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Cardiovascular > Cardiac Arrest and Life Support > Flashcards

Cardiac Arrest and Life Support Flashcards

1
Q

What is the chain of survival in cardiac arrest?

A

Early recognition and call for help -> early CPR -> early defibrillation -> post-resuscitation care.

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2
Q

What does early recognition of cardiac arrest prevent?

A

Arrests and deaths, admissions to ICU and inappropriate resuscitation attempts.

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3
Q

What are most cardiac arrests caused by?

A

Problems with airway, breathing and circulation (oxygen delivery problems).

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4
Q

How can you increase haemoglobin concentration?

A

Blood transfusion.

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5
Q

How can you increase heart rate?

A

Atropine or B-stimulant e.g. ephedrine.

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6
Q

How would you raise preload, improve contractility and either increase or decrease afterload?

A

Preload - IV fluids, raise legs.
Contractility - treat cause e.g. PCI for MI.
Afterload - decrease with vasodilators, increase with vasoconstrictors.

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7
Q

What is the gold standard for measuring oxygen saturations?

A

Arterial blood gas.

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8
Q

How would you measure haemoglobin concentration at the bedside?

A

Using hemocue.

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9
Q

How would you determine whether a blood pressure change is due to HR, preload, contractility or afterload change?

A

Clinical info.

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10
Q

What can airway obstruction be caused by?

A

CNS depression (tongue), lumen blocked (blood, vomit, foreign body), swelling (trauma, infection, inflammation), muscle (laryngospasm, bronchospasm).

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11
Q

How can you assess airway obstruction?

A

Talking; difficulty breathing, distressed or choking; shortness of breath; noisy breathing e.g. stridor, wheeze, gurgling; see-saw resp pattern; using accessory muscles.

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12
Q

How would you treat airway obstruction?

A

Airway opening by head tilt chin lift, jaw thrust, suction; simple adjunts?; advanced techniques e.g. LMA, tracheal tube; oxygen (increase FiO2).

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13
Q

What are the indicators of organ perfusion?

A

Chest pain, mental state, urine output.

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14
Q

How would you treat circulation problems?

A

Get IV/IO access, take bloods, treat cause, haemodynamic monitoring.

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15
Q

At what stage would you check blood glucose and how low would it be where you would give glucose?

A

Disability, less than 3mmol/l.

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16
Q

What are the 3 things you should do if you think someone is approaching the end of their life?

A
  1. Effective and timely communication with patients and relatives whenever possible and appropriate.
  2. Clear documentation of all decisions and reasons.
  3. Clear documentation of discussions or why discussions not possible/appropriate.
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17
Q

What are the 4 groups of patients and how should you deal with them?

A
  1. Responsive = conscious (leave/get help).
  2. Breathing = unconscious (recovery position/help).
  3. Not breathing = respiratory arrest (help/ventilation).
  4. No pulse = cardiac arrest (help/CPR).
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18
Q

How long should it take you to give 2 rescue breaths and what should you watch for after giving one?

A

Less than 5 seconds. Chest fall.

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19
Q

What would you do in hospital if someone is unconscious and not breathing normally?

A

Call the resuscitation team and do CPR.

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20
Q

What are the shockable and non-shockable rhythms?

A

Shockable - VF/VT. Non-shockable - asystole/PEA.

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21
Q

What could cause and ECG to look like VF when it wasn’t?

A

Movement, electrical interference.

22
Q

What is another name for polymorphic VT?

A

Torsade de pointes.

23
Q

What do you do after you shock?

A

Immediately resume CPR for 2 minutes then assess rhythm again.

24
Q

When is the only time you would use a precordial thump?

A

If defibrillator is not immediately available in witnessed and monitored VF/VT chest.

25
Q

What are the benefits of monitoring/defibrillating with self-adhesive pads?

A

Analyses and you can do CPR while it charges, shock is delivered more rapidly, similar impedance/efficacy, operator defibrillates from a safe distance.

26
Q

Describe the steps in manual defibrillation.

A

Charge paddles on patient, shout “stand clear/O2 away”, visual check of area, check monitor, “stand clear” to CPR provider, deliver shock, resume CPR immediately.

