Cardiac Arrest Flashcards
what is cardiac arrest?
effective cessation of the heart so no circulation and therefore no oxygen delivered
how to recognise a cardiac arrest?
unresponsive patient
not breathing normally
no pulse
what are the core standards?
Deterioration recognised early with effective help system to prevent arrest
Arrest recognised early and CPR started immediately
Help summoned as soon as arrest is recognised (if not already)
Defibrillation, if appropriate, within 3 minutes of arrest (where achievable)
Appropriate post-arrest care if resuscitated including safe transfer
Standards measured continually + identified problems dealt with
At least annual training and updates in CPR
Staff understanding of decisions relating to CPR
Appropriate equipment available for resuscitation
what is the chain of survival?
early recognition and call for help
early CPR
early defib
post resus care
what causes cardiorespiratory arrest?
decreased respiratory drive
decreased respiratory effort
lung disorders
how can we assess oxygen delivery factors?
ABCDE SaO2 [Hb] heart rate BP
what can cause obstruction resulting in cardiac arrest?
CNS depression- tongue
lumen blocked- blood, vomit, foreign body
swelling- trauma, infection, inflammation
muscle- laryngospasm, bronchospasm
how can we improve SaO2?
clear airway
adequate breathing
how can we improve [Hb]?
tranfusion trigger
treat anaemia
how can we improve heart rate?
atropine or B stimulant
how can we improve SV?
preload- IV fluids, raise legs
contractility- treat cause (eg PCI for MI)
afterload- excess- use vasodilators
-reduced- use vasconstrictors
what causes decreased respiratory drive?
CNS depression
what causes decreased respiratory effort?
muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs
what causes lung disorders?
pneumothorax haemothorax infection acute exacerbation COPD asthma pulmonary embolus ARDs
what are primary circulation problems which can lead to cardiac arrest?
Acute coronary syndromes Dysrhythmias Hypertensive heart disease Valve disease Drugs Hereditary cardiac diseases Electrolyte / acid base abnormalities Electrocution
what are secondary circulation problems which can lead to cardiac arrest?
Asphyxia Hypoxaemia Blood loss Hypothermia Septic shock
what is the approach to a critically ill person due to circulation problems?
General exam – distress, pallor etc
Indicators of organ perfusion- chest pain, mental state, urine output
Blood pressure
Pulse – tachycardia, bradycardia
Peripheral perfusion - capillary refill time (CRT)
Bleeding, fluid losses, JVP, CVP
what is the treatment of a critically ill patient due to circulation problems?
1st ensure Airway, Breathing, O2 IV / IO access, take bloods Treat cause -Fluid challenge -Inotropes/vasopressors -Oxygen/Aspirin/Nitrates/ Morphine for ACS Haemodynamic monitoring
how do you treat someone with an airway obstruction?
Airway opening- head tilt, chin lift, jaw thrust, suction
Simple adjuncts
Advanced techniques- LMA, tracheal tube
Oxygen! (increase FiO2)
how to treat someone who is critically ill due to disability?
Treat underlying cause Blood glucose if < 3 mmol l-1 give glucose Consider lateral (recovery) position Check drug chart
how would you recognise someone who was critically ill due to a disability?
AVPU or GCS + pupils
what are shockable rhythms?
VF
VT
what are non shockable rhythms?
asystole
PEA
describe VF
shockable bizarre irregular waveform no recognisable QRS complexes uncoordinated electrical activity coarse/ fine crackles exclude artifact - movement - electrical interference
describe VT
shockable if pulseless monomorphic VT - broad complex rhythm - rapid rate - constant QRS morphology polymorphic VT - torsade de pointes
when is a precordial thump used?
only if defib no available in witnessed and monitored cardiac arrest
what is defibrillation?
Use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur
describe how to shock a patient
deliver first shock continue CPR after 2 mins, second shock continue CPR after 2 mins, deliver third shock give adrenaline and amiodarone continue CPR
what is asystole?
non shockable absent ventricular (QRS) activity atrial activity (P waves) may persist rarely a straight line trace adrenaline as soon as possible every 3-5 mins thereafter
what is pulseless electrical activity?
non shockable clinical features of cardiac arrest ECG normally associated with an output exclude/ treat reversible causes adrenaline as soon as possible every 3-5 mins thereafter
what are the reversible causes that can be treated?
4 Hs hypoxia hypovolaemia hypo/hyperkalaemia/metabolic hypothermia
4Ts thrombosis tension pneumothorax tamponade toxins
describe the treatment of hypoxia
secure airway (tracheal tube or supraglottic airway device) do not interrupt CPR avoid hyperventilation
advantages of mouth to mask
Avoids direct person to person contact
Decreases potential for cross infection
Allows oxygen enrichment
limitations of mouth to mask
Maintenance of airtight seal
Gastric inflation
advantages of ventilation using self inflating bag
Avoids direct person to person contact
Allows oxygen supplementation – up to 85%
Can be used with facemask, LMA, Combitube, tracheal tube
limitations of ventilation using self inflating bag
When used with a facemask:
Risk of inadequate ventilation
Risk of gastric inflation
Need two persons for optimal use
advantages of supraglottic airway devices
Rapidly and easily inserted
Variety of sizes
More efficient ventilation than facemask
Avoids the need for laryngoscopy
limitations of supraglottic airway devices
No absolute guarantee against aspiration
Not suitable if very high inflation pressures needed
Unable to aspirate airway
what is the treatment of hypovolaemia?
IV fluids
what is the treatment of hypo/hyperkalaemia/metabolic?
correct according to U and Es/ blood gases or likely abnormality from history
what is the treatment of hypothermia?
consider rewarming
what is the treatment of thrombosis?
consider thrombolysis
what is the treatment of a tension pneumothorax?
needle thoracentesis
what is the treatment of tamponade?
needle cardiocentesis
what is the treatment of toxins?
specific treatment/ antidote if poss
what are components of post cardiac arrest syndrome?
post cardiac arrest brain injury
post cardiac arrest myocardial dysfunction
systemic iscahemia/ reperfusion response
persistent precipitating pathology
what is the immediate treatment post resus?
reach target SpO2 of 94-98%
advanced airway
ventilate to normocapnia
waveform capnography
what is the post resus treatment if someone had circulatory issues?
12 lead ECG reliable IV access intra-arterial BP monitor target SBP > 100bpm fluid (crystalloid) consider inotrope/ vasopressor
what is targeted temp management used for?
therapeutic hypothermia
unconscious adults with ROSC after arrest should be cooled to 32 to 36 degrees
start as soon as possible and continue for 12-24 hr
external or internal techniques
