CARDIAC ARREST Flashcards
adrenaline admin
- Administer adrenaline IV every four minutes:
a) 1 mg IV for an adult.
amiodarone admin
Administer amiodarone if the rhythm is VF or VT at any time after the first dose of adrenaline:
a) 300 mg IV for an adult.
Clear reasons for not starting resuscitation include:
ū Signs of rigor mortis or post-mortem lividity.
ū A clear advance directive not to receive resuscitation for cardiac arrest.
ū Scenarios where resuscitation is futile or clearly not in the best interest of
the patient. Examples include unwitnessed cardiac arrest with asystole as the initial rhythm, patients who are dying from cancer and patients with severe comorbidities.
things to consider before stopping CPR
ū The cause of the cardiac arrest.
ū Whether or not the cardiac arrest was witnessed.
ū Whether or not there was bystander CPR.
ū The response time.
ū The initial rhythm.
ū The total estimated time in cardiac arrest.
ū The patient’s comorbidities.
timeframes for stopping CPR
- It is appropriate to stop resuscitation 20 minutes after the onset of resuscitation by ambulance personnel in poor prognosis scenarios.
- It is appropriate to stop resuscitation 40 minutes after the onset of resuscitation by ambulance personnel in good prognosis scenarios.
- It is appropriate to stop resuscitation earlier than described above, if it becomes clear that it was inappropriate to have commenced resuscitation, or the rhythm has deteriorated into asystole for more than a few minutes despite resuscitation.
adult ventilation rate
For an adult the CPR compression to ventilation ratio is 30:2 when ventilation is via a bag and mask. This ratio prioritises chest compressions on the basis that an adult is most likely to have had a primary cardiac arrest. If an adult has had
a cardiac arrest secondary to asphyxiation or respiratory failure, alter the ratio to 15:2.
child ventilation rates
For a child the CPR compression to ventilation ratio is 15:2 when ventilation
is via a bag and mask (exception – the ratio is 3:1 for neonates). The 15:2 ratio reduces the priority of chest compressions on the basis that a child is most likely to have had a cardiac arrest secondary to respiratory failure. If a child has had a primary cardiac arrest, alter the ratio to 30:2.
The level of end tidal CO2 (ETCO2) is a marker of
the blood flow being achieved during CPR. With good CPR an ETCO2 of greater than 20 mmHg should usually be achieved, unless there is an obstruction to blood flow, for example from a pulmonary embolus.
otentially reversible causes of PEA include
ū Hypoxia.
ū Hypothermia.
ū Hypovolaemia (including anaphylaxis).
ū Hyper/hypokalaemia (and other metabolic abnormalities).
ū Tension pneumothorax.
ū Tamponade (cardiac).
ū Toxins (poisoning).
ū Thrombosis (pulmonary and coronary).
Cardiac arrest secondary to drowning
- Prioritise the ventilation aspect of CPR and use a CPR ratio of 15:2 unless an ETT is in place.
- Place an ETT if ROSC is not achieved in the first few minutes.
- IV drugs have a very low priority.
Cardiac arrest secondary to hanging
- Prioritise the ventilation aspect of CPR and use a CPR ratio of 15:2 unless an ETT is in place.
- Cervical spine immobilisation is not routinely required. This is because clinically significant cervical spine injury following hanging is extremely rare unless the patient has fallen the height of their body.
- The survival rate is low, but survivors usually come from the group that are in PEA and get ROSC within 5-10 minutes with good CPR alone.
- Prolonged resuscitation in the presence of asystole is inappropriate.
- IV drugs have a very low priority
Cardiac arrest secondary to trauma
Perform the following tasks, focusing on the most likely reversible causes:
Control external bleeding.
Ventilate at 10 breaths/minute via an ETT or SGA and attach ETCO2.
Perform bilateral finger thoracostomies if chest injury is possible.
Gain IV or IO access and administer 0.9% sodium chloride:
2-3 litres for an adult.
40-60 ml/kg for a child.
Arrange for blood to be administered if this is available.
Splint the pelvis if pelvic injury is possible.
Align long bone fractures that are significantly displaced.
Administer TXA IV:
1 g for an adult.
See the paediatric drug dose tables for a child.
Begin transport as soon as possible.
Consider commencing chest compressions once the above tasks are complete.
Stop resuscitation if the rhythm deteriorates into asystole for more than a few minutes
Cardiac arrest secondary to asthma
- Focus on using a ventilation rate of only 6/minute to avoid dynamic hyperinflation (gas trapping).
- IV adrenaline has a high priority.
- Exclude tension pneumothorax, noting this is rare. Needle chest decompression carries a significant risk of causing pneumothorax and finger thoracostomy is the preferred technique if chest decompression is required.
- Diagnosing tension pneumothorax is very difficult in the presence of cardiac arrest secondary to asthma because:
ū Breath sounds are likely to be reduced because of poor air movement, and
ū The jugular veins are usually distended because of raised intrathoracic
pressure, and
ū The percussion note is often hyperresonant because of dynamic
hyperinflation. - In the setting of cardiac arrest secondary to asthma, the convincing signs of tension pneumothorax are most likely to be a clear difference in breath sounds and percussion note between the two sides.
Cardiac arrest secondary to anaphylaxis
- IV adrenaline has a high priority.
- If the patient is in PEA and not immediately responding to resuscitation, escalate the adrenaline doses:
a) For an adult escalate the second dose to 3 mg and the third dose to 5 mg.
b) For a child escalate the doses following the same principle.
fluid is a priority
Cardiac arrest secondary to cyclic antidepressant poisoning
The cardiac toxicity of cyclic antidepressants is partly caused by blockade of sodium channels within the heart.
* This cardiac toxicity may be reduced by a large bolus of sodium ions which is best accomplished using 0.9% sodium chloride:
a) 2-3 litres IV for an adult.
b) 40-60 ml/kg IV for a child.
* If 8.4% sodium bicarbonate is immediately available or can be delivered to the scene within ten minutes, in addition to 0.9% sodium chloride, administer:
a) 100 ml IV for an adult.
b) 2 ml/kg IV for a child.
* Do not administer amiodarone.
