Cardiac Arrest and airway mx - CPGs

Question 1

CPR rates for adults

Answer 1

30:2 100/min pause for ventilations

SGA inserted: 15:1 no pause for ventilations

Question 2

Paed CPR ratios

Answer 2

Single rescuer: 30:2 pause for ventilations
2 rescuers: 15:2 pause for ventilations
SGA 2 rescuers: 15:2 no pause

Question 3

Newborn CPR ratios

Answer 3

3:1 120/min

Question 4

Pad placement

Answer 4

Sternal: right of sternal margin, midclavicular line above right nipple
Apex; Midaxillary line 6th intercostal space

Question 5

CPR interfering pt

Answer 5

25mcg Fentanyl IV every 3-5 mins

Question 6

Causes of PEA

Answer 6

Hypoxia, exanguination, asthma, TPT, anaphylaxis, upper airway obstruction

Question 7

Hypothermic arrest management

Answer 7

Double interval for Adrenaline doses

More than 3 shocks unlikely to be successful

Question 8

Purpose/mechanism of CPR

Answer 8

To provide sufficient vital organ blood flow to preserve life until definitive care.
It takes a number of compressions to get intrathoracic pressure high enough to create mechanical circulation therefore minimise hands off chest time

Question 9

Role of DCCS

Answer 9

Attempts to cause simultaneous depolarisation of all cardiac cells (myocytes) in order for body’s natural pacemakers to resume normal function (only for VT/VF)

Question 10

Role of Adrenaline in Cardiac Arrest

Answer 10

Main reason is for alpha effects - vasoconstrictive effects lead to increased PVR which increases VR and CO and CPP
Beta 1 - increases irritability of ventricles and hopefully enable generation of a rhythm.
Beta 1 - increased myocardial contractility and CO

Question 11

Management of Medical Arrest

Answer 11

-analyse in auto and check pulse
-ensure not slow VT or VF with pacing spikes
-shock 200J
-pulse check every 2 mins
-SGA (15:1)
-IV access TKVO
Adrenaline 1mg every 4 mins
-Etco2 and OG tube

Question 12

Management of Traumatic arrest

Answer 12

• control haemorrhage over everything else
• airway: ensure patent, insert SGA
• TPT: bilateral decompression
• volume replacement: 20ml/kg normal saline IV

Question 13

Withholding resus reasons

Answer 13

• estimated time from collapse to AV attendance greater than 10mins
• Declared dead by doctor
• Injuries incompatible with life
• DNR
• Risk to paramedic/patient/bystander
• Inadequate resources
• Prolonged arrest - rigor mortis, decomposition

Question 14

Ceasing Resus

Answer 14

• 30-45mins of AV resus with no compelling reasons to continue
• VF: 45mins ALS resus, cant have autopulse on and no reasons but remains in VF

Question 15

Compelling reasons to continue resus

Answer 15

• pupils reacting
• agonal resps
• periods of ROSC
• youth and/or no co-morbidities

Question 16

Verification of Death

Answer 16

• no carotid pulse
• no breath sounds for 2 mins
• no heart sounds for 2 mins
• fixed and dilated pupils
• no response to centralised stimulus
• no motor response or facial grimace to pain

Question 17

Paediatric DCCS joules

Answer 17

4J/kg

Question 18

Definition of SGA

Answer 18

An airway adjunct that provides a low pressure deal around posterior perimeter of the larynx
Should sit superior to oesophageal sphincter

Question 19

Indications of SGA insertion

Answer 19

• unconscious without gag reflex
• ineffective ventilation with BVM
• more than 10 mins assisted ventilation required
• unable to intubate

Question 20

Precautions of SGA insertion

Answer 20

• fat: obesity, increased airway pressures required, pregnant
• kids: less than 12 yrs
• sniff: unable to prepare pt in sniffing position
• vomit in airway

Question 21

Contras of SGA insertion

Answer 21

• Gag reflex intact/resistance to insertion
• Airway obstruction
• Trismus/jaw tone
• Epiglottitis
• Sedation required to assist or maintain SGA

Question 22

Side effects of SGA insertion

Answer 22

does not prevent passive regurgitation