Cardiac Arrest

Question 1

What is involved in the BLS primary survey?

Answer 1

ABCDs

Question 2

In the “airway” of ABCs, how method is used to open the airway? What method if trauma is suspected?

Answer 2

Is the airway open? The airway should be opened using head tilt-chin lift or if trauma is suspected jaw thrust.

(If trauma is suspected, cervical immobilization must be maintained.)

Question 3

In the ABCs, how long should circulation be assessed for prior to starting CPR?

Answer 3

5-10 seconds

Question 4

In CPR, if no pulse is present, the rhythm should be assessed using a _________________.

Answer 4

defibrillator

manual defibrillator or AED

Question 5

How is ACLS secondary survey different from BLS primary survey?

Answer 5

…More advanced

• A: In addition to head tilt-chin life, jaw thrust, use oropharyngeal airway, or nasopharyngeal airway (Endotracheal intubation most effective)
• B: Assess rise and fall of the chest, auscultate breath sounds (check if equal), look for absence of breath sounds over the epigastrum, monitoring end-tidal CO2 using capnometry or capnography
• C: Obtain IV or IO access, start pt on cardiac monitor

Question 6

What is the acronym for ACLS drugs that are safe for endotracheal intubation administration?

Answer 6

NAVEL

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine

Question 7

Consider the ddx of causes of suspected cardiac arrest (especially potentially reversible causes).

Answer 7

• Hypovolemia
• Hypoxia
• Acidosis
• Hypothermia
• Tension pneumothorax
• Cardiac tamponade
• Electrolyte abnormality
• Overdose
• Trauma
• Acute Coronary Syndrome

Question 8

What are some initial studies/labs to order with suspected cardiac arrest?

Answer 8

• EKG: (r/o cardiac ischemia, various toxin exposure, hyperkalemia)
• ABG: shows the acid-base and oxygenation status of the patient
• Electrolytes
• CXR
• Bedside US may be used to evaluate cardiac activity or the presence of pericardial effusions.

Question 9

Almost all episodes of sudden cardiac death initiate from this rhythm.

Answer 9

What is ventricular tachydysrhythmia?

• Successful resuscitation is dependent on rapid defibrillation

Question 10

ACLS recommends chest compressions should be interrupted only for _________, ___________, and ___________ since even a 5-10 second pause in compressions reduces the probability that the shock will terminate VF/pulseless VT.

Answer 10

ventilation, rhythm checks, and shock delivery

Question 11

After shock administration, what should you do next? When should you check the rhythm?

Answer 11

CPR starting with compressions should be immediately initiated after the shock without performing a pulse or rhythm check for 2 minutes (5 cycles) of CPR.

Question 12

The interruption in CPR to check the rhythm should not exceed ___ seconds.

Answer 12

10 sec

Question 13

What are the shockable rhythms?

Not shockable?

Answer 13

V-tach, V-fib

not shockable: PEA, asystole

Question 14

How much Joules of energy should you use in a shock?

Answer 14

200 Joules

Question 15

Besides compressions, breathing, and shocks, what else should be administered, what dose, and how often?

Answer 15

1. Obtain IV/IO access to administer epinephrine 1 mg q 3-5 min (start at first 2 min shock interval)
2. Amniodarone 300mg, followed by 150mg as indicated every 3-5 min (start at 2nd 2 min shock interval)

Question 16

In the past, what med could have been substituted for epi 1mg during CPR?

Answer 16

Vasopressin 40 U

• Substituted for the first or second dose of epinephrine. No vasopressor medications have been shown to improve the survival rate for PEA, but are recommended to improve aortic diastolic blood pressure and coronary artery perfusion.

Question 17

Studies have shown that resuscitation efforts are unlikely to be successful after ___ minutes of combined BLS and ACLS.

Answer 17

20 min

Question 18

In the past, this alternative medication should be considered for asystole or slow PEA and may be repeated every 3 to 5 minutes for a total of 3 doses. (not still recommended)

Answer 18

Atropine 1mg IV/IO

Question 19

What is the rationale behind therapeutic hypothermia in CPR?

Answer 19

A large proportion of victims will suffer anoxic brain injuries. Initiation of mild hypothermia (cooling to 32-34 C) has been demonstrated to decrease the 6 month mortality rate and lead to improved functional recovery at hospital discharge.

Question 20

Review inclusion criteria for therapeutic hypothermia.

Answer 20

• Patients resuscitated after out-of-hospital witnessed arrest with VT/VF as initial rhythm
• Resuscitation initiated by EMS within 5-15 minutes of arrest
• No more than 60 minutes from collapse to return of spontaneous circulation (ROSC)
• Persistent coma after ROSC
• Adult age
• Endotracheal intubation and mechanical ventilation

Question 21

Review contraindications for therapeutic hypothermia.

Answer 21

• Severe cardiogenic shock (SBP<90 mmHg) despite fluids and inotropes
• Cause of coma other than cardiac arrest (overdose, CVA)
• Pregnancy
• Known coagulopathy
• Life-threatening arrhythmias
• Initial temperature <30 C
• Preexisting DNR status
• Pediatric patients