Cardiac Arrest Flashcards by Lucy Allan

what is cardiac arrest?

effective cessation of the heart so no circulation and therefore no oxygen delivered

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how to recognise a cardiac arrest?

unresponsive patient
not breathing normally
no pulse

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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

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what is the chain of survival?

early recognition and call for help
early CPR
early defib
post resus care

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what causes cardiorespiratory arrest?

decreased respiratory drive
decreased respiratory effort
lung disorders

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how can we assess oxygen delivery factors?

ABCDE
SaO2
[Hb]
heart rate 
BP

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what can cause obstruction resulting in cardiac arrest?

CNS depression- tongue
lumen blocked- blood, vomit, foreign body
swelling- trauma, infection, inflammation
muscle- laryngospasm, bronchospasm

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how can we improve SaO2?

clear airway

adequate breathing

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how can we improve [Hb]?

tranfusion trigger

treat anaemia

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how can we improve heart rate?

atropine or B stimulant

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how can we improve SV?

preload- IV fluids, raise legs
contractility- treat cause (eg PCI for MI)
afterload- excess- use vasodilators
-reduced- use vasconstrictors

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what causes decreased respiratory drive?

CNS depression

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what causes decreased respiratory effort?

muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs

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what causes lung disorders?

pneumothorax
haemothorax
infection
acute exacerbation COPD
asthma 
pulmonary embolus
ARDs

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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

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what are secondary circulation problems which can lead to cardiac arrest?

Asphyxia
Hypoxaemia
Blood loss
Hypothermia
Septic shock

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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

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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

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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)

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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?

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