Cardiac arrest - Full summary Flashcards
What are the 4Hs that can cause cardiac arrest?
Hypoxia
Hypovolaemia
Hypothermia
Hypo/hyperkalaemia (+other metabolic)
What are the 4Ts that can cause cardiac arrest?
Tension pneumothorax
Tamponade
Toxins (Opiates and benzodiazepines)
Thrombus
What are some signs of cardiac arrest?
Unresponsive
Abnormal, agano breathing
Absent pulse
What is the number to call for a cardiac arrest in public?
999
What is the number to call for a cardiac arrest in hospital?
2222
What are the 2 methods of recording patient response?
ACVPU
Glasgow Coma Scale
What does ACVPU stand for?
A - Alert
C - Confusion
V - Voice
P - Pain
U - Unresponsive
What is the Glasgow coma scale?
A scale from 3-15
3 - Coma
15 - Fully alert
What should be performed before CPR in a patient with a suspected cardiac arrest?
Check alertness
Check airway
Check breathing
Check pulse
What is meant by good quality CPR?
Delivered to the lower half of the sternum
Compress chest by 5-6cm
Done with straightened arms
Performed at 100-120 bpm
Allow chest to fully recoil between compressions
Deliver chest compressions and breaths at a ratio of 30:2
What are the 4 possible rhythms in cardiac arrest?
Ventricular fibrillation
Pulseless ventricular tachycardia
Pulseless electrical activity
Asystole
What are the shockable rhythms of cardiac arrest?
Ventricular fibrillation
Pulseless ventricular tachycardia
What are the non-shockable rhythms of cardiac arrest?
Pulseless electrical activity
Asystole
What rhythm of cardiac arrest can be seen in the following ECG?
Ventricular fibrillation
What are the 2 forms of ventricular tachycardia?
Monomorphic
Polymorphic
What rhythm of cardiac arrest can be seen in this ECG?
Monomorphic ventricular tachycardia
What is Torsades du Point?
This is a form of highly irregular, polymorphic ventricular tachycardia, translating to “Twisting of the peaks”
What rhythm of cardiac arrest is seen on this ECG?
Torsades du Pointes
What is a precordial thump?
This is a thump to the chest that can be given to the lower half of the sternum in patients with Ventricular fibrillation or ventricular tachycardia (rarely effective)
What are the 2 main drugs that should be given in cardiac arrest?
Adrenaline
Amiodarone
When should adrenaline be given in cardiac arrest?
Every 3-5 minutes, after 3 shocks
When should amiodarone be given in cardiac arrest?
After 3 shocks
What is meant by ROSC?
Return of Spontaneous Circulation
This is the movement of the heart beat back into a functioning beat
What is the main sign of return to spontaneous circulation?
Rise in ETCO2 (End Tidal CO2)
What should be performed after return to spontaneous circulation?
ABCDE approach
Urgent cardiac catheterisation and PCI if required
ICU management
Neuro-protective ventilation
Neurological assessment after 72 hours
What does ABCDE stand for?
Airway
Breathing
Circulation
Disability
Exposure
What is a DNAR?
Do Not Attempt Resuscitation
This is a pre-agreed document that prevents the person from receiving CPR if they go into cardiac arrest
What can still be performed under a DNAR?
Fluids
Antibiotics
Medication
Why would someone sign a DNAR?
This is usually because the patient is too ill to fully recover from cardiac arrest and their quality of life will be significantly reduced if they were resuscitated
What are some reasons why CPR would not be administered?
DNAR
In cases of obvious mortal injury
If there is a safety threat to the ALS provider
If there is persistent asystole for >20 minutes
What is checked for in A of ABCDE?
Talking
Difficulty breathing
Noisy breathing
See-saw breathing
What is checked for in B of ABCDE?
Respiratory rate
Respiratory effort
Equal air entry
Added sounds
Tracheal deviation
Chest expansion
Percussion
Oxygen saturations
What is checked for in C of ABCDE?
Colour
Temperature to touch
Capillary refill time
Heart rate
Pulse character
Heart sounds
Blood pressure
What is checked for in D of ABCDE?
Hypoxia
Hypercapnia
ACVPU
Pupils
Blood glucose
Temperature
What is done in E of ABCDE?
Clothing removed to allow thorough examination
Avoid heat loss
Maintain dignity
