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1st Year Medicine > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

What type of rhythms do most in hospital cardiac arrests have?

A

Non shockable.

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2
Q

What are the most common antecedents to cardiac arrest?

A

Hypoxia and hypotension.

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3
Q

What requirements must a doctor fulfil when managing cardiac arrest?

A

Early recognition of abnormal physiology.
Identifying at risk patients.
Must identify when proper resus is appropriate e.g. DNAR.

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4
Q

What is the ideal time frame for initiating defibrillation?

A

Within 3 mins.

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5
Q

What facets of physiology are most cardiac arrests associated with?

A

Airway, breathing and circulation.

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6
Q

What are the 6 main factors involved in oxygen delivery that can go wrong and cause cardiac arrest?

A 
Oxygen saturation.
Hb.
HR.
Preload.
Contractility
afterload.
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7
Q

What is the gold standard for measuring oxygen saturation?

A

Arterial blood gasses.

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8
Q

What blood test gives us HB amounts?

A

FBC, ABG and hemocue.

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9
Q

What is a blood reassure change always due to?

A

Changes in HR, preload, contractility, afterload change. E.g. TPR.

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10
Q

How can we improve SaO2?

A

FiO2, clear airway and ensure adequate breathing.

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11
Q

How can we ensure appropriate HB levels?

A

Set a transfusion trigger, treat anaemia, group and save, cross match, get IV access.

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12
Q

How can we help BP through preload?

A

IV fluids and raise the legs.

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13
Q

How can we help BP through contractility?

A

Treat the cause e.g. PCI for MI.

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14
Q

How can we help BP through afterload?

A

For excess afterload, use vasodilators.

If reduced afterload then use vasoconstrictors e.g. In septic shock.

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15
Q

What must we reassess ABCDE?

A

Whenever the patients condition changes.
After an intervention is made.
Periodically when looking after a patient.

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16
Q

What are the steps when approaching an in hospital critically ill patient?

A 
Personal safety.
Check responsiveness.
Vital signs.
Get help.
Assess
Treat
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17
Q

How can we recognise an airway obstruction?

A

Dyspnoea, unable to speak, distress, choking, SOB, noises, use of accessory muscles and see saw breathing.

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18
Q

How can we treat airway obstruction?

A

Airway manoeuvres.
Adjuncts.
Intubation.
FiO2.

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19
Q

How can we assess breathing?

A

Look - for accessory muscles, Cyanosis. Respiratory rate. Consciousness level. Chest deformity.
Listen - noisy breathing and breath sounds.
Feel - expansion, percussion and tracheal position.

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20
Q

How do we treat breathing problems?

A

Oxygen, open airway, treat underlying cause and support breathing e.g. Bag and mask.

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21
Q

What is a fissuring plaque?

A

Lipid rich stable eccentric plaque causing luminal obstruction.

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22
Q

How do we assess circulatory issues in relation to cardiac arrest?

A

Look at the patient.
Vital signs.
Cap refill time, peripheral colour and temp.
Organ perfusion - chest pain, mental state, urine output etc.
Blood and fluid losses.

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23
Q

How do we treat circulatory problems in the critically ill patient?

A

Airway, breathing, O2, IV access, bloods, fluid challenge, haemorrhagic monitoring, into ropes or vasopressors, O2, aspirin, GTN, analgesia etc.

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24
Q

What two ways can we assess disability in patients?

A

AVPU or GCS. And always blood glucose!!!

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25
Q

What must we be mindful of during exposure of the critically ill patient?

A

Heat loss and dignity.

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26
Q

How do we manage an out of hospital critically ill patient initially?

A

Personal safety, responsiveness, help, check airway and look, listen, feel for vitals. Start management.

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27
Q

What four group can initial assessment of a critically ill patient lead to and how do we manage them?

A

1 - responsive - leave and get help.
2 - breathing but unconscious - recovery position and help.
3 - not breathing - respiratory arrest- help and ventilation.
4 - no pulse - cardiac arrest - help/CPR.

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28
Q

How do clinically diagnose a cardiac arrest?

