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Cardiovascular > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

what is cardiac arrest

A

effective cessation of heart, no circulation and oxygen delivery

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2
Q

how do you recognise cardiac arrest

A

unresponsive patient, not breathing normally, no pulse

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3
Q

what is SaO2 or its indirect measurement SpO2

A

concentration of oxygen bound to haemoglobin in arterial blood

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4
Q

what is the formula for oxygen delivery

A

DO2= SaO2 x [Hb] x O2cc (carrying capacity of Hb) x Co (HR x SV)

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5
Q

what rhythms are shock able

A

ventricular fibrillation and pulse-less ventricular tachycardia

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6
Q

what does cardiac arrest often preceed

A

hypoxia and hypotension

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7
Q

what are the core standards for cardiac arrest

A
  • recognise deterioration EARLY and prevent if possible
  • arrest recognised early and CPR started immediately
  • help summon as soon as arrest recognised
  • defibrillation if appropriate, within 3 mins
  • appropriate post arrest care
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8
Q

how do you increase SaO2 (SpO2)

A

increase FiO2, clear airway, maintain adequate breathing

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9
Q

how do you increase [Hb]

A

transfusion trigger, treat anaemia

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10
Q

how do you treat low HR

A

atropine or B-stimulant (ephedrine)

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11
Q

how do you treat decreased pre load

A

IV fluid, raise lags

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12
Q

how do you treat low contractility

A

treat cause e.g. PCI for MI

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13
Q

how do you treat excess afterload

A

vasodilators (get this in e.g. high BP)

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14
Q

how do you treat reduced after load

A

vasoconstrictors (get this in e.g. septic shock)

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15
Q

how do you asses SaO2

A

pulse oximetry, ABG

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16
Q

how do you assess [Hb]

A

FBC

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17
Q

how do you assess HR

A

pulse, pulse oximeter, ECG monitor, arterial BP monitor

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18
Q

what are the two main component affecting BP

A

cardiac output and total peripheral resistance

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19
Q

what can cause airway obstruction

A

CNS depression- tongue

lumen blocked- blood, vomit, forgein body

swelling- trauma, infection, inflammation

muscle- laryngospasm, bronchospasm

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20
Q

how can you recognise airway obstruction

A

talking, difficulty breathing, distressed, choking, shortness of breath, stridor, wheeze, gurgling, see-saw respiratory pattern, accessory muscles

21
Q

how is an airway obstruction treated

A

airway opening (head tilt chin lift, jaw thrust, suction)
simple adjuncts/ advanced techniques (tracheal tube)
oxygen

22
Q

what can cause breathing problems

A

airway problems,
decreased resp drive (CNS depression),
decreased resp effort (muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs)
lung disorders (pneumothorax, haemothorax, infection, COPD exacerbation, asthma, PE, ARDS)

23
Q

what are the clinical signs of breathing problems

A

resp distress, accessory muscles, cyanosis, resp rate, chest deformity, conscious level, noisy breathing, expansion, percussion, tracheal position

24
Q

what are the primary causes of circulation problems

A 
Acute coronary syndromes
Dysrhythmias
Hypertensive heart disease
Valve disease
Drugs
Hereditary cardiac diseases
Electrolyte / acid base  abnormalities
Electrocution
25
Q

what are the secondary causes of circulation problems

A 
Asphyxia
Hypoxaemia
Blood loss
Hypothermia
Septic shock
26
Q

what are the clinical signs of circulatory problems

A

distress, pallor, organ perfusion (chest pain, mental state, urine output), BP, HR, cap refill, bleeding, fluid losses, JVP, CVP

27
Q

how is disability in ABCDE treated

A

ABC then treat underlying cause
-e.g. blood glucose
consider recovery position
check drug chart

28
Q

what happens in exposure in ABCDE

A

Remove clothes to enable thorough examination (to avoid missing causes of problems)

avoid heat loss and maintain dignity

29
Q

whats haematoma

A

solid swelling of clotted blood within the tissues

30
Q

what is respiratory arrest

A

unresponsive, not breathing but have pulse

31
Q

how is a-systole and PEA treated

A

adrenaline 1mg IV ASAP, every 3-5 mins after and CPR

32
Q

what heart rhythms are not shockable

A

a systole, pulseless electrical activity

33
Q

describe VF on an ECG

A

irregular, no recognisable QRS complex, random frequency and amplitude

34
Q

is ventricular fibrillation shockable

A

yes

35
Q

describe ventricular tachycardia on an ECG

A

two types
monomorphic VT- broad complex rhythm, rapid rate, constant QRS morphology

Polymorphic VT- torsade de pointes

36
Q

when is VT shockable

A

when it is pulseless

37
Q

what is a precordial thump

A

rarely effective, used only if defibrillator not immediately available and in witnessed and monitored VF/VT cardiac arrest

38
Q

what is defibrillation

A

use of electrical current to reset heart electrical rhythm with hope that regular rhythm will recur

39
Q

when should amidarone be given and what does it do

A

during CPR after 3 shocks- anti arrhythmic drug

40
Q

what effect does adrenaline have

A

alpha vasoconstriction

beta inotropic

41
Q

what are the potentially reversible causes of cardiac arrest

A

four H’s and four T’s

  • hypoxia
  • hypovolaemia
  • hypo/hyper-kalaemia/ metabolic
  • thrombosis- coronary or pulmonary
  • tension pneumothorax
  • tamponade
  • toxins
42
Q

what is avoiding hyperventillation

A

ensuring that large volumes and high rates are not used as these will increase intrathoracic pressure, decreasing venous return and coronary perfusion

43
Q

how can an airway be secured

A

tracheal tube, supraglottic airway device

44
Q

what is a risk of mask to mouth and self inflating bag ventilation

A

gastric inflation, risk of inadequate ventilation

45
Q

what extra advantage does a self inflating bag have

A

allows oxygen supplementation (up to 85%)

46
Q

what is ROSC

A

return of spontaneous circulation

47
Q

what is post cardiac arrest syndrome

A

brain injury, myocardial dysfunction, systemic ischaemia/ re-perfusion response, persistent precipitating pathology

48
Q

when can therapeutic hypothermia be used

A

unconscious adults with ROSC should be cooled to 32-37 degrees

Cardiovascular (34 decks)

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