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SAAS CPGs > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

In adults, what is the compression to ventillation ratio rate before an advanced airway is inserted?

A

30:2 with pause for ventillation; 1 sec inspiratory time.

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2
Q

In adults, what is the compression to ventillation ratio rate AFTER an advanced airway is inserted?

A

15:1 or at a rate of 6-10 per minute with no pause for ventillation.

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3
Q

Where should pads be placed in anterior-posterior configuration?

A

Anterior over patient’s precordium (i.e. portion of body over pts heart and lower chest)
Posterior to heart, just below left scapula

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4
Q

Where should pads be placed in bi-axillary configuration?

A

On the lateral chest walls, one on the left and one on the right.

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5
Q

What is refractory VF?

A

VF that persists beyond 3 shocks.

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6
Q

When can stacked shocks be considered?

A

In a witnessed arrest where pads are already applied and the patient was well perfused and oxygenated pre-arrest.

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7
Q

For timing of medication, how many shocks are counted in stacked shocks?

A

Stacked shocks are counted as one shock for medication timing.

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8
Q

What are the reversible causes of cardiac arrest (4Hs 4Ts)

A

Hypoxia
Hypovolemia
Hypo/hyperthermia
Hypo/hyperkalemia (/ metabolic disorders)
Thrombosis (STEMI, PE)
Tension pneumothorax
Tamponade
Toxins

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9
Q

How does identification of a reversible cause change cardiac arrest management?

A

When the cause of cardiac arrest is potentially reversible, consider aggressive and prolonged resuscitation efforts which may include clinical support or when the reversible cause is unable to be managed on scene, consider transport to hospital.

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10
Q

What are the priorities in traumatic cardiac arrest?

A

All of
* Control haemorrhage
* Fluid resuscitation
* Open/control the airway (early SGA with capnography)
* Bilateral chest decomression

should take priority over standard interventions used to manage sudden cardiac death which is often related to coronary occlusion.

Chest compressions can be performed whilst reversible causes addressed if resources allow.

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11
Q

Should adrenaline be used in traumatic cardiac arrest?

A

There is little evidence for the use of adrenaline in cardiac arrest due to trauma and as such is not recommended until after control and correction of reversible causes.

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12
Q

What are the special circumstances for cardiac arrest that require a change in management?

A

Trauma
Hypothermia
Asthmatic arrest
Pregnancy with gestation > 20 weeks
Morbid obesity

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13
Q

What changes in managment should occur in hypothermic cardiac arrest?

A

In hypothermic cardiac arrests, patients with a tympanic temperature <30C should receive a maximum of three defibrillations and all cardiac arrest drugs should be withheld.

Patients with a temperature of 30-35C should receive resuscitation as normal with the exception of drug administration intervals being doubled (e.g. adrenaline every 8 minutes).

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14
Q

What changes in managment should occur in asthmatic cardiac arrest?

A

In cardiac arrests caused by asthma, ventilations will be difficult due to increased airway resistance. Appropriate ventilations with small tidal volumes and slow ventilation rates should occur as required to allow for adequate chest deflation.

Severe gas trapping may be relieved with a period of apnoea (disconnection of the BVM from the advanced airway) of up to 30 seconds between breaths.

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15
Q

What changes in managment should occur in cardiac arrest pregnancy?

A

Pregnant patients in cardiac arrest with a known or suspected gestation >20 weeks should be resuscitated with manual displacement of the uterus to the left to minimise aorto-caval compression.
If manual displacement is not possible, then consider a 15°-30° tilt of the patient to the left if it is feasible and doesn’t interfere with high performance CPR.

IV/IO access should occur above the level of the diaphragm.

Early consult with the MedSTAR Medical Retrieval Consultant (MRC) via the EOC Clinician should occur to discuss management options, but this should not delay rapid transport.

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16
Q

What changes in cardiac arrest managment should occur in obese patients?

A

Compressor fatigue may necessitate the need to change compressors more frequently than 2 minutes.

Significant increases in inspiratory airway pressures may be required during ventilations. This may result in excessive leakage with a supraglottic airway during uninterrupted compressions; and returning to a standard 30:2 compression-ventilation ratio may be required (interrupted compressions to ventilate).

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17
Q

Which adult patients are most likely to benefit from transport under CPR?

A

Patients most likely to benefit from transport under CPR include:
* lived independently pre-arrest
* had chest compressions within 10 mins of arrest
* had initial rhythm of VF or VT
* have intermittent but unsustained ROSC or signs of life

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18
Q

In adults, when should CPR be ceased?

A

If no signs of sustained response to treatment, continue reasonable treatment options for at least:
* 10 mins due to clinical futility (e.g. persistent asystole or traumatic arrest)
* 30 mins in all other cases

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19
Q

What are the components of the charge and check script?

A

“Hands off” - after defibrilator is charged
“I’m safe” - compressor confirms hands are off
“Confirm shockable rhythm”, or “confirm non-shockable rhythm”

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20
Q

When should IV/IO adrenaline be administered in adult cardiac arrest?

