Cardiac Arrest Flashcards
1
Q
- When are pulse checks required?
A
Potentially perfusing rhythm - presence of QRS complexes which may be accompanied by a rise in EtCO2.
2
Q
- When should Mechanical CPR be used?
A
Not before 16mins, unless inadequate resources (<3 CPR trained rescuers) or crew fatigue affecting compression quality
3
Q
- When can you Tx with mCPR?
A
- Paramedic witnessed arrest OR presenting rhythm VF/VT refractory to initial Rx
- Likely reversible with medical intervention
- Pt ≤65 and lives independently
- Alfred hospital ≤60min from collapse (pt aged 15-35) OR ECMO or PCI ≤45min from collapse (pt aged 36-65)
4
Q
- What is the Rx for CPR-interfering pt incl. gag reflex or pt suspected to be aware?
A
- Fentanyl 100mcg IV every 1-2mins - if ineffective, Ketamine 50-100mg IV every 1-2mins (on consult)
- No IV: Fentanyl 200mcg IM or Ketamine 200mg IM single dose
5
Q
- What are some considerations for Hypothermic CA <30deg?
A
- Prevent further heat loss
- Double interval for Adrenaline and Amiodarone
- Greater than 3 shocks unlikely to be successful while pt is severely hypothermic
6
Q
- What are the PEA reversible causes of CA?
A
- Tension pneumothorax
- Upper airway obstruction
- Exsanguination
- Asthma
- Anaphylaxis
- Hypoxia
7
Q
- What is the pharmacological Rx for Cardiac arrest?
A
Adrenaline 1mg IV, repeat every 2nd cycle (4 minutely)
Flush all medications with 20-30mL Normal Saline
8
Q
- What needs to be considered with undifferentiated blunt trauma in traumatic CA?
A
Pelvic splint applied after other interventions - when pelvic # clearly contributing to CA, pelvic splint can be applied earlier
9
Q
- What is the Rx for Traumatic CA?
A
- Haemorrhage control priority
- Airway - patent, oxygenation and ventilation - SGA
- TPT - decompress bilaterally
- Volume replacement - NS 20 mL/kg
10
Q
- What needs to be considered with fluid administration for ROSC Mx?
A
Excessive fluid admin during intra-arrest and post-ROSC period may detrimental. Judicious admin of fluid especially important in VF/VT - should not exceed 20 mL/kg, unless correcting hypovolaemia
11
Q
- When should resuscitation be withheld in unwitnessed arrests?
A
An initial rhythm of asystole and estimated downtime greater than 10 mins
12
Q
- When should the cessation of resuscitation occur?
A
- PEA/Asystole: adult who has received 30-45mins of ALS resuscitation with no compelling reason to continue
- VF/VT: adult receiving 45mins of ALS resus, cannot be transported with mCPR and no other compelling reason to continue, but remains in VF.
13
Q
- What are compelling reasons to continue resuscitation?
A
- Signs of life including pupil reaction, agonal or gasping respirations
- Periods of ROSC
- Youth and/or absence of co-morbidities
14
Q
- What are the 6 determinants of death?
A
- No palpable carotid pulse
- No heart sounds heard for 2mins
- No breath sounds heard for 2 mins
- Fixed and dilated pupils
- No response to centralised stimulus
- No motor (withdraw) response/facial grimace to painful stimulus
ECG strip that shows 2mins of asystole is optional 7th
15
Q
- What are Reportable deaths?
A
- Unexpected, unnatural or violent death
- Death following a medical procedure
- Death of a person held in custody or care
- Person under the auspice of Mental Health Act but not in care
- Person unknown
