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CSB335 > Cardiac arrest > Flashcards

Cardiac arrest Flashcards

1
Q

What is the definition of cardiopulmonary arrest?

A

Cessation of cardiac function with the pt displaying no pulse, no breathing, and unresponsiveness

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2
Q

What are the possible primary causes of CA?

A

AMI/IHD/CHF
Cardiomyopathy
Pericarditis
Valvular stenosis

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3
Q

What are the possible secondary causes of CA?

A 
Acute asthma
Tension pneumothorax
Drug OD
Drowning
Trauma
Electrolyte imbalance
Anaphylaxis
Electrocution
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4
Q

List the steps in the chain of survival

A 
Early intervention
Access
CPR
Defibrillation
ACLS
Post-resus care
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5
Q

What is the compression to breaths ratio for paeds?

A

15:2

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6
Q

In paediatric arrests which is done first, ventilation or compressions? Justify your answer

A

Ventilation, as bradycardia is usually due to hypoxia

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7
Q

How does the QAS calculate paediatric body weight?

A

(age x 3) + 7

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8
Q

When is CPR indicated for a newborn (minutes/hours post birth)?

A

When HR is <60bpm despite ventilation for 30 seconds

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9
Q

How are compressions performed on a newborn?

A

Compress with two thumbs on lower third of the sternum

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10
Q

What is the ratio of compressions to breaths for a newborn?

A

3:1

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11
Q

When should an advanced airway be applied in CA?

A

After 6 minutes (3 cycles) unless traumatic (immediately in trauma settings)

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12
Q

How much adrenaline should be given when an adult pt is in a shockable rhythm and when?

A

1mg after the 2nd shock then every 3-5 minutes

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13
Q

List the H’s

A

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hypo/hyperthermia

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14
Q

List the T’s

A

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary/coronary/CVA)

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15
Q

What is included in post-resuscitative care?

A
  • Reassess
  • 12 lead ECG
  • Rx precipitating causes
  • Aim for SpO2 94-98% and normocapnia
  • BGL mx
  • Temp mx
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16
Q

How much adrenaline should be given when a paediatric pt is in a shockable rhythm and when?

A

10mcg/kg after 2nd shock then every 3-5 minutes

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17
Q

How much adrenaline should be given when a paediatric pt is in a non-shockable rhythm and when?

A

10 mcg/kg immediately then every 3-5 minutes

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18
Q

How much adrenaline should be given when an adut pt is in a non-shockable rhythm and when?

A

1mg immediately then every 3-5 minutes

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19
Q

Provide a rationale for defibrillation

A

Defibrillation produces simultaneous depolarisation of a critical mass of the myocardium and may enable the resumption of coordinated electrical activity

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20
Q

How much of the myocardium does defibrillation need to send into absolute refractory for it to be successful?

A

A critical mass of >70%

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21
Q

What are the indications for defibrillation?

A

VF and pulseless VT

22
Q

What is the most desirable chest compression point on adults and why?

A

Lower half of the sternum - higher is not effective and lower risks abdominal organ damage

23
Q

What is the ideal depth and rate of compressions on adults?

A

One third of the chest at a rate of 100/minute

24
Q

Describe placement of defibrillation pads on adults

A

Para-sternal over the 2nd intercostal space, and mid-axillary over the 6th intercostal space

25
Q

Where are defibrillation pads placed on paeds?

A

Centrally anterior and posterior

26
Q

Is removal of oxygen from an LMA or ETT required for defibrillation? Explain your answer.

A

No - these are sealed units

27
Q

What four things must be checked when confirming it is safe to defibrillate?

A
  • Excess hair has been removed
  • Pad placement is correct
  • The pt is dry
  • Everyone is clear
28
Q

What is monophasic defibrillation?

A

Shock goes from one pad to the other

29
Q

What is biphasic defibrillation?

A

Shock goes from one pad to the other then back again

30
Q

Which is better, monophasic or biphasic defibrillation?

A

There is no definitive evidence in favour of either

31
Q

Under QAS guidelines what are the energy levels of the first three shocks for adult pts using a LifePak12?

A

1 - 200j
2 - 300j
3 - 360j

32
Q

At what energy level does the Corpuls3 deliver shocks for adults?

A

200j

33
Q

What energy level does QAS recommend for paed defibrillation?

A

All shocks 4 joules/kg

34
Q

What use is waveform capnography (ETCO2)?

A
  • Confirm airway
  • Assess adequacy of CPR
  • Significant rise is an early sign of ROSC
35
Q

What are some examples of CA in special circumstances?

A 
Anaphylaxis
Asthma
Pregnancy
Trauma
Drug OD/poisoning
Hypothermia
36
Q

How is resuscitation altered in asthmastic CA?

