Cardiac Arrest

Question 1

Cardiac Arrest Adult - Treatment Priorities

Answer 1

• D R a b C h
• commence compressions and ventilations immediately
• CPR ratios:
  
  • not intubated @ 30:2, 100/min, 1/3 chest depth, pausing for ventilations
  • intubated or LMA @ 15:1, 100/min, 1/3 chest depth, no pause
• first rhythm analysis should be conducted in AED mode
• if VF/pulseless VT, deliver DCCS @ 200J, note time, change to manual mode
• clear airway using suction/magills as required and insert LMA (auscultate to confirm position and tape in situ) CPR 15:1, no pause
• provide assisted ventilations via BVM with 100% O2 @ 10ml/kg
• SITREP confirming arrest for MICA and FSV
• check temperature if exposed and adjust as required:
  
  • > 32 degrees: standard guideline
  • 30-32 degrees: standard DCCS, double intervals between drugs and rewarm to 33 degrees only if ROSC
  • <30 degrees: continue CPR and rewarming until temp >30, one DCCS and one drug bolus only
• @2/60 pulse check, analyse rhythm in manual mode, print 6sec strip to confirm and swap positions
• use bystanders/backup for CPR, work on IV access
• Adrenaline 1mg in 1ml IV @3/60

+++ if PEA: Normal Saline 20ml while working to identify treatable causes

Question 2

Cardiac Arrest Paediatric - Treatment Priorities

Answer 2

• D R a b C h
• commence compressions and ventilations immediately, even if bradycardic (HR <40 children or <60 infants/newborns)
• CPR ratios:
  
  • not intubated @ 30:2 single rescuer, or 15:2 dual rescue, 100/min, 1/3 chest depth, pausing for ventilations
  • intubated @ 15:2, 100/min, 1/3 chest depth, no pause
• first rhythm analysis should be in AED mode only if >9y MRX or >13y Zoll; otherwise manual mode and print 6sec strip to confirm
• if VF/pulseless VT, deliver DCCS @ 4J/kg, note time, change to manual mode
• clear airway using suction/magills as required and insert OPA
• provide assisted ventilations via BVM with 100% O2 @ 10ml/kg
• SITREP confirming arrest for MICA and FSV
• check temperature if exposed and adjust as required:
  
  • > 32 degrees: standard guideline
  • 30-32 degrees: standard DCCS, double intervals between drugs (MICA) and rewarm to 33 degrees only if ROSC
  • <30 degrees: continue CPR and rewarming until temp >30, one DCCS and one drug bolus (MICA) only
• @2/60 pulse check, analyse rhythm in manual mode, print 6sec strip to confirm and swap positions

+++ if PEA: identify treatable causes

Question 3

Cardiac Arrest Newborn - Treatment Priorities

Answer 3

• normal values for the newborn: HR 120-160bpm, RR 40-60, Temp 36.5-37.5, BGL 2.6-3.2mmol/L
• non-vigorous newborn (not moving or crying at birth):
  
  • stimulate/dry/warm
  • briefly inspect airway & suction/magills ONLY if meconium-stained amniotic fluid w/ resp distress
  • cut cord early to enable resuscitation
• @30sec: not breathing +/- HR <100:
  
  • IPPV ra @ 40-60bpm
• @60sec: inadequate breathing and HR 60-100:
  
  • continue IPPV with O2 @ 40-60bpm
    OR
• @60sec: inadequate breathing and HR <60:
  
  • commence CPR 3:1 and IPPV with O2
• reassess every 30sec