Cardiac Arrest

Question 1

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

Answer 1

VF/VT

Non-VF/VT (systole and PEA)

Question 2

How do you detect cardiac arrest?

Answer 2

ABSENCE OF PULSE - this is very important to detect on your A-E work up. Patient will be unconscious
Absence of breathing is concerning - look for chest movements while feeling for their carotid pulse.
If the pulse is absent then immediately start the cardiac arrest algorithm

Question 3

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

Answer 3

Immediately start CPR under the BLS algorithm
Chest compression to breath ratio 30:2
Attach a defibrillator as soon as possible

Question 4

Which cardiac rhythms are shockable and which are non-shockable? Which has worse outcomes

Answer 4

VF/VT - SHOCKABLE

PEA/Asystole - UNSHOCKABLE - poorer outcomes

Question 5

What will the defibrillator do once attached?

Answer 5

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%

Question 6

Once a shock has been delivered what should you do immediately?

Answer 6

Restart CPR - without re-assessing the rhythm or feeling for a pulse
Continue CPR for a further 2 mins and then the defibrillator will re-assess the rhythm

Question 7

IF VF/VT still persists after a 3 rounds of defibrillation then what can you consider?

Answer 7

Giving 1mg IV adrenaline just before the 3rd shock

Question 8

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

Answer 8

300mg IV amiodarone just before the 4th shock

Question 9

If there has been no response to 4 shocks, IV adrenaline and IV amiodarone then what can be tried next?

Answer 9

Continue shocking approximately every re-assessing rhythm every 2 mins and give further 1mg IV adrenaline every other shock (approx 3-5mins)
Always try and identify reversible causes

Question 10

What are the unshockable rhythms?

Answer 10

PEA (Pulseless electrical activity)

Asystole

Question 11

If someone is found to be in an unshockable rhythm how should they be managed?

Answer 11

Continue BLS along CPR protocol (30:2) and assess their rhythm every 2 mins with defibrillator

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

When can we consider giving atropine in unshockable rhythms?

Answer 14

Always give it if they are in asystole or their PEA is slow (<60/min)
3mg IV

Question 15

What are the 8 reversible causes of CARDIAC ARREST

Answer 15

FOUR Hs and FOUR Ts
Hypoxia 
Hypothermia 
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, academia

Tension pneumothorax
Thrombus (coronary or pulmonary)
Tamponade
Toxins

Question 16

What is the most common cause of cardiac arrest?

Answer 16

Thrombosis caused by ACS/MI

Question 17

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

Answer 17

PEA

Question 18

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

Answer 18

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 - might be in the UNSHOCKABLE RHYTHM PATHWAY
***NO LONGER RECOMMENDED BUT IS STILL IN SOME ALGORITHMS