A

Slow ventilation rate to ~6/minute

Take the BVM off and allow the pt to exhale

37
Q

What has CA in asthmatics been linked to?

A
  • Severe bronchospasm and mucous plugging leading to asphyxia
  • Arrhythmias due to hypoxia/stimulant drugs/electrolyte abnormalities
  • Hyperinflation due to air trapping
  • Tension pneumothorax
38
Q

Explain the concept of air trapping in asthmatics

A

It is harder to for asthmatics expel air than take it in and ‘breath stacking’ occurs, gradually increasing pressure and eventually reducing BP and venous return.

39
Q

What are some considerations in asthmatic CA?

A
  • Consider early ETT
  • If dynamic hyperinflation is suspected during CPR, compression of the chest wall and/or a period of apnoea (ETT disconnection after 2 minutes of CPR) may relieve gas trapping
  • Consider possible co-existence of anaphylaxis
40
Q

What are common causes of CA in pregnancy?

A
  • Cardiac disease
  • Pulmonary thrombo-embolism
  • Haemorrhage
  • Sepsis
  • Hypertensive disorders of pregnancy
  • Poisoning and self-harm
  • Amniotic fluid embolism
  • Pregnant women can also have the same causes of cardiac arrest as females of the same age group (e.g. anaphylaxis, drug OD, trauma)
41
Q

What are the additional management points for CA in pregnancy?

A
  • Manually displace the uterus to the left to remove caval compression: tilt woman’s uterus 15-30 degrees towards her left hip (if feasible). The angle of tilt used needs to allow high quality chest compressions and permit Caesarean delivery of the foetus if necessary.
  • Urgent tx as an emergency Caesarean section may be performed at hospital: the fetus will need to be delivered if resuscitation efforts fail.
42
Q

What are some common causes of CA in trauma?

A

Hypovolaemia
Tension pneumothorax
Pericardial tamponade

43
Q

What are the additional management points for CA involving poisoning?

A
  • Normal resuscitation guidelines for OD of beta blockers/calcium channel blockers/cocaine and stimulants/digoxin/carbon monoxide/TCAs
  • Naloxone for opioid OD
  • Be aware that carbon monoxide poisoning has high mortality
  • Consider a hyperbaric chamber for carbon monoxide poisoning
  • Sodium bicarbonate for TCA OD
44
Q

How does CA mx change when the pt is hypothermic?

A
  • Withhold resuscitation drugs if <30 degrees Celcius
  • Shock three times at 360j if in VF/VT then no more until pt is over 30 degrees Celcius
  • Double drug administration interval when pt is between 30 and 35 degrees Celcius
45
Q

What is the rapid CPR discontinuation criteria?

A

CPR may be withdrawn before expiration of 20 continuous minutes if:

  • Pt was observed to be unresponsive and pulseless for at least 10 minutes prior to paramedic arrival
  • No CPR was provided during this period
  • The pt is exhibiting signs of life extinct
  • The pt’s cardiac rhythm is asystole
46
Q

What is the general CPR discontinuation criteria?

A

CPR must be administered by the paramedic for 20 continuous minutes after which it may be withdrawn if:

  • Pt is exhibiting signs of life extinct
  • Pt’s cardiac rhythm is asytole or PEA at a rate <10bpm
47
Q

What are the indications for ROLE?

A 
No palpable carotid pulse
No heart sounds for 30 seconds
No breath sounds for 30 seconds 
Fixed dilated pupils
No response to centralised stimuli
48
Q

Describe ROSC mx

A

CCP backup (sedation, antidysrhythmics, seizure control)
Swap from defib pads to Lead II ECG
Posture as per LOC
Mx BGL

49
Q

Describe ROSC mx

A

CCP backup (sedation, antidysrhythmics, seizure control)
Swap from defib pads to Lead II ECG
Posture as per LOC
Mx BGL
O2 depending on respiratory effort and SpO2 to minimise hypercapnia
Vigilant ABC monitoring
Urgent tx

50
Q

Describe ROSC mx

A

CCP backup (sedation, antidysrhythmics, seizure control)
Swap from defib pads to Lead II ECG
Posture as per LOC
Mx BGL
O2 depending on respiratory effort and SpO2 to minimise hypercapnia
Vigilant ABC monitoring
Urgent tx

51
Q

What are the signs of obvious death?

A
  • Decomposition/putrefaction
  • Hypostasis
  • Rigor mortis
52
Q

List the injuries incompatible with life

A
  • Decapitation
  • Cranial and cerebral destruction
  • Hemicorporectomy (or similar massive injury)
  • Incineration
  • Foetal maceration

CSB335 (12 decks)

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