Cardiac arrest

Question 1

4Hs and 4Ts

Answer 1

Reversible causes → 4H’s + 4 T’s

H
Hypoxia
Hypothermia
Hyper/hypo-kalaemia
Hypovolaemia

T
Tension pneumothorax
Tamponade
Thrombosis
Toxins

Question 2

Investigations

Answer 2

Breathing: ABG

Circulation:

1. ECG and cardiac monitoring - allows identification of rhythm
2. Bloods

U&E, FBC, clotting

Disability: blood glucose

Exposure: Toxicology

Question 3

First responders

Answer 3

If witnessed + monitored at time of arrest consider a precordial thump with ulnar aspect of fist

Airway – clear + maintain (head tilt, jaw thrust + chin lift)

Breathing – look, listen + feel to assess. No breathing give 2 rescue breaths

C – assess carotids for 10 secs

Absent = 30 compressions ~100bpm

30 compressions, 2 breaths, repeat

Defibrillator use as soon as possible

Proceed to ALS as soon as possible

Question 4

ALS shockable

Answer 4

Ventricular tachycardia or fibrillation, SVT

• Defibrillation shock (150 J)
• CPR - 2 minute cycle, 30:2
• Reassess rhythm
• Repeat steps 1-3 provided rhythm remains shockable

Drugs

• 1mg IV/IO adrenaline after 3rd shock, then every 3-5 minutes
• 300mg IV amiodarone bolus if shockable rhythm persisting after 3rd shock
• Consider 150mg IV.IO amiodarone after 5 shocks

Question 5

ALS non shockable

Answer 5

PEA (pulseless) and asystole

Start CPR - 30:2

Adrenaline 1mg IV

Continue giving every other cycle of CPR e.g. 1, 3, 5 (every 3-5 minutes)

Atropine 3mg IV if rate < 60bpm