Cardiac Arrest and Resuscitation

Question 1

How soon after “clinical” death does biological death usually occur?

Answer 1

3-6 mins

Question 2

How is cardiac arrest confirmed?

Answer 2

• patient response (shake and shout)
• open airway and check for normal breathing and pulse in 10s
• check for signs of life (movements etc)

Question 3

What makes CPR high quality?

Answer 3

• 30:2
• chest compressions of 5-6cm
• full recoil
• 2 per second (100-120 bpm)
• switch CPR provider every 2 mins

Question 4

What should be avoided in CPR?

Answer 4

• spending too much time off the chest
• leaning over the patient (Shoulders should be above patients sternum)
• Over ventilating (should mimic normal breaths - otherwise complications => gastric inflation)
• Delayed use of DeFib

Question 5

What can Waveform Capnography be used to assess?

Answer 5

• patients CO2 output during CPR
• measured by anaesthetist
• should be around 2-2.5kPa in high quality CPR
• If patient is shocked back to life, this increases to 5-5.5kPa

Question 6

What should you do to maximise the amount of energy transferred from the AED to the patient?

Answer 6

• correct pad placement
• make sure pads are stuck securely with no air trapping
• remove hair on chest if necessary
• more energy may be required in larger patients, patients with specific disease etc due to higher resistance

Question 7

Describe the main differences between VF and pVT

Answer 7

VF - bizzare irregular waveform, no QRS complexes recognisable, random amplitudes

pVT - monomorphic = broad but consistent QRS complexes, rapid rate
polymorphic = torsades de pointes

Question 8

What is the main difference between a manual DeFib and AED that can minimise time off the chest?

Answer 8

Manual DeFib allows CPR to continiue whilst the Defibrillator is charging

Question 9

What drug should be given after the 3rd shock from the defibrillator?

Answer 9

Adrenaline IV (1mg)

Amiodarone may also be given - only slightly better than controls in studies

Question 10

Describe the appearance of asystole

Answer 10

• absent ventricular activity (no QRS complexes)

- P waves (atrial activity) may still be present

Question 11

How are asystole and PEA treated if patients cannot be shocked with the defib?

Answer 11

High quality CPR

adrenaline 1mg IV every 3-5 mins

Question 12

If vascular access cannot be achieved intravenously, where can blood be taken from in an emergency?

Answer 12

Intraosseous

Question 13

HOw can metabolic disturbances (hypo/hyperkalaemia) be tested for at the bedside?

Answer 13

ABG (after arterial stab)

Question 14

What treatment is given in hyperkalaemia?

Answer 14

calcium gluconate FIRST TO PROTECT HEART

insulin - to lower potassium
dextrose - to counteract insulin and prevent

Question 15

What treatment/intervention is given if a patient has a tension pneumothorax compressing their heart and causing cardiac arrest?

Answer 15

Needle decompression or thoracotomy

Question 16

How is cardiac tamponade treated?

Answer 16

Pericardiocentesis or thoracotomy

Question 17

How is cardiac arrest due to toxins treated?

Answer 17

antidote

Question 18

How are patients treated for a PE and why should CPR continue for up to 90 mins after treatment is given?

Answer 18

• fibrinolytic therapy can take 60-90 mins to work

=> mechanical CPR given for 90 mins

Question 19

What are the 6 stages of ECG interpretation?

Answer 19

Electrical activity present?
Rate?
Rhythm? (irreg./reg)
Narrow or broad QRS?
Atrial activity (P waves) present?
Is atrial activity related to ventricular activity (does QRS follow P waves)?