Cardiac Arrest Flashcards
What are the core standards for cardiac arrest response?
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 benefit of early recognition of cardiac arrest?
It helps to prevent cardiac arrests and deaths
admissions to ICU
inappropriate resuscitation attempts
How can oxygen delivery be improved?
SaO2 – ↑FiO2, Clear airway, Adequate breathing
[Hb] - Transfusion trigger, Treat anaemia - Gp&S / X-match, IV access, (Fe etc)
BP
Heart Rate – Atropine or β-stimulant (e.g. ephedrine) for bradycardia, pace
Stroke Volume
Preload – IV fluids, raise legs
Contractility - treat cause (e.g. PCI for MI)
Afterload
excess afterload (e.g. HBP) use vasodilators
reduced afterload (e.g. septic shock) use vasoconstrictors
What are the ways of assessing oxygen delivery factors ie. SaO2, [Hb], HR & BP?
SaO2- pulse oximetry, arterial blood gas (gold standard)
[Hb]- part of full blood count, bedside (Hemocue)
HR- pulse, pulse oximetry, ECG monitor with sound, arterial BP monitor
BP- CO x TPR
so once the HR is accounted for then BP determined by SV and/or TPR
SV depends on preload, contractility, afterload
BP change is always due to HR, preload, contractility or afterload change
Use clinical info to determine which
What are the causes of cardiorespiratory arrest?
Airway problems (SpO2) Decreased respiratory drive (CNS depression) Decreased respiratory effort (muscle weakness, nerve damage, restrictive chest defect, pain from broken ribs) Lung disorders (pneumothorax, haemothorax, infection, acute COPD exacerbation, asthma, PE)
What are some potential causes of airway obstruction?
CNS depression - tongue
Lumen blocked - blood vomit a foreign body
Swelling - trauma, infection, inflammation
Muscle - laryngospasm, bronchospasm
How can airway obstruction be treated?
Airway opening (head tilt chin lift) simple adjuncts tracheal tube LMA increased FiO2
When encountering an unresponsive patient how long do you check to see if they’re breathing?
no more than 10 seconds
In chest compressions what is the appropriate chest depression and the appropriate rate?
5-6 cm sternal depression and 100-120 compression per minute
What rhythms are shockable?
VF/VT
What rhythms are non-shockable?
Asystole/ PEA
What is the ECG appearance of ventricular fibrillation?
Bizarre irregular waveform no recognisable QRS random frequency & amplitude unco-ordinated electrical activity Coarse/ fine exclude artifact of movement and interference
What is the ECG presentation of VT?
Monomorphic VT - broad complex rhythm rapid rate constant QRS morphology Polymorphic VT Torsade de pointes
What is the precordial thump?
A potentially successful technique of hitting the sternum
only used when the defibrillator is not immediately available and there has been a witnessed and monitored VF/VT cardiac arrest - should never delay defibrillation
What is defibrillation?
Use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur.
