Cardiac Arrest - Adult Flashcards
List the 3 care objectives in a medical cardiac arrest.
- HPCPR - commence immediately and maintain with minimal interruption to compressions.
- Rapid defibrillation of VF/PVT (if in doubt, shock)
- 2 minute rotations and rhythm checks
List the ratio of compressions to ventilations if NO ETT/SGA.
30:2, pause for ventilations.
List the ratio of compressions to ventilations if ETT/SGA insitu.
15:1
6 - 8 ventilations/min
no pause for ventilations.
If any doubt exists to the presence of a pulse, then…?
Start compressions immediately.
When are carotid pulse checks required?
Only in the setting of PPR: QRS complexes which may be accompanied by a rise in EtCO2.
What can be used as a surrogate marker of cardiac output?
EtCO2 - may reach normal physiologic values with high quality CPR.
A gradual fall in ETCO2 may indicate..?
CPR fatigue
Fluid administration in shockable rhythms should be…?
Limited to TKVO and medication flushes as it may be detrimental.
What is the timeframe for achieving a first defibrillation in HPCPR?
≤2 minutes.
List the 4 metrics of high quality HPCPR.
Rate 100-120 compressions/min
Depth ≥5cm, allow for full recoil.
Ventilations duration: 1s per ventilation
2 minutely compressor rotations
List the 4 core components of high performance CPR.
- Time to first defib ≤ 2mins
- Perform high quality CPR
- Minimise interruptions to chest compressions ≤ 3s
- Utilise Team Leader and checklist
How are interruptions to chest compressions kept to ≤ 3s?
- Focus on team performance and communication.
- Charge defibrillator during compressions.
- On-screen rhythm analysis
- Hover hands over chest and resume compressions immediately after defib/disarm
mCPR should not occur prior to ___ mins into the resuscitation, unless.?
16.
Unless inadequate resources or crew fatigue affecting compression quality.
When is transport with mCPR appropriate?
If all of the following are met:
- Paramedic witnessed arrest or initial presenting rhythm VF/VT refractory to Mx
- Likely reversible with medical intervention
- Pt ≤ 65 and lives independently
- Alfred ≤ 60mins from collapse (age 15-35) OR
- ECMO/PCI is ≤ 45mins from collapse (age 35-65).
Transporting patients without mCPR is associated with..?
Poorer outcomes and risks paramedic safety.
If the arrested pt has a known/suspected gestation >20 weeks, what is the management?
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.
When should sedation be considered for the arrested patient?
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).
What are the ALS and MICA options for sedation in the CPR interfering patient?
ALS: 25mcg IV Fentanyl, rpt @3-5mins PRN
MICA: 20mg IV/IO Ketamine rpt @3-5mins PRN
What is the primary goal in a hypothermic cardiac arrest?
Prevent further heat loss prior to ROSC/Tx. Increasing temperature pre-hospitally is unlikely.
At what temperature is a pt treated as a hypothermic arrest, and what changes are required to Mx?
<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.
List the 6 reversible causes of PEA.
- TPT
- UAO
- Exsanguination
- Asthma
- Anaphylaxis
- Hypoxia
When should fluids be administered in cardiac arrest, and what is the volume?
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.
Hypoglycaemia in cardiac arrest is rare. Should BGL’s be assessed?
Yes, but prioritise all other Mx above BGL - Mx as per Hypoglycaemia if low.
What is the specific indication to treat a cardiac arrest as medical?
Unconscious and ?pulseless in the setting of gasping/agonal respirations where the Hx, MOI and injuries do not suggest traumatic cause.
How often and what dose of Adrenaline is administered in cardiac arrest?
1mg IV Adrenaline every 2nd cycle/4mins.
Flush all medications with 20-30mL NS.
After gaining IV access and inserting SGA, what additional monitoring/adjuncts should be applied?
Insert OG tube via SGA and attach ETCO2 monitoring.
What are the care objectives for traumatic cardiac arrest?
- Major haemorrhage control
- Management of correctable causes in order of clinical need: ventilation/O2, exclusion of TPT, fluid replacement
- Standard arrest management including rhythm check
How can major haemorrhages be controlled in traumatic arrest?
Tourniquets, haemostatic dressings and/or direct pressure.
When should a pelvic splint be applied in a traumatic arrest?
After other interventions, unless clearly contributing to arrest in which it can be applied earlier.
When should early cessation of arrest protocols be considered in a traumatic arrest?
When all correctable causes have been managed and the patient’s presenting rhythm is asystole and remains in asystole.
In the event of penetrating trauma and PEA arrest, what is the priority?
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.
In the event of penetrating trauma and PEA arrest where the pt is being transported for an emergency thoracotomy, should compressions be undertaken?
No - compressions are not required during transport.
What volume of fluid is indicated in traumatic cardiac arrest?
20ml/kg
