Cardiac Arrest

Question 1

Outline management of a patient in VF during OT

Answer 1

CALL FOR HELP
Check the ECG, feel for a pulse and commence compressions
Check the airway, intubate if required
Stop volatile, give 100% O2
Deliver shock once defib pads applied
Continue along ACLS algorithm

Question 2

What are the 4Hs and 4Ts

Answer 2

The reversible causes of cardiac arrest
Hypoxia, Hypovolaemia, Hypothermia, Hypo/Hyperkalaemia (electrolytes)
Tension pneumothorax, Tamponade, Thrombosis, Toxins

Question 3

Which 3 interventions have been validated in the literature

Answer 3

Basic CPR - 30 compressions to 2 breaths
Defibrillation for VF/VT
Oxygenation and ventilation through a secure airway

Question 4

Which resuscitation drugs cannot be given via ETT

Answer 4

Calcium

Sodium Bicarbonate

Question 5

What are the common perioperative causes of arrest and how can they be reversed

Answer 5

Hypoxaemia - secure airway and ventilate with 100% O2
Hypovolaemia - Give fluid
Drug effect - Allergy, CVS depression, CVS stimulation - give a reversing agent
Sympathetic blockade - Vasopressors, fluid
“Lazarus” phenomenon (breath stacking causing high intrathoracic pressure) - disconnect the patient from the circuit
Hyperkalaemia - Calcium chloride 5-10mLs of 10%, NaHCO3 50-100mmol, hyperventilate
Hypokalaemia - KCl 5mmol IV
Tension PTX - needle decompression
Cardiac tamponade - Pericardiocentesis
Torsades - Magnesium 2gm over 10mins then infusion

Question 6

Outline the adult ACLS algorithm

Answer 6

CPR 30 compressions to 2 breaths
Attach defib
Assess rhythm - VF/VT shock, PEA/Asystole - Adrenaline
Continue CPR
Reevaluate rhythm every 2mins
Give 1mg adrenaline every 2nd cycle (both paths)
Give 300mg Amiodarone after 3rd shock (shock path)
Post resus care on ROSC

Question 7

When are drugs delivered in shockable rhythms

Answer 7

Immediately after the shock has been delivered

Question 8

What is the compression/breath ratio for infant and children CPR

Answer 8

15:2

Question 9

What is the adrenaline dose for children

Answer 9

10mcg/kg

Question 10

What is the Amiodarone dose for children

Answer 10

5mg/kg

Question 11

How is Amiodarone prepared

Answer 11

300mg (2 ampoules) in 20mLs 5% Dextrose

Question 12

Where are defib electrodes/pads applied

Answer 12

(R) chest, MCL, 2nd ICS

(L) mid axillary line, 5th ICS

Question 13

What is the biphasic shock energy for an adult and child patient

Answer 13

Adult = 200J
Child = 4J/kg

Question 14

Outline post resus care

Answer 14

Re-evaluate ABCDE
Perform a 12 lead ECG
Treat precipitating causes
Re-evaluate oxygenation, ventilation
Consider cooling
Document all interventions
Cancel elective list
Inform supervisor and probably take some time off
Take an opportunity to debrief if required

Question 15

What are the most common causes of reversible arrest in children

Answer 15

Hypoxia and vagal stimulation

Question 16

Outline the neonatal resus pathway

Answer 16

Not breathing/crying, poor tone - prevent heat loss, open airway and stimulate
HR below 100, Gasping or apnoea - Positive pressure ventilate, SpO2 monitoring
HR below 100 - Open airway, reduce leaks, inc pressure and O2
HR below 60 - Chest compressions 90/min, (3:1 breath) 100% O2, consider intubate or LMA
HR still below 60 - venous access, adrenaline, volume expansion

Question 17

What are the targeted pre-ductal SpO2 after birth

Answer 17

1min 60-70%
2min 65-85%
3min 70-90%
4min 75-90%
5min 80-90%
10min 85-90%

Question 18

What is the dose of Adrenaline

Answer 18

10-30mcg/kg