees:
ROSC management - general
- Support circulation, airway and breathing
- Maintain MAP for cerebral perfusion
- Manage cardiac arrhythmia
- determine and manage 4 Hs and 4Ts
- BGL
ROSC Mx - Airway & Ventilation
- High concentration O2 initially, titrated to maintain SpO2 94-100%
- EtCO2 35-40mmHg; presumed resp cause will be slightly higher; TCA OD - 25-30; DKA <30
ROSC Mx - Perfusion
- Avoid fluid overload; up to 20ml/kg unless suspected hypovolaemia (ICP)
- 21-lead (may be false-+ve)
Witnessed cardiac arrest
- If AT witness arrest and within 20 secs, presenting VF.VT administer 2 quick successive defibs without commencing chest compressions with 10 secs in between.
- Check for pulse or ROSC between shocks
- After 3rd unsuccessful shock, commence CPR