27
Q

What should the minimum pause in CPR be when defibrillating and how is this achieved?

A

5 secs, by planning and communicating actions.

28
Q

When would you give 1mg of IV adrenaline?

A

After the 3rd shock if VF/VT persists.

29
Q

How often do you give adrenaline after the 3rd shock?

A

After alternate shocks (every 3-5 mins).

30
Q

What kind of drug is amiodarone?

A

A potassium channel blocker.

31
Q

How often after the 3rd shock should you give amiodarone?

A

After every 3rd shock.

32
Q

As asystole is non-shockable, what would you do to treat it?

A

Give adrenaline 1mg IV as soon as possible then every 3-5 mins thereafter (2 cycles).

33
Q

What is pulseless electrical activity (PEA)?

A

When there are clinical features of cardiac arrest but the ECG is normally associated with an output.

34
Q

How would you treat pulseless electrical activity?

A

Exclude/treat reversible causes, then same as asystole.

35
Q

During CPR, what would you use to measure carbon dioxide being exhaled?

A

Waveform capnography.

36
Q

When an advanced airway is in place, should you stop CPR?

A

No do continuous CPR.

37
Q

How are drugs for cardiopulmonary resuscitation kept?

A

In Min-I-jets.

38
Q

What quantity of amiodarone would you give?

A

300mg.

39
Q

What are the potential reversible causes of cardiac arrest?

A

4 Hs: hypoxia, hypovolaemia, hypo/hyperkalaemia/metabolic, hypothermia.
4 Ts: thrombosis (coronary/pulmonary), tension pneumothorax, cardiac tamponade, toxins.

40
Q

What are the advantages and limitations of mouth to mask ventilation?

A

Advantages: avoid direct person contact, decreases potential for cross infection, allows oxygen enrichment.
Limitations: maintenance of airtight seal, gastric inflation.

41
Q

What are the advantages and limitations of ventilation using self-inflating bag?

A

Advantages: avoids direct person to person contact, allows oxygen supplementation (up to 85%), can be used with facemask, LMA, Combitube and tracheal tube.
Limitations (when used with facemask): risk of inadequate ventilation, risk of gastric inflation, need two persons for optimal use.

42
Q

Give an example of a supraglottic airway device.

A

Advantages: rapidly and easily inserted, variety of sizes, more efficient ventilation than facemask, avoid the need for laryngoscopy.
Limitations: no absolute guarantee against aspiration, not suitable if very high inflation pressure needed, unable to aspirate airway.

43
Q

What can you monitor with waveform capnography?

A

Intubation success, compression quality, ROSC (return of spontaneous circulation).

44
Q

When should you stop CPR?

A 
When ROSC (return of spontaneous circulation). 
When seems useless (time, diagnosis, pre-arrest conditions, DNR/DNAR order).
45
Q

What are the 4 possible post cardiac arrest syndromes?

A
  1. Post-cardiac arrest brain injury.
  2. Post-cardiac arrest myocardiac dysfunction.
  3. Systemic ischaemia/reperfusion response.
  4. Persistent precipitating pathology.
46
Q

What is the target systolic blood pressure for someone post-cardiac arrest, and how is this measured?

A

> 100mmHg, intra-arterial blood pressure monitor.

47
Q

What should you do if you think the cardiac arrest had a likely cardiac cause?

A

Look for ST elevation on ECG, if there is then do coronary angiogram and PCI. If there is not, still consider coronary angiogram and PCI.

48
Q

What should you do if it is unlikely to be a cardiac cause or if angiography yields nothing?

A

Consider CT brain or CTPA (CT pulmonary angiography).

49
Q

What is the end stage after treating the cause of cardiac arrest?

A

Admit to intensive care unit.

50
Q

What temperature should unconscious adults with ROSC after arrest be cooled to?

A

32-36*C.

51
Q

How long should this be continued for?

A

12-24 hours.

52
Q

What are the stages to go through before transferring a patient?

A

Discuss with admitting team, CCU vs ICU (need for airway), cannulae drains and tubes secured, chest drains, monitoring, patient’s notes, reassessment before leaving.

Cardiovascular (32 decks)

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