A

Unresponsive and not breathing properly e.g. Agonal breaths.

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29
Q

How long do we assess breathing for in the unconscious patient?

A

No more than 10 seconds.

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30
Q

What should we do if we doubt an unconscious patients breathing is normal?

A

Take it as being not normal. For and ask for AED. Get help.

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31
Q

How many chest compressions should we do in CPR, what depth do we use and what speed?

A

30 for 2 breaths. 5-6 cms. 100-120 bpm.

32
Q

How long should we blow into a victims mouth during CPR?

A

1 second.

33
Q

How long maximum should the 2 rescue breaths take?

A

No more than 5 seconds.

34
Q

Where should chest compressions be done?

A

Middle of lower half of sternum in the centre of the chest.

35
Q

What are the two shockable rhythms?

A

VF and VT.

36
Q

What two rhythms are not shockable?

A

Asystole and PEA.

37
Q

What must we make sure we exclude from ECG tracings before we diagnose VF?

A

Artifacts from muscle movement etc.

38
Q

What does a VF wave look like?

A

Bizarre, irregular waveform. No recognisable QRS complexes. Random frequency and amplitude. Uncoordinated electrical activity.

39
Q

What two types of VF wave do we get?

A

Coarse and fine.

40
Q

What does a ventricular tachycardia rhythm look like?

A

Monomorphic VT - Broad complex rhythm, rapid rate and constant QRS morphology.
Polymorphic VT - torsade de pointes.

41
Q

What does torsade de pointes look like?

A

QRS amplitude varies and the QRS complexes appear to twist around the baseline. Looks like a big squiggle then a small then repeat.

42
Q

When should we use a precordial thump and what is its efficacy?

A

Only used if defib not available in a witnessed VF/VT arrest. De-emphasised now as it is rarely effective.

43
Q

When should we apply AED pads during CPR?

A

While CPR is going on so we don’t interrupt it.

44
Q

What are the steps in manual defibrillation?

A 
Diagnose shockable rhythm from ECG.
Select correct energy level.
Charge paddles on patient.
Shout - stand clear, O2 away!
Visually check.
Check monitor.
Stand clear to CPR provider. 
Deliver shock
Resume CPR immediately.
Minimise pauses by planning and communicating actions.
45
Q

How long do wait after delivering the first shock to do a second one?

A

2 mins.

46
Q

What do we do after the third shock?

A

Maintain CPR and Give adrenaline 1mg IV then give this after alternate shocks.

47
Q

When we check for signs of life after two mins of CPR and see organised electrical activity what do we do?

A

We check for signs of life and if there is return of spontaneous circulation, then start post resus care.

48
Q

When we check for signs of life after two mins of CPR and there are no signs of resumption of life signs what do we do?

A

If no ROSC go to non VF/VT algorithm. If asystole go to non VF/VT algorithm.

49
Q

What should we do if we see asystole on the monitors?

A

Check electrodes and give 1mg adrenaline IV as soon as possible and every 3-5 mins thereafter (every two cycles).

50
Q

What is PEA?

A

Non shockable rhythm usually associated with an ECG output.

51
Q

What should we do if we see PEA?

A

Exclude/treat reversible causes.
Adrenaline 1mg IV as soon as possible.
Every 3-5 mins 2 cycles thereafter.

52
Q

What are the two drug mini jets we get?

A

Adrenaline 1mg.

Amiodarone 300mg.

53
Q

What receptors does adrenaline work on?

A

Alpha vasoconstrictor and beta inotropic.

54
Q

What are the possible causes of PEA?

A 
4H's and T's.
Hypoxia
Hypovolaemia 
Hypo/hyperkaelaemia 
Hypothermia.

Thrombosis
Tamponade
Toxins
Tension pneumothorax.

55
Q

What are the advantages and disadvantages of mouth to mask ventilation?

A

Avoids contact so decreases infection potential while allowing O2 enrichment.
Difficult to get an airtight seal and risk of gastric inflation.

