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BCEHS Guidelines 2024 > Cardiac Arrest Management > Flashcards

Cardiac Arrest Management Flashcards

1
Q

What is peri-arrest?

A

Period of time either before or immediately following a full cardiac arrest. The pt. condition is unstable.

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2
Q

What are the signs and symptoms of a peri-arrest pt.? (not all will be listed here)

A

-Shock/hypotension MAP <65
-Syncope
-myocardial ischemia
-Heart failure
-cardiac arrhythmias

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3
Q

Are pharmaceuticals or electrical therapy warranted in a unstable ‘peri-arrest’ pt.?

A

Electrical therapy is warranted where needed for symptomatic peri-arrest pt.
Pharmaceuticals are warrants to bridge other failure signs and symptoms

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4
Q

What saturation levels of o2 should a paramedic titrate to?

A

> 94 <100%

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5
Q

What are the steps to treat bradycardia?

A

1.perform 12 lead to determine causation of bradycardia
2. Rule out hyperkalemia through past med hx. of pt., if hyperkalemia is 1 #1 dx. YOU MUST CALL CLINICALL prior to any treatments ie. calcium, bicard, salbutamol
3. If acs, rule out right sided, give ASA, nitro, iv line, pads, fentanyl for pain decreasing myocardial o2 demand, atropine for bradycardia
4. EPI infusion starting at 2mcg/min while increasing if necessary to a max of 10mcg/min
5. Transcutaneous pacing using procedural sedation and pain management

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6
Q

What are the steps in treating narrow complex tachycardia?

A
  1. rhythm strip to determine what kind of SVT/ 12 lead
  2. Afib with RVR if stable, convey and observe
  3. A-flutter if stable, convey and observe
  4. SVT (orthodromic) narrow, regular and stable, modified valsalva, adenosine 6mg/12mg, if both admin of adenosine fail CLINCALL is required to discuss further treatment.
  5. If all of the above rhythms are unstable synchronized cardioversion is required AFTER YOU CALL CLINICALL TO DISCUSS TREATMENT
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7
Q

What are the step in treating wide complex tachycardia?

A
  1. Rhythm strip followed by 12 lead ecg
  2. Stable monomorphic amiodarone 150mg infusion over 10mins CLINICALL IS REQUIRED TO PERFORM THIS TREATMENT
  3. Unstable monomorphic WCT synchronized cardioversion 100-200-300-360 with procedural sedation
  4. Stable polymorphic WCT mag sulfate infusion 2g over 15mins CLINICALL IS REQUIRED FOR YOU TO GIVE MAG SULFATE
  5. Unstable polymorphic WCT defib 200-300-360
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8
Q

What are the 4 electrical rhythms pt. that suffer a sudden adult cardiac arrest?

A
  1. Ventricular Tachycardia
  2. Ventricular Fibrillation
  3. Pulseless electrical activity
  4. Asystole
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9
Q

What typically causes a wide PEA?

A

metabolic are primary causes of a wide PEA

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10
Q

What typically causes a narrow PEA?

A

hypovolemia is the typical cause of a narrow PEA (seen in trauma most of the time)

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11
Q

What are you 5 H’s to treat in cardiac arrest?

A
  1. Hypoxia - Igel or et tube
  2. Hypovolemia - fluid, plug the holes and transport
  3. H+ excess (acidosis) - calcium and sodium bicard
  4. Hypothermia - gradual rewarming
  5. Hypo/hyperkalemia - calcium/ bicarb/ salbutamol
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12
Q

What are the 5 T’s to treat in cardiac arrest?

A
  1. Toxins - not to much to reverse in the field
  2. Thrombus of heart (STEMI) - obtain rosc and call hospital to activate cath lab
  3. Thrombus of lungs (PE) - early transport
  4. Tamponade - nothing we can do in the field
  5. Tension pneumo - decompress with needle thoracentesis
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13
Q

What kind of access can you perform during cardiac arrest?

A

IV that is proximal
IO at the humeral site, tibia is less preferred
External jugular cannulation

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14
Q

How long should you check for a pulse on a hypothermic pt?

