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Cardiovascular > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

what is cardiac arrest?

A

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

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2
Q

how to recognise a cardiac arrest?

A

unresponsive patient
not breathing normally
no pulse

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3
Q

what are the core standards?

A

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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4
Q

what is the chain of survival?

A

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

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5
Q

what causes cardiorespiratory arrest?

A

decreased respiratory drive
decreased respiratory effort
lung disorders

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6
Q

how can we assess oxygen delivery factors?

A 
ABCDE
SaO2
[Hb]
heart rate 
BP
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7
Q

what can cause obstruction resulting in cardiac arrest?

A

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

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8
Q

how can we improve SaO2?

A

clear airway

adequate breathing

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9
Q

how can we improve [Hb]?

A

tranfusion trigger

treat anaemia

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10
Q

how can we improve heart rate?

A

atropine or B stimulant

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11
Q

how can we improve SV?

A

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

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12
Q

what causes decreased respiratory drive?

A

CNS depression

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13
Q

what causes decreased respiratory effort?

A

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

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14
Q

what causes lung disorders?

A 
pneumothorax
haemothorax
infection
acute exacerbation COPD
asthma 
pulmonary embolus
ARDs
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15
Q

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

A 
Acute coronary syndromes
Dysrhythmias
Hypertensive heart disease
Valve disease
Drugs
Hereditary cardiac diseases
Electrolyte / acid base  abnormalities
Electrocution
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16
Q

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

A 
Asphyxia
Hypoxaemia
Blood loss
Hypothermia
Septic shock
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17
Q

what is the approach to a critically ill person due to circulation problems?

A

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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18
Q

what is the treatment of a critically ill patient due to circulation problems?

A 
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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19
Q

how do you treat someone with an airway obstruction?

A

Airway opening- head tilt, chin lift, jaw thrust, suction
Simple adjuncts
Advanced techniques- LMA, tracheal tube
Oxygen! (increase FiO2)

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20
Q

how to treat someone who is critically ill due to disability?

A 
Treat underlying cause
Blood glucose
if < 3 mmol l-1 give glucose
Consider lateral (recovery) position
Check drug chart
21
Q

how would you recognise someone who was critically ill due to a disability?

A

AVPU or GCS + pupils

22
Q

what are shockable rhythms?

A

VF

VT

23
Q

what are non shockable rhythms?

A

asystole

PEA

24
Q

describe VF

A 
shockable
bizarre irregular waveform 
no recognisable QRS complexes 
uncoordinated electrical activity 
coarse/ fine crackles
exclude artifact 
- movement 
- electrical interference
25
Q

describe VT

A 
shockable if pulseless 
monomorphic VT 
- broad complex rhythm
- rapid rate
- constant QRS morphology 
polymorphic VT
- torsade de pointes
26
Q

when is a precordial thump used?

A

only if defib no available in witnessed and monitored cardiac arrest

27
Q

what is defibrillation?

A

Use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur

28
Q

describe how to shock a patient

A 
deliver first shock
continue CPR
after 2 mins, second shock
continue CPR
after 2 mins, deliver third shock
give adrenaline and amiodarone 
continue CPR
29
Q

what is asystole?

A 
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
30
Q

what is pulseless electrical activity?

A 
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
31
Q

what are the reversible causes that can be treated?

A 
4 Hs
hypoxia
hypovolaemia
hypo/hyperkalaemia/metabolic
hypothermia 
4Ts
thrombosis
tension pneumothorax
tamponade
toxins
32
Q

describe the treatment of hypoxia

A 
secure airway (tracheal tube or supraglottic airway device)
do not interrupt CPR
avoid hyperventilation
33
Q

advantages of mouth to mask

A

Avoids direct person to person contact
Decreases potential for cross infection
Allows oxygen enrichment

34
Q

limitations of mouth to mask

A

Maintenance of airtight seal

Gastric inflation

35
Q

advantages of ventilation using self inflating bag

A

Avoids direct person to person contact
Allows oxygen supplementation – up to 85%
Can be used with facemask, LMA, Combitube, tracheal tube

36
Q

limitations of ventilation using self inflating bag

A

When used with a facemask:
Risk of inadequate ventilation
Risk of gastric inflation
Need two persons for optimal use

37
Q

advantages of supraglottic airway devices

A

Rapidly and easily inserted
Variety of sizes
More efficient ventilation than facemask
Avoids the need for laryngoscopy

38
Q

limitations of supraglottic airway devices

A

No absolute guarantee against aspiration
Not suitable if very high inflation pressures needed
Unable to aspirate airway

39
Q

what is the treatment of hypovolaemia?

A

IV fluids

40
Q

what is the treatment of hypo/hyperkalaemia/metabolic?

A

correct according to U and Es/ blood gases or likely abnormality from history

41
Q

what is the treatment of hypothermia?

A

consider rewarming

42
Q

what is the treatment of thrombosis?

A

consider thrombolysis

43
Q

what is the treatment of a tension pneumothorax?

A

needle thoracentesis

44
Q

what is the treatment of tamponade?

A

needle cardiocentesis

45
Q

what is the treatment of toxins?

A

specific treatment/ antidote if poss

46
Q

what are components of post cardiac arrest syndrome?

A

post cardiac arrest brain injury
post cardiac arrest myocardial dysfunction
systemic iscahemia/ reperfusion response
persistent precipitating pathology

47
Q

what is the immediate treatment post resus?

A

reach target SpO2 of 94-98%
advanced airway
ventilate to normocapnia
waveform capnography

48
Q

what is the post resus treatment if someone had circulatory issues?

A 
12 lead ECG 
reliable IV access
intra-arterial BP monitor
target SBP > 100bpm
fluid (crystalloid)
consider inotrope/ vasopressor
49
Q

what is targeted temp management used for?

A

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

Cardiovascular (31 decks)

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