Cardiac Arrest

Question 1

What are the reversible causes of cardiac arrest?

Answer 1

Hypoxia 
Hypothermia
Hypovolaemia
Hypo/hyperkalemia
Thrombosis
Tamponade (cardiac)
Toxins
Tension pneumothorax

Question 2

What is the normal value and range for ETCO2?

Answer 2

5.3 kPa (4.7-6.0)

Question 3

What factors affect ETCO2?

Answer 3

Production by cellular metabolism
Transport to lungs (cardiac output)
Elimination by ventilation

Question 4

What can be determined from ETCO2 monitoring?

Answer 4

1. Tube placement
2. Quality of CPR
3. ROSC
4. Guide to ventilation rate
5. Prognostication

Question 5

High quality CPR will result in ETCO2 values of?

Answer 5

2 - 2.5 kPa

Question 6

How is ROSC indicated on the capnograph?

Answer 6

Immediate and sustained increase in ETCO2.

Question 7

How does capnograph help with rate of ventilation?

Answer 7

Provides a rate.

Question 8

How can ETCO2 predict outcome?

Answer 8

Higher values indicate increased likelyhood of ROSC. Values below 1.9 during resus predict non-survivors.

Question 9

At what rate should ventilations system be given?

Answer 9

10 per min over one second.

Question 10

What is the drug regimen for shockable rhythms?

Answer 10

Adrenaline and amiodarone after 3 and 5 shock.

Adrenaline alternate loops thereafter.

Question 11

What is the drug regimen for non-shockable rhythms?

Answer 11

Adrenaline as soon as IV access has been gained then alternate loops (3-5 mins).

Question 12

How should you confirm death after a failed resuscitation?

Answer 12

Absence of central pulse
No heart sounds on auscultation
Asystole on ECG
Pupils fixed and dilated

Question 13

How does the time delay between stopping CPR and delivering the shock affect success rate?

Answer 13

Every 5 secs of pause decreases chance of success by 50%.

Question 14

If using an LMA during a cardiac arrest, can continuous compressions be used?

Answer 14

Yes, however, in the presence of high airway resistance and poor lung compliance there is a risk of hypoventilation due to leaks. Abandon continuous compressions if persistent leaks and hypoventilation is occurring.

Question 15

What are the disadvantages of using an ET tube for cardiac arrest?

Answer 15

Some studies have shown a worse outcome when ET tubes are used. Studies have suggested that the median time off the chest to place an ET tube is 45 seconds with a third taking over a minute.

Question 16

If placing an ET tube during a cardiac arrest, a skilled operator should be able to…..

Answer 16

Place the tube with continuous compressions stopping only briefly as tube passes vocal cords.

Question 17

When might an ET tube be placed to avoid interrupting compressions?

Answer 17

After ROSC.

Question 18

What is the time limit for interruptions of compression to tube a patient?

Answer 18

10 seconds. If this is not possible BVM or BV/SAD should be used.

Question 19

List four components of post-cardiac arrest syndrome.

Answer 19

Post-cardiac arrest brain injury
Post-cardiac arrest myocardial dysfunction
Systemic ischaemia/reperfusion response
Persisting precipitating pathology