A

up to 60 seconds

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15
Q

If your end tidal is show <10mmHg during an arrest, what corrections if any should you make?

A

attempt to improve CPR quality

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16
Q

When can yo switch to continuous ventilations during cardiac arrest?

A

after a IGEL or ET tube is secured

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17
Q

How often do you ventilate during an arrest with an IGEL or ET tube in place?

A

every 6 seconds

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18
Q

What is the first medication you should give during an arrest assuming you have shocked a shockable rhythm?

A

epi 1mg

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19
Q

What would you initial shock jules be?

A

200j

20
Q

Do you shock a PEA or asystole?

A

NO, give epi right away

21
Q

After two shocks and one epi what is your next medication going to be?

A

Amiodarone 300mg
Lidocaine 1.5mg/kg

22
Q

How long after can you give your second medication of antiarrhythmics?

A

10mins

23
Q

What is your dose for your second antiarrhythmics

A

amiodarone 150mg
Lidocaine 1mg/kg

24
Q

How many epi’s can you give during an arrest?

A

BCEHS has removed the recommend max in December 2023. This is up to the discretion of the ACP and progression of the pt. Consultation with EPOS is highly recommended.

25
Q

What if there is CPR induced consciousness, what medication if any do you give to help?

A

Midazolam

26
Q

After obtaining ROSC, what are your goals of care?

A

Maintaining oxygenation, ventilation and adequate BP (MAP of 65)

27
Q

What is your oxygenation thresholds after ROSC?

A

o2 of 92-98%

ETCO2 30-40mmHg

28
Q

What is you BP thresholds after ROSC?

A

MAP of >65

29
Q

How much fluid should you administer during arrest and once you obtained ROSC?

A

20ml/kg max

30
Q

How long after ROSC do you perform an ecg?

A

at least 10 mins

31
Q

What should the pt. be positioned on the stretcher?

A

supine with head of the bed 30 degrees

32
Q

Do you want to warm or cool the pt. after obtaining ROSC?

A

Allow passing cooling to occur. Avoid hyperthermia

33
Q

What vasopressor is preferred in ROSC?

A

Epi

34
Q

Should you check a BGL during the arrest or once you got ROSC?

A

Do not do it during the arrest, get it once you’ve obtained ROSC and treated all other H’s and T’s

35
Q

Should you allow for passive cooling after obtaining ROSC in a traumatic arrest?

A

no, you should keep the pt. normotempurature

36
Q

What are the 3 main treatable causes for traumatic cardiac arrest that could increase the survivability of the pt.?

A
  1. Hypovolemia - plug holes, t-pod, anatomical position, restrictive fluid admin
  2. Hypoxemia - IGEL or ET tube
  3. Tension Pneumothorax - bi-lateral needle thoracentesis
37
Q

MARCH acronym stands for?

A

Massive hemorrhage control
Airway intervention
Respiration
Circulation
Hemorrhage recheck and control

Can be used to prioritize a traumatic arrest

38
Q

Should bi-lateral needle thoracentesis be performed on every blunt and penetrating chest traumatic cardiac arrest?

A

YES

39
Q

Where is the preferred location for needle thoacentesis?

A

5th intercostal superior to the 6th rib, mid axillary line

40
Q

What are the main etiologies of pediatric cardiac arrests?

A

respiratory
shock states (sepsis)

41
Q

What is the ventilation rates during CPR for pediatrics?

A

20-30 BPM

42
Q

Should you use a cuffed or uncuffed et tube on pediatrics?

A

cuffed

43
Q

What are the jules used for a shockable rhythm in a pediatric cardiac arrest?

A

2j/kg then 4j/kg

44
Q

What is the dose of lidocaine for pediatrics in cardiac arrest that have a shockable rhythm that is refractory to the defibs?

A

1.0-1.5mg/kg then 0.5mg to 1.0mg/kg after 10 mins from your initial dose with a refractory Vfib/Vtach

45
Q

What is the dose of epi during pediatric cardiac arrest?

A

0.01mg/kg to max of 1.0mg

BCEHS Guidelines 2024 (13 decks)

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