Cardiac Arrest

Question 1

SCA = sudden, termination ___ activity associated
LOC, __ ___ and ____

Answer 1

SCA = sudden, termination cardiac activity associated
LOC, spontaneous breathing and circulation

Question 2

T/F all unresponsive persons should be assumed to have cardiac arrest and CPR should be started immediately

Answer 2

true. it takes too long to confirm on the scene. Don’t be fooled by the pulse or agnoal repsiration

Question 3

Question 4

Outline some cardiovascular and non cardiac causes of SCA

Answer 4

cardiovascular: acute MI, ischemica, v fib, valvular heart disease, WPW, long QT, brugada, aneusym/dissection or aorta, cardiac tampnate or trauma.

non cardiac: PE, pneumothorax, drugs, varices, peripartum, severe hypoxia, hypoglycemia, hypothermia, hypo/hyperkalemia, acidosis.

Question 5

outline the 3-phase time-sensitive model.

Answer 5

1. electrical; defibrillation is paramount
2. circulatory; chest compressions, vasopressors and defibrillation
3. metabolic: new therapies: PCI, ECLS, TTM

Question 6

the main cause of SCA is ____ resulting in ____, but arrythmias like ___ is increasing in proportion

Answer 6

the main cause of SCA is CAD resulting in Vfib, but arrythmias like PEA or Asystole is incerasing in proportion over time. probably cause we are treating CAD with beta blockers and stuff which also prevent Vfib.

Question 7

2 main meds used in SCA

Answer 7

Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of irregular heartbeats. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular tachycardia

EPINEPHRINE 1mg

Question 8

H’s and T’s of causes of cardiac arrest

Answer 8

hypokalemia, (or hyperkalemia), hypothermia, hypovolemia, hypoxia

tamponade, tension pneumothorax, thrombosis, toxins

Question 9

CA resuscitation overal goals

Answer 9

chest compressions, oxygenation/ventrilation, early defibrillation, immediate attention to reversible causes like hypoxia or hyperkalemia

Question 10

possible etiologies to this rhythm

Answer 10

this is Vfib. could be ischemic heart disease, severe hypoxia, electrocution, drug toxicity, anti-arrhthmic drugs, trauma, valve problem, congenital heart disease, heart surgery

Question 11

when you are performing CPR what intervals should you give epinephrrin

Answer 11

epinephrine every 3-5 minutes. Consider advanced airway

Question 12

CABDD initial management of Vfib

Answer 12

chest compressions

airway

breathing

defibrillation

diagnosis

Question 13

___ ___ ___ is a syndrome characterized by an absent pulse, unconsciousness, and organized electrical activity on the ECG

Answer 13

pulseless electrical actibity

• definining pathophysiology is challenging given the heterogeneity and lack of valid models.
• 50% may be ischemic, 1/3 undergo PCI

Question 14

5 H’s and 5 T’s of pulseless electrical activity.

Answer 14

Question 15

NOTE:

Question 16

PEA management

Answer 16

• Priorities:
– C-A-B’s
– Epinephrine 1 mg asap and then q3-5 min
– Early identification of treatable conditions (see if you can overturn any H’s or T’s)

Question 17

T/F Resuscitation guidelines since 2010 have de-
emphasized advanced airway/ETT

Answer 17

TRUE. CPR most important. if you are competant, then sure do an airway. FOR SHOCKABLE RHYTHMS< they don’t need time taken to intubate them. SHOCK!

Question 19

epinephrine is a strong ___ agonist. What are it’s effects

Answer 19

strong Alpha1 agonist. thus, it promotes contractility of the heart, increases heart rae, and increases SVR. increasing SVR is a negative aspect of it when you are trying to do CPR though

Question 20

in addition to epinephrine, what two other drugs have been proven useful in cardiac arrest setting?

Answer 20

amiodarone and lidocaine.

Question 21

S __, __, Epi: The Right Cocktail? It showed improved NEUROLOGICAL survival by 13.9%

Answer 21

epineprhine, vasopressin and steroids.

Question 22

EtC02< 10-20 mm Hg after ___ mins ACLS strongly associated with failure of resuscitation

Answer 22

after 20 minutes. also cardiac standstill on echo is a positive predictor of poor outcome

Question 23

• Initial objectives of post resuscitation care are to:

Answer 23

– Optimize cardiopulmonary function and systemic
perfusion, especially perfusion to the brain

– Try to identify the precipitating causes of the arrest

– Institute measures that may improve long-term,
neurologically intact survival

Question 24

temperature relationship with resuscitation

Answer 24

fever is a large negative in post cardiac resuscitaiton care. in all we’re still doing hypothermic practices. (33-36 degrees)

Question 25

pathophysiological processes of post cardiac arrest syndrome

Answer 25

• brain injury )hypoxic0ischemic encephalopathy)
• myocardial dysfunction
• systemic ischemia/reperusion injury

Question 26

Predictors of poor outcome from coma/cardiac arrest:

• Absence of ___ or
corneal responses 72
hours

• Absent ___ response
other than extensor 72
hours

• Myoclonic status
___

• Elevated ___ (biomarker)

Answer 26

• Absence of PUPILLARY or
corneal responses 72
hours

• Absent MOTOR response
other than extensor 72
hours

• Myoclonic status
EPILEPTICUS

• Elevated NSE

Question 27

NOTE

Answer 27

Question 28

outline aspects of the CASPRI score

Answer 28

Question 29

Ho w to Neuroprognosticate?

Answer 29

• Physical exam remains the gold standard

• No sign or test in isolation should be the basis
for decisions •

Constellation of findings is important • In the TTM era allow time and more time…

Question 30