Cardiac Arrest and Life Support

Question 1

What is the chain of survival in cardiac arrest?

Answer 1

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

Question 2

What does early recognition of cardiac arrest prevent?

Answer 2

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

Question 3

What are most cardiac arrests caused by?

Answer 3

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

Question 4

How can you increase haemoglobin concentration?

Answer 4

Blood transfusion.

Question 5

How can you increase heart rate?

Answer 5

Atropine or B-stimulant e.g. ephedrine.

Question 6

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

Answer 6

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

Question 7

What is the gold standard for measuring oxygen saturations?

Answer 7

Arterial blood gas.

Question 8

How would you measure haemoglobin concentration at the bedside?

Answer 8

Using hemocue.

Question 9

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

Answer 9

Clinical info.

Question 10

What can airway obstruction be caused by?

Answer 10

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

Question 11

How can you assess airway obstruction?

Answer 11

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

Question 12

How would you treat airway obstruction?

Answer 12

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

Question 13

What are the indicators of organ perfusion?

Answer 13

Chest pain, mental state, urine output.

Question 14

How would you treat circulation problems?

Answer 14

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

Question 15

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

Answer 15

Disability, less than 3mmol/l.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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).

Question 18

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

Answer 18

Less than 5 seconds. Chest fall.

Question 19

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

Answer 19

Call the resuscitation team and do CPR.

Question 20

What are the shockable and non-shockable rhythms?

Answer 20

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

Question 21

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

Answer 21

Movement, electrical interference.

Question 22

What is another name for polymorphic VT?

Answer 22

Torsade de pointes.

Question 23

What do you do after you shock?

Answer 23

Immediately resume CPR for 2 minutes then assess rhythm again.

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

Describe the steps in manual defibrillation.

Answer 26

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.

Question 27

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

Answer 27

5 secs, by planning and communicating actions.

Question 28

When would you give 1mg of IV adrenaline?

Answer 28

After the 3rd shock if VF/VT persists.

Question 29

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

Answer 29

After alternate shocks (every 3-5 mins).

Question 30

What kind of drug is amiodarone?

Answer 30

A potassium channel blocker.

Question 31

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

Answer 31

After every 3rd shock.

Question 32

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

Answer 32

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

Question 33

What is pulseless electrical activity (PEA)?

Answer 33

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

Question 34

How would you treat pulseless electrical activity?

Answer 34

Exclude/treat reversible causes, then same as asystole.

Question 35

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

Answer 35

Waveform capnography.

Question 36

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

Answer 36

No do continuous CPR.

Question 37

How are drugs for cardiopulmonary resuscitation kept?

Answer 37

In Min-I-jets.

Question 38

What quantity of amiodarone would you give?

Answer 38

300mg.

Question 39

What are the potential reversible causes of cardiac arrest?

Answer 39

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

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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.

Question 42

Give an example of a supraglottic airway device.

Answer 42

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.

Question 43

What can you monitor with waveform capnography?

Answer 43

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

Question 44

When should you stop CPR?

Answer 44

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

Question 45

What are the 4 possible post cardiac arrest syndromes?

Answer 45

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

Question 46

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

Answer 46

>100mmHg, intra-arterial blood pressure monitor.

Question 47

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

Answer 47

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.

Question 48

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

Answer 48

Consider CT brain or CTPA (CT pulmonary angiography).

Question 49

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

Answer 49

Admit to intensive care unit.

Question 50

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

Answer 50

32-36*C.

Question 51

How long should this be continued for?

Answer 51

12-24 hours.

Question 52

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

Answer 52

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