Cardiac Arrest - Adult

Question 1

List the 3 care objectives in a medical cardiac arrest.

Answer 1

1. HPCPR - commence immediately and maintain with minimal interruption to compressions.
2. Rapid defibrillation of VF/PVT (if in doubt, shock)
3. 2 minute rotations and rhythm checks

Question 2

List the ratio of compressions to ventilations if NO ETT/SGA.

Answer 2

30:2, pause for ventilations.

Question 3

List the ratio of compressions to ventilations if ETT/SGA insitu.

Answer 3

15:1
6 - 8 ventilations/min
no pause for ventilations.

Question 4

If any doubt exists to the presence of a pulse, then…?

Answer 4

Start compressions immediately.

Question 5

When are carotid pulse checks required?

Answer 5

Only in the setting of PPR: QRS complexes which may be accompanied by a rise in EtCO2.

Question 6

What can be used as a surrogate marker of cardiac output?

Answer 6

EtCO2 - may reach normal physiologic values with high quality CPR.

Question 7

A gradual fall in ETCO2 may indicate..?

Answer 7

CPR fatigue

Question 8

Fluid administration in shockable rhythms should be…?

Answer 8

Limited to TKVO and medication flushes as it may be detrimental.

Question 9

What is the timeframe for achieving a first defibrillation in HPCPR?

Answer 9

≤2 minutes.

Question 10

List the 4 metrics of high quality HPCPR.

Answer 10

Rate 100-120 compressions/min
Depth ≥5cm, allow for full recoil.
Ventilations duration: 1s per ventilation
2 minutely compressor rotations

Question 11

List the 4 core components of high performance CPR.

Answer 11

1. Time to first defib ≤ 2mins
2. Perform high quality CPR
3. Minimise interruptions to chest compressions ≤ 3s
4. Utilise Team Leader and checklist

Question 12

How are interruptions to chest compressions kept to ≤ 3s?

Answer 12

1. Focus on team performance and communication.
2. Charge defibrillator during compressions.
3. On-screen rhythm analysis
4. Hover hands over chest and resume compressions immediately after defib/disarm

Question 13

mCPR should not occur prior to ___ mins into the resuscitation, unless.?

Answer 13

16.

Unless inadequate resources or crew fatigue affecting compression quality.

Question 14

When is transport with mCPR appropriate?

Answer 14

If all of the following are met:

1. Paramedic witnessed arrest or initial presenting rhythm VF/VT refractory to Mx
2. Likely reversible with medical intervention
3. Pt ≤ 65 and lives independently
4. Alfred ≤ 60mins from collapse (age 15-35) OR
5. ECMO/PCI is ≤ 45mins from collapse (age 35-65).

Question 15

Transporting patients without mCPR is associated with..?

Answer 15

Poorer outcomes and risks paramedic safety.

Question 16

If the arrested pt has a known/suspected gestation >20 weeks, what is the management?

Answer 16

mCPR where available, continue resuscitation and Tx for possible resuscitative hysterotomy. The uterus should be pushed to the left (rather than tilt the whole pt) to minimise aorto-caval compression.

Question 17

When should sedation be considered for the arrested patient?

Answer 17

If interferes with CPR, gag-reflex is present or the pt is suspected to be aware during resuscitation (excluding minor isolated movements such as eye rolling).

Question 18

What are the ALS and MICA options for sedation in the CPR interfering patient?

Answer 18

ALS: 25mcg IV Fentanyl, rpt @3-5mins PRN
MICA: 20mg IV/IO Ketamine rpt @3-5mins PRN

Question 19

What is the primary goal in a hypothermic cardiac arrest?

Answer 19

Prevent further heat loss prior to ROSC/Tx. Increasing temperature pre-hospitally is unlikely.

Question 20

At what temperature is a pt treated as a hypothermic arrest, and what changes are required to Mx?

Answer 20

<30c.
Doubled interval for adrenaline and amiodarone.
>3 shocks unlikely to be successful while severly hypothermic - consider AAV, mCPR- otherwise Mx as normal.
Where hypothermia is clearly the cause of arrest, consult Clinician/hospital for Tx with mCPR.

Question 21

List the 6 reversible causes of PEA.

Answer 21

1. TPT
2. UAO
3. Exsanguination
4. Asthma
5. Anaphylaxis
6. Hypoxia

Question 22

When should fluids be administered in cardiac arrest, and what is the volume?

Answer 22

In a PEA arrest where hypovolaemia, anaphylaxis or asthma is suspected and the patient has a rhythm that may be fluid responsive, administer Normal Saline 20mL/kg IV/IO.

Question 23

Hypoglycaemia in cardiac arrest is rare. Should BGL’s be assessed?

Answer 23

Yes, but prioritise all other Mx above BGL - Mx as per Hypoglycaemia if low.

Question 24

What is the specific indication to treat a cardiac arrest as medical?

Answer 24

Unconscious and ?pulseless in the setting of gasping/agonal respirations where the Hx, MOI and injuries do not suggest traumatic cause.

Question 25

How often and what dose of Adrenaline is administered in cardiac arrest?

Answer 25

1mg IV Adrenaline every 2nd cycle/4mins.

Flush all medications with 20-30mL NS.

Question 26

After gaining IV access and inserting SGA, what additional monitoring/adjuncts should be applied?

Answer 26

Insert OG tube via SGA and attach ETCO2 monitoring.

Question 27

What are the care objectives for traumatic cardiac arrest?

Answer 27

1. Major haemorrhage control
2. Management of correctable causes in order of clinical need: ventilation/O2, exclusion of TPT, fluid replacement
3. Standard arrest management including rhythm check

Question 28

How can major haemorrhages be controlled in traumatic arrest?

Answer 28

Tourniquets, haemostatic dressings and/or direct pressure.

Question 29

When should a pelvic splint be applied in a traumatic arrest?

Answer 29

After other interventions, unless clearly contributing to arrest in which it can be applied earlier.

Question 30

When should early cessation of arrest protocols be considered in a traumatic arrest?

Answer 30

When all correctable causes have been managed and the patient’s presenting rhythm is asystole and remains in asystole.

Question 31

In the event of penetrating trauma and PEA arrest, what is the priority?

Answer 31

Emergency thoracotomy is the priority, if it can be performed within 20mins of arrest. If Tx to an MTS is achievable within this timeframe, do not delay this for MICA, IV or ETT.

Question 32

In the event of penetrating trauma and PEA arrest where the pt is being transported for an emergency thoracotomy, should compressions be undertaken?

Answer 32

No - compressions are not required during transport.

Question 33

What volume of fluid is indicated in traumatic cardiac arrest?

Answer 33

20ml/kg