A

When resources allow:
* Shockable - after second shock then every second loop (4min)
* Non-shockable - ASAP

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21
Q

When should IV/IO amiodarone be administered in adult cardiac arrest?

A

If shockable rhythm, amiodarone 300mg after 3rd shock

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22
Q

What is the guideline for managing CPR induced consciousness?

A

Provide verbal reassurance

Unsuccessful reassurance:
* consider IV/IO midazolam 1 - 2 mg
* repeat every 5 mins prn
* total max dose 5 mg

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23
Q

How much fluid should be administered in suspected hypovolemic or obstructive shock causes of arrest?

A

250ml aliquots, reassess, up to 30ml/kg

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24
Q

What tools are available to control haemorrhage in traumatic arrest?

A
  • Direct pressure
  • Arterial tourniquet
  • Arterial compression
  • Pelvic binder
  • Fracture management and splinting
25
Q

What are the most common causes of pediatric arrest?

A

Hypoxia, hypovolemia, or both.

Causative conditions include trauma, drowning, septicaemia, SIDS, asthma, upper airway obstruction, and congenital abnormalities of heart/lungs.

26
Q

What size orogastric tube is used for i-gel suctioning? How is the tube sized?

A

Size 10
Nose to earlobe, then earlobe to xiphisternum

27
Q

When should compressions be initiated in a pediatric?

A

Following ventilations, if the patient is unresponsive and not breathing normally and the heart rate is less than 60, or a palpable pulse cannot be detected within 10 seconds, external chest compressions should be commenced.

28
Q

What is the ratio of compressions to breaths in a pediatric? Should compressions be continued or stop?

A

15:2 and pause for ventillation. Advanced airway does not change this.

29
Q

What do low etCO2 levels suggest during pediatric cardiac arrest?
What does a high etCO2 suggest?

A

Low CO2 levels in expired breath from a patient receiving CPR may be due to inadequate external chest compressions or excessive ventilation.

Low CO2 levels may also indicate a treatable condition such as pneumothorax, hypovolaemia or cardiac tamponade.

A high CO2 level reading may indicate acidaemia or inadequate ventilations.

30
Q

Should adrenaline be used in traumatic pediatric arrest?

A

In cardiac arrest due to trauma, opening the airway, haemorrhage control, restoration of circulating blood volume and correcting obstructive shock states take priority.

There is little evidence for the use of adrenaline in cardiac arrest due to trauma, and as such is not recommended until after control and correction of reversible causes.

31
Q

How can gas trapping be relieved in an asthmatic arrest?

A

Gentle ventilations with small tidal volumes and slow ventilation rates should occur as required to allow for adequate chest deflation.

Severe gas trapping may be relieved with a period of apnoea (disconnection of the BVM from the advanced airway) to allow adequate chest deflation

32
Q

Should parents be allowed to be present during pediatric resuscitation?

A

Family members should be offered the opportunity to be present during the resuscitation of their child. Evidence suggests that the presence of parents at the child’s side during resuscitation enables them to gain a realistic understanding of the efforts made to save their child and they subsequently may show less anxiety and depression. A staff member must be designated to be the parents’ support and interpreter of events throughout the resuscitation as soon as sufficient resources are available.

33
Q

What head position should be used to ensure patent airway in 1) infants, 2) small pediatrics (1-8yrs, and 3) older pediatrics (9-16yrs)

A

Infants - neutral position (no extension)
Small children - slight neck extension
Older children - neck extension (same as adults)

34
Q

When is amiodarone indicated in pediatric arrest - when/how much administered?

A

Indicated for shockable rhythm refractory to 3x shocks.
5mg/kg after 3rd shock

35
Q

When is adrenaline indicated in pediatric medical (non-traumatic) arrest - when/how much administered?

A

Shockable rhythm - 10mcg/kg after 2nd shock, continue after every 2nd shock
Non-shockable rhythm - 10mcg/kg asap, then after every 2nd loop.

36
Q

When is fluid indicated in pediatric arrest (medical AND traumatic), and how much is administered?

A

Indicated in suspected hypovolaemic or obstructive cause of arrest
Administer IV saline 10 mL/kg aliquots (max 250 mL) and reassess up to 40 mL/kg

37
Q

What is the criteria for declaration of life extinct?

A

1 full minute of nil:
* heart sounds
* pulse
* respirations
and nil pupil reaction to light

38
Q

What are the criteria for non-initiation of CPR?

A
  • Patient’s wishes (ACD, relative, substitute decision maker, etc)
  • Obvious death
  • Patient is pulseless, not breathing, with fixed dilated pupils, and unresponsive > 30 mins with no CPR prior to SAAS arrival
39
Q

How much fluid may be administered to hypotensive adults post ROSC?

A

250ml aliquots up to 10ml/kg (max 1000ml) until either
* radial pulse achieved
* SBP>=100

Consult SAAS Medical Practitioner via EOC Clinician if hypotension persists.

40
Q

How much fluid may be administered to hypotensive pediatrics post ROSC?

