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ACC > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

What are the two types of rhythm that someone can go into during cardiac arrest?

A 
Shockable (VF or pulseless VT)
Non shockable (PEA or assystole)-poorer outcomes
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2
Q

How do you detect cardiac arrest?

A

ABSENCE OF PULSE - this is very important to detect on your A-E work up. IF THE PULSE IS ABSENT, IMMEDIATLY START CARDIAC ARREST ALGORITHM

  • Patient will be unconscious
  • Absence of breathing is concerning - look for chest movements while feeling for their carotid pulse.
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3
Q

If someone doesn’t have a pulse then what should you do?

A

No pulse detected

  1. Immediately start chest compression to breath ratio 30:2 (continue this ratio until defib available) CRASH CALL
  2. Attach a defibrillator ASAP (time from this moment)
  3. When you have enough people, the manage airway and get access
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4
Q

What will the defibrillator do once attached?

A
  • It will assess the rhythm and decide whether it is appropriate to deliver a shock
  • Prompt shocking in shockable rhythms is vital, in VF with each passing minute the chance of spontaneous circulation returning reduces by 7-10%
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5
Q

What do you do if a shockable rhythm is detected?

A

If a SHOCKABLE rhythm is detected

  • Give 1 shock (150J)
  • IMMEDIATELY straight back on the chest (30:2)
  • Reassess rhythm after 2 MINS (<5 secs)
  • Give 1mg IV Adrenaline (1 in 10,000) every 3-5 mins
  • Amiodarone 300mg IV after 3rd shock
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6
Q

What do you do if a NON shockable rhythm is detected?

A

If a NON SHOCKABLE rhythm is detected

  • IMMEDIATELY straight back onto the chest (30:2)
  • Reassess rhythm after 2 MINS (<5 secs)
  • Give 1mg IV Adrenaline (1 in 10,000) every 3-5 mins
  • Once airway is secure you can do continuous compressions
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7
Q

What medications can you give in a cardiac arrest? (2)
dose?
how do you give?
when do you give?

A

IV Adrenaline (1 in 10,000)

  • Given in shockable (after 3 shocks) AND non shockable
  • 1 mg (10ml) bolus every 3-5 mins minutes as necessary

IV amiodarone
-300mg after 3 SHOCKS (only give in shockable)

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8
Q

If VT/VF still persists after the 3rd shock and the IV adrenaline what can we consider?

A

300mg IV amiodarone just before the 4th shock

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9
Q

Patient with VT/VF-has had no response to 4 shocks, IV adrenaline and IV amiodarone then what can be tried next?

A

Continue shocking and re-assessing rhythm every 2 mins

Give further 1mg IV adrenaline every other shock (approx 3-5mins)

Always try and identify REVERSIBLE causes

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10
Q

What are the unshockable rhythms?

A

PEA (Pulseless electrical activity)

Asystole

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11
Q

What are the three possible situations that could occur when you reassess someone’s rhythm?

A

ROSC - return of spontaneous circulation - start post resuscitation care
Still in unshockable rhythm - Continue CPR
If VF/VT - deliver shock and change to VF/VT algorithm

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12
Q

What are the shockable rhythms?

A

Shockable rhythms

-VF or pulseless VT

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13
Q

If someone is in a unshockable rhythm twice in a row what should you consider doing?

A

Gain IV access to delivery 1mg IV adrenaline every alternate round

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14
Q

What are the 8 reversible causes of CARDIAC ARRESTand how would you fix?

A

FOUR Hs and FOUR Ts
Hypoxia (oxygen)
Hypothermia (bear hugger, warmed saline, blanket)
Hypovolaemia (fluids)
Hyper/hypokalaemia, hypoglycaemia, hypocalcaemia, academia (ABGs, treat hyperkalemia with calcium CHLORIDE in cardiac arrest)

Tension pneumothorax (5th ICS mid axillary)
Thrombus (coronary or pulmonary) (alteplase-CPR must last 90-120 mins) 
Tamponade (bedside echo-classically post MI/pericarditis/trauma) 
Toxins (classically patient controlled analgesia)
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15
Q

What is the most common cause of cardiac arrest?

A

Thrombosis caused by ACS/MI

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16
Q

What sort of rhythm of cardiac arrest will tension pneumothorax commonly cause?

A

PEA (non shockable)

17
Q

What is the difference between amiodarone and atropine and which algorithm are they both used in?

A

Amiodarone is anti-arrhythmic used to prolong refractive period of heart contraction used in SHOCKABLE RHYTHM (VF/VT) PATHWAY

Atropine is used in the treatment of BRADYCARDIAS - bind to ACh receptors on heart from the vagus nerve

18
Q

What is done in a rhythm check?
How often is a rhythm check done?
When do you give adrenaline in relation to the rhythm checks?

A

Rhythm check is done every 2 minuets
“we are in (insert rhythm e.g. VF)”
“this is (insert shockable/non shockable)
“back on the chest”
-Give adrenaline every other rhyme check (will be every 4 mins)

19
Q

Who is allowed on the chest when you are charging?

Who is allowed on the chest when shocking?

A

CHARGING: only chest compressions allowed on chest
SHOCKING: no one allowed on chest

20
Q

Descibe a good chest compression?

A
  • Chest compressions should be 5-6cm in depth

- 100-120bpm

21
Q

What does VF look like on ECG?

A

VF

  • chaotic, irregular (up and down all over the place)
  • 300-600bpm (never has pulse)
22
Q

What does VT look like on ECG?

A

VT

  • broad QRS complexes
  • can be compatible with life if it has a pulse>CHECK PULSE (if absent this is cardiac arrest)
23
Q

What does PEA look like on ECG?

A

PEA
-can look quite organised/sinus rhythm>CHECK PULSE
(if absent this is cardiac arrest)

24
Q

Who can complete a DNACPR

A

DNACPR must be done by F2s and above

25
Q

What is the max rate of potassium infusion?

A

Potassium infusion: MAX RATE of 20mmol/hr

26
Q

What does ‘downtime’ in cardiac arrest cause?

A

Downtime in cardiac arrest can cause false hyperkalemia and false high lactate

27
Q

What is the treatment of opiod OD?

A
  • 400mg IV naloxone
  • 2nd bolus
  • infusion
28
Q

When can you do continuous breaths?

What rate should these continuous breaths be?

A
  • Continuous breaths can be done when ET tube is secured

- Continuous breaths should be done at a rate of 10 breaths/min

ACC (23 decks)

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