56
Q

What are the advantages and disadvantages of self inflating bag ventilation?

A

+ avoids contact, allows up to 85% O2 supplementation. Can be used with face masks, LMAs or tubes.
- risk of inadequate ventilation when used with a face mask. Risk of gastric inflation and needs two people for optimal use.

57
Q

What are the advantages and disadvantages of supraglottic airway devices e.g. LMA?

A

+ Rapidly and easily inserted, variety of sizes, more efficient than face mask, avoids laryngoscopy.
- aspiration risk, not suitable for high ventilation pressures. Unable to aspirate airway.

58
Q

When should we stop CPR?

A

When there is ROSC, it seems useless and if DNAR.

59
Q

What are the four parts of post cardiac arrest syndrome?

A
  1. Post cardiac arrest brain injury.
  2. Post cardiac arrest myocardial dysfunction.
  3. Systemic ischaemia/reperfusion response.
  4. Persistent precipitating pathology.
60
Q

What is the goal of post resus care?

A

To restore quality of life with normal cerebral perfusion/function. Normal other organ perfusion/function and stable cardiac rhythm.

61
Q

What is the gold standard of airway management during an arrest?

A

ETT intubation.

62
Q

What measures should we consider in patients with impaired cerebral function following a cardiac arrest?

A

Continued intubation, sedation and controlled ventilation.
Insert gastric tube to deflate stomach to improve lung compliance.
Secure the airway for transfer.

63
Q

What examinations/investigations should we do for airway and breathing in a post cardiac arrest patient?

A

Inspection, palpating and percussion for pneumothorax, trauma, aspiration, pulmonary oedema etc.
CXR for all of above plus pneumoperitoneum, tracheal/gastric/chest drain placement.
ABG’s.
Capnography.

64
Q

How should we optimise respiratory function post cardiac arrest?

A 
Adjust fiO2 to achieve ideal SaO2/SpO2.
Adjust minute volume to achieve ideal PaCO2/ETCO2.
Alter pH
Avoid excessive hyperventilation.
Improve circulation to alter pH.
65
Q

How do we look for signs of inadequate perfusion in post arrest patients?

A

Look for colouring, distended neck veins, urine volumes, pulmonary oedema, cap refill time.

66
Q

What investigation should we do regarding circulation in post cardiac arrest patients?

A 
FBC, U&Es, glucose, ABG's, LFTs. 
12 lead.
Standard ECG monitoring.
CVP measurement.
Echo.
67
Q

What circulatory conditions should we monitor for post arrest?

A 
Bp
Systemic inflammatory response syndrome.
Reperfusion injury.
Arrhythmias
Myocardial stunning.
68
Q

What is myocardial stunning?

A

Section of the myocardium shows a contractile abnormality.

69
Q

How steps can we take to improve circulation post arrest?

A 
Fluids.
Coronary reperfusion therapy.
Inotropes.
Diuretics and vasodilators.
Maintain temperature if conscious, consider cooling if not.
70
Q

What GCS score do we have if we get P or U on an AVPU?

A

8 or less.

71
Q

What is the GCS range and what are we checking for?

A

3-15

Pupils, limb tone, movement and posture.

72
Q

What are potential problems for optimising brain function post arrest?

A

Hyperaemia followed by hypoperfusion. No cerebral Autoregulation.

73
Q

What is therapeutic hypothermia?

A

Unconscious adults after ROSC should be cooled to 32-34 deg asap and continued for 12-24 hours. Uses external or internal techniques.

74
Q

What patients should we exclude from therapeutic hypothermia?

A

Severe sepsis and cardiogenic shock.

75
Q

What are the complications of therapeutic hypothermia?

A

Infection, CVS instability, coagulopathy, hyperglycaemia and electrolyte imbalances.

76
Q

When is the earliest we can predict a poor outcome following ROSC after arrest?
How do we predict this?

A

3 days. By absent pupil light reflexes and absent motor response to pain.

77
Q

What type of rhythms do most out of hospital cardiac arrests have?

A

Shockable.

1st Year Medicine (64 decks)

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