Cardiac Arrest

Question 1

Comp:vent ratio for -
Adults, no SGA
Adults, SGA
Paeds, no SGA
Paeds, SGA

Answer 1

Adults, no SGA - 30:2 (vent pause)
Adults, SGA - 15:1 (no pause)
–> 6 to 8 vents/min

Paeds, no SGA - 15:2 (vent pause)
Paeds, SGA - vent every 6s (no pause)
—> 10 vents/min

Question 2

Initiate arrest protocol for paediatrics

Answer 2

If pulseless
HR <60 for infants
HR <40 for children <12

Question 3

Paediatric arrest guideline should be used for patients aged…?

Answer 3

15 and under. 16 and over should be managed as per adult guideline.

Question 4

HPCPR metrics (4)

Answer 4

rate 100-120
depth >5cm, allow for full recoil
1s duration per vent
2min compressor rotation

Question 5

Evidence of CPRIP (3)

Answer 5

1. Interferes with CPR
2. Gag reflex preventing adequate SGA/ETT insertion or ventilation
3. Suspected awareness/pain/combative movements interrupting resus

Question 6

Management of CPRIP

Answer 6

Fentanyl 100mcg Iv every 1-2mins, no max.

Ketamine (if fentanyl ineffective) 50-100mg IV every 1-2mins, no max.

NO IV - Fentanyl 200mcg IM or Ketamine 200mg IM (single dose)

Adequate control normally occurs after 200mcg IV Fentanyl.

Question 7

Hypothermic arrest, temp <___.
Changes/considerations for arrest (3)

Answer 7

<30

1. Double Adrenaline (every 8m) and Amiodarone intervals
2. Prevent further heat loss prior to ROSC/Tx
3. > 3 shocks unlikely to be successful while severely hypothermic, consider AAV/mCPR to hosp (continue DCCS as normal)

Question 8

PEA reversible causes (CPG)

Answer 8

TPT
Upper airway obstruction
Exsanguination
Asthma
Anaphylaxis
Hypoxia

Question 9

5H’s and 5T’s

Answer 9

Hypoxia
Hypothermia
Hypovolaemia
Hydrogen (acidosis)
Hypoglycaemia

TPT
Trauma
Thrombus (MI)
Thromboembolus (PE)
Toxins

Question 10

When should Normal Saline 20mL/kg be considered in arrest? (3)

Answer 10

PEA arrest from hypovolaemia, anaphylaxis or asthma (or rhythm may be fluid responsive)

Question 11

Adult defib J
Paed defib J

Answer 11

200J for 16 and over
4J/kg for 15 and under

Question 12

Adrenaline dosing in arrest
Adult
Paed

Answer 12

16 and over = 1mg every 4mins
15 and under = 10mcg/kg

Question 13

Amiodarone dosing in arrest
Adult

Answer 13

300mg IV if VF/VT after 3rd shock
then
150mg IV if VF/VT persists after 5th shock

Question 14

Hyperkalaemic arrest/ crush injury intervention

Answer 14

Calcium Gluconate 1g IV, slow push, every 5mins for max 4g
Sodium Bicarbonate 100mL IV

Question 15

Rationale for Calcium Gluconate and Sodium Bicarbonate in hyperkalaemic arrest

Answer 15

Calcium gluconate = antagonise cardiac membrane excitability

Sod Bic = increases K+ shift into cells by upregulating Na-K-ATPase pump

Question 16

Fluid/flush admin in cardiac arrest notes

Answer 16

May be harmful in shockable rhythms
Limit to TKVO once IV inserted
Flush all meds with 20-30mL NS
Consider 20mL/kg in PEA

Question 17

Preferred CPR technique for:
infants
small children
medium children/adolescents

Answer 17

<1y - Two thumb
1-4y - Single hand
5+ - Both hands

Question 18

When to use paed pads vs. adult feedback pads

Answer 18

Paed pads for <25kg, up to 8y
Adult feedback >25kg, over 9y

Question 19

Volume replacement in traumatic arrest
Adults
Paeds

Answer 19

Adults 20mL/kg
Paeds 20mL/kg

Question 20

Traumatic cardiac arrest interventions

Answer 20

1. Haemorrhage control (consider pelvic binder here)
2. Airway + BVM
3. Decompress chest
4. IV access, volume replacement
5. Pelvic binder
6. Normal arrest protocol

Question 21

Note about penetrating trauma in PEA arrest

Answer 21

If able to access emergency thoracotomy within 20mins of collapse/PEA onset of a penetrating trauma, Tx to MTS immediately. Withhold compressions.

Question 22

Sodium Bicarbonate for TCA overdose arrest, dose + rationale

Answer 22

Sodium Bicarbonate 100mL IV

Increases sodium substrate for VGSCs in channel blockade, increased free TCA protein binding and decreased VGSC binding in alkaline bloodstream.