Cardiac Arrest (Medical) Flashcards
Can you administer fluid in patients in shockable rhythms?
It may be detrimental and should be limited
What are the compression/ventilation ratios?
No SGA/ETT:
- 30:2 (pause for ventilations)
- compressions 100-120 per minute
SGA/ETT
- 15:1 (no pause for ventilations)
- compressions 100-120 per minute
When can you apply mechanical CPR?
- It should not be applied <16 mins into the arrest unless inadequate resources or crew fatigue
- if ROSC achieved, apply in anticipation of re-arrest
What do you need to consider in hypothermic cardiac arrest?
- if temp <30 degrees - double the interval for adrenaline and amiodarone doses
- Standard DCCS intiailly
- > 3 DCCS is unlikely to be successful without rewarming
When can you commence CPR?
- When the patient is unconscious and pulseless
OR
unsure of the presence of pulse with gasping/agonal or absent breaths - Hx, MOI or injuries do not suggest traumatic cause
How frequently should you change CPR operators and complete a rhythm check +/- shock?
Every 2 minutes
What is ETCO2 and what does it mean?
It can be used as a surrogate marker of cardiac output and may approach physiological values with high quality CPR
When do we aim to defibrillate by?
<2 mins
What does high quality CPR include?
Rate: 100-120 compressions per minute
Depth: >5 cm, allow for full recoil
Ventilation duration: 1 second per ventilation
2 minute rotations of compressor
How do you minimise interruptions of CPR
- Focus on team performance and communications
- Charge defib during compressions
- On screen rhythm analysis
- Hover hands over chest and resume compressions immediately after defibrillation or disarm
When can you transport with mechanical CPR
When all of the following criteria are met
- Paramedic witnessed arrest OR presenting rhythm VT/VF refractory to initial Rx
- Likely reversible with medical intervention
- Pt <65 years old and lives indep
- Alfred hospital <60 min from collapse (patients aged 15-35)
- ECMO or PCI <45 min from collapse (pts aged 36-65)
What do you do if your patient >20 weeks gestation arrests?
Push the uterus to the left during transport to minimise aorto-caval compressions (rather than tilting the patient to the left)
How can you manage a patient interfering with CPR?
- Fentanyl 100mcg IV every 1-2 mins (no max dose)
- if fentanyl ineffective Ketamine 50-100mg IV every 1-2mins (no max dose)(ALS on consult only)
- If no IV access - Fentanyl 200mcg IM or Ketamine 200mg IM (single dose)
What is the primary goal for hypothermic cardiac arrest <30 degrees?
Prevent further heat loss prior to ROSC or transport - significant improvement from pre-hospital intervention is unlikely
What are the reversible causes of PEA?
- Tension pneumothorax
- Upper airway obstruction
- Exanguination
- Asthma
- Anaphylaxis
- Hypoxia
