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medicine cardiovascular > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

What is cardiac arrest

A

Effective cessation of the heart so there is no circulation and 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

Presenting rhythm in most cardiac arrests

A

Ventricular fibrillation or ventricular tachycardia

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4
Q

What happens if there is not a shockable rhythm in cardiac arrest?

A

Cardiopulmonary resuscitation should commence in order to obtain a shockable rhythm

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5
Q

How to get better outcomes for patients suffering cardiac arrest

A

Early recognition of abnormal physiology, identifying patients at risk, identify when resuscitation is important

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6
Q

Core standards in cardiac arrest

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 and 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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7
Q

Chain of survival

A

Early recognition and call for help, early CPR (to buy time), early defibrillation (to restart the heart), post-resuscitation care to restore quality of life

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8
Q

What are most cardiac arrests caused by?

A

Problems with airway, breathing, circulation

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9
Q

How can we improve oxygen delivery factors:

  • SaO2
  • [Hb]
  • BP and heart rate
  • Preload
  • Contractility
  • Afterload
A
  • SaO2 = increase FiO2, clear airway, adequate breathing
  • [Hb] = transfusion trigger, treat anaemia
  • BP/HR = atropine or beta stimulant for bradycardia and pace
  • Preload = IV fluids, raise legs
  • Contractility = treat cause
  • Afterload = If excess, use vasodilators, reduced, use vasoconstrictors
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10
Q

How can we assess SaO2?

A

Clinical, pulse oximetry, arterial blood gas (gold standard)

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11
Q

How can we assess [Hb]?

A

Clinical, part of FBC, bedside

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12
Q

How can we assess heart rate?

A

Pulse, pulse oximetry, ECG monitor with sound, arterial BP monitor

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13
Q

What can airway obstruction be caused by?

A

CNS depression, lumen blocked, swelling, muscle

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14
Q

What can cause CNS depression?

A

Tongue

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15
Q

What can cause a blocked lumen?

A

Blood, vomit, foreign body

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16
Q

What can cause swelling?

A

Trauma, infection, inflammation

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17
Q

What muscular causes of airway obstruction are there?

A

Laryngospasm, bronchospasm

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18
Q

Recognition of airway obstruction

A

Talking, difficulty breathing, distressed, choking, SOB, noisy breathing (wheeze, stridor, gurgling), using accessory muscles

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19
Q

Treatment of airway obstruction

A

Airway opening - head tilt chin lift, simple adjuncts, LMA, tracheal tube, oxgyen

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20
Q

Causes of breathing problems

A

Airway problems, decreased respiratory drive, decreased respiratory effort, lung disorders

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21
Q

Recognition of breathing problems

A

Look - respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, conscious level
Listen - noisy breathing, breath sounds
Feel - expansion, percussion, tracheal position

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22
Q

Treatment of breathing problems

A

Airway, oxygen, treat underlying cause, support breathing if adequate

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23
Q

Primary causes of circulatory problems

A

Acute coronary syndromes, dysrhythmias, hypertensive heart disease, valve disease, drugs, hereditary cardiac disease, electrolyte abnormalities, electrocution

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24
Q

Secondary causes of circulatory problems

A

Asphyxia, hypoxaemia, blood loss, hypothermia, septic shock

25
Q

Recognition of circulation problems

A

General exam (pallor, distress), indicators of organ perfusion, BP, pulse, peripheral perfusion, bleeding, fluid losses, JVP

26
Q

Recognition of disability

A

AVPU, GCS + pupils

27
Q

Treatment for disability

A

Airway, breathing, circulation, treat underlying cause, blood glucose <3mmol/L give glucose, consider recovery position

28
Q

How to assess exposure

A

Remove clothes to check and avoid missing causes of problems e.g. injury, rash, bleeding but maintain dignity and avoid heat loss

29
Q

Management of collapsed patient outside of hospital

A
  • Safe to approach
  • Check responsive (Responsive – give appropriate aid, Unresponsive – shout for help)
  • Clear airway
  • Check breathing
  • Check circulation
30
Q

Responsive patient and how you would treat

A

Conscious - leave and get help

31
Q

Unresponsive and breathing patients and how you would treat

A

Unconscious - recovery position and get help

32
Q

Unresponsive and not breathing and how you would treat

A

Respiratory arrest - get help and ventilate

33
Q

Unresponsive treatment and no pulse and how you would treat

A

Cardiac arrest - get help and start CPR

34
Q

Chest compressions:

  • Where should they be performed?
  • How deep should the be?
  • Rate
A
  • Centre of chest
  • 5-6cm
  • 100-120 per minute
35
Q

When should you stop CPR?