A

Consult SAAS Medical Practitioner via EOC Clinician for pediatrics (i.e. whatever they say).

41
Q

In post-ROSC adults who require ventillation, what rate is used? Pediatrics?

A

Adults - BVM with high flow O2 at rate 10-12bpm.
Pediatrics - as above, but normal age-appropriate respiratory rate per RDR.

42
Q

In post-ROSC patients who do not require ventillation, what is the target SpO2? rate is used? Why?

A

Target SpO2 for both adults and pediatrics is 94-98% - titrate O2 to achieve this.
Want to prevent hypoxia and hyperoxia, as both result in negative patient outcomes.

43
Q

What are the differences in post-ROSC management between adults and pediatrics?

A

In pediatrics early consult with a SAAS Medical Practitioner via the EOC Clinician must occur to ensure timely management of the anticipated physiological abnormalities.

Paediatric cardiac arrest is less likely to be precipitated by a cardiac cause (i.e. less likely to require Code STEMI activation).

Correction and avoidance of hypoxia is paramount to the outcome of paediatric patients.

Maintaining BP appropriate for age is important post-ROSC, and hypotension should be addressed. Refer to SAAS paediatric RDR chart for normative values.

Post-ROSC hyperthermia has increased prevalence in children, and is associated with poorer outcomes. Avoid hyperthermia accordingly.

There is an increased risk of hypoglycaemia. Greater emphasis must be placed on early post-ROSC BGL, and its management.

44
Q

What is the treatment for post-ROSC hypoglycemia (BGL< 3.5) in adults?

A

Adults - IV glucose 10% targeting BGL 3.5-10mmol/L.
Follow infusion with 100ml IV saline.

45
Q

What is the treatment for post-ROSC hypoglycemia (BGL< 3.5) in pediatrics?

A

Consult EOC clinician for IV glucose 10%, starting at 2ml/kg, targeting BGL 3.5-10mmol/L.
Max dose 5ml/kg.

Follow infusion with IV saline 1ml/kg.

46
Q

What is the target temperature in post-ROSC patients?

A

36.0-37.5C

47
Q

What is the concentration of amiodarone?
What is the dose for adult patients?
Pediatrics?

A

Concentration 150mg/3ml (50mg/ml)
Adult dose is 300mg (6ml)
Pediatric dose 5mg/kg (0.1ml/kg)
≤ 1 yr use 1 mL syringe to draw up age appropriate dose

48
Q

When is amiodarone indicated? When is it contraindicated?

A

Indicated for cardiac arrest / shockable rhythm refractory to 3x DCCS

Contraindicated for hypothermic patients < 30C (all cardiac arrest drugs withheld)

49
Q

When is fluid indicated in patients post-ROSC?
How much may be given?
What is the target?
Is consultation required?

A

Indicated for hypotensive patients with altered GCS.

Up to 1000mL may be given (consult if more required).

Aim for SBP 100 mmHg, or radial pulse

Consult for Pts < 16yrs

50
Q

How much fluid may be given in cardiac arrest?

A

Up to 30ml/kg; consult if further fluids required.

51
Q

What is the concentration of amiodarone?
What is the dose for adult patients?
Pediatrics?

A

Concentration 150mg/3ml (50mg/ml)
Adult dose is 300mg (6ml)
Pediatric dose 5mg/kg (0.1ml/kg)
≤ 1 yr use 1 mL syringe to draw up age appropriate dose

52
Q

When is amiodarone indicated? When is it contraindicated?

A

Indicated for cardiac arrest / shockable rhythm refractory to 3x DCCS

Contraindicated for hypothermic patients < 30C (all cardiac arrest drugs withheld)

53
Q

What is the midazolam dose for CPR induced consciousness?
Repeat doses / dose interval?
Max dose?

A

Dose 1-2mg IV/IO (1-2ml of 5mg/5ml). Consider co-administration with fentanyl.
Repeat every 5min prn
Max dose 5mg

54
Q

When is fluid indicated in patients post-ROSC?
How much may be given?
What is the target?
Is consultation required?

A

Indicated for hypotensive patients with altered GCS.

Up to 1000mL may be given (consult if more required).

Aim for SBP 100 mmHg, or radial pulse

Consult for Pts < 16yrs

55
Q

What age ranges can be given sublingual ketamine without consult? With consult?

A

Without consult: 16-64yrs
With consult: < 16 or >=65yrs

56
Q

What are the contraindications for ketamine (x2)?

A

Allergy/adverse reaction
Pts experiencing psychiatric episode

57
Q

What are the onset, peak time and duration of sublingual ketamine?

A

Onset 10min
Peak 20-30min
Duration 1-2hrs

58
Q

What is the dose for sublingual ketamine?
Can a repeat dose be given? How much and when?
What is the max dose?

A

25-50mg (1-2 wafers)
Can give additional 25mg after 15min in uncontrolled severe pain
Max doses: 75mg in 1st hour, can give subsequent 50mg in second hour (total max 5 wafers)

SAAS CPGs (9 decks)

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