A

Return of spontaneous circulation, when you are physically exhausted, when it seems useless (time, diagnosis, pre-arrest condition, DNR)

36
Q

Management of choking if mild airway obstruction

A

Encourage to cough and continue to check for deterioration to ineffective cough or until obstruction relieved

37
Q

Management of choking if severe airway obstruction and unconscious

A

CPR

38
Q

Management of choking if severe airway obstruction and conscious

A

5 x back blows

5 x abdominal thrusts

39
Q

When should a precordial thump be used?

A

Only used if defibrillator not immediately available in witnessed and monitored VF/VT cardiac arrest

40
Q

Defibrillation

A

The use of electrical current to reset the heart electrical rhythm with hope that regular rhythm will recur

41
Q

Defibrillation with self-adhesive pads:

- Benefits

A
  • Can and should apply during CPR
  • Analyse then CPR when charging
  • Shock delivered more rapidly
  • Similar transthoracic impedance/efficacy
  • Operator defibrillates from safe distance
  • Pads minimise interruptions
42
Q

Procedure for manual defibrillation

A
  • Diagnose VF/VT from ECG and signs of cardiac arrest
  • Select correct energy level
  • Charge paddles on patient
  • Shout “stand clear/O2 away”
  • Visual check of area
  • Check monitor
  • “stand clear” to CPR provider
  • Deliver shock
  • Resume CPR immediately
  • Minimise pause 5 secs by planning/communicating actions
43
Q

How long should you consider CPR after delivering a shock before you pause to assess the rhythm?

A

2 minutes

44
Q

Steps if VT/VF persists after shock

A

Deliver 2nd shock, CPR for 2 mins, deliver 3rd shock, CPR

45
Q

What do you do if VT/VF persists after a 3rd shock with defibrillator?

A

Give IV adrenaline (1mg) and amiodarone (300mg)

46
Q

Treatment for asystole

A

Give IV adrenaline 1mg as soon as possible, CPR and give adrenaline every 3-5 minutes

47
Q

Treatment for pulseless electrical activity

A

Exclude/treat reversible causes, give IV adrenaline 1mg as soon as possible and give every 3-5 mins thereafter

48
Q

Potentially reversible causes for cardiac arrest - Four Hs and Four Ts

A
  • Hypoxia
  • Hypovolaemia
  • Hypo-/hyperkalaemia/metabolic
  • Hypothermia
  • Thrombosis – coronary or pulmonary
  • Tension pneumothorax
  • Tamponade
  • Toxins
49
Q

Advantages and limitations of mouth to mask ventilation

A

Advantages: avoids direct person-to-person contact, decreases potential for cross-infection, allows oxygen enrichment
Limitations: maintenance of airtight seal, gastric inflation

50
Q

Advantages and limitations of ventilation using a self-inflating bag

A

Advantages: avoids direct person-to-person contact, allows oxygen supplementation up to 85%, can be used with facemask, LMA, combitube, tracheal tube
Limitations: risk of inadequate ventilation, gastric inflation, need for 2 persons for optimal use

51
Q

Advantages and limitations of using a supraglottic airway device

A

Advantages: rapidly and easily inserted, variety of sizes, more efficient ventilation than facemask, avoids need for laryngoscopy
Limitations: no absolute guarantee against aspiration, not suitable if very high inflation pressures are needed, unable to aspirate airway

52
Q

Treatment for hypovolaemia

A

IV fluids

53
Q

Treatment for hypo/hyperkalaemia/metabolic

A

Correct according to Us&Es/blood gases or likely abnormality from history

54
Q

Treatment for hypothermia

A

Consider rewarming

55
Q

Treatment for thrombosis

A

Consider thrombolysis

56
Q

Treatment for tension pneumothorax

A

Needle thoracentesis

57
Q

Treatment for cardiac tamponade

A

Needle cardiocentesis

58
Q

Treatment for toxins causing cardiac arrest

A

Specific treatment/antidote if possible

medicine cardiovascular (24 decks)

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