Cardiac arrest- special circumstances

Question 1

what circumstances may you mdofiy als guidlines

Answer 1

• Drowning
• Hypothermia
• Asthma
• Anaphylaxis
• Maternity
• Hanging - asphyxiation
• Electrolyte imbalances (hypokalaemia etc)
• Trauma
• Poisoning/Overdose

Question 2

what are the 3 serveratiy of hyperthermia

Answer 2

• Mild = 35-32oC
• Moderate = 32-28oC
• Severe = <28oC

Question 3

what are the complicationsin hyperthermia

Answer 3

Difficult/inaccurate recording of core body temperature

• Beware of; slow, weak pulses; slow, shallow breathing; dilated pupils and increased muscle tone

Question 4

what to do if the core body temperture is bellow 30

Answer 4

• Core body temperature is <30 °C, limit defibrillation attempts to three (delivered at maximum defibrillator output)
Withhold adrenaline, and amiodarone until the patient has been warmed to >30 °C

Question 5

what to do if pt body temperture is between 30-35

Answer 5

Between 30–35 °C, the intervals between drug doses should be doubled

Question 6

what to do if pt body temperture is abover 35

Answer 6

• Above >35 °C, standard drug protocols should be used

Question 7

if pt is drowning what to do before starting cpr

Answer 7

• Give 5 initial breaths – supplemented with O2 if available
• This may be more difficult than usual due to airway resistance, may need cricoid pressure

if no response start cpr

Question 8

what should you beware of in cpr when pt has drowned

Answer 8

Massive amounts of foam can sometimes come out of the victim’s
mouth
• Consider hypothermia and modify algorithm accordingly.

Question 9

what do to if are in cardiac arrest due to astma

Answer 9

• Follow standard ALS guidelines
• If IV or IO access cannot be established
rapidly, give IM adrenaline
• Intubate to enable ventilation of stiff lungs and avoid gastric inflation

Question 10

what do to if are in cardiac arrest due to anaphylaxis

Answer 10

• Follow standard ALS guidelines
• If IV or IO access cannot be established rapidly, give IM adrenaline
• Adrenaline is of high importance

Question 11

what do to if are in cardiac arrest due to opioid overdose

Answer 11

• Index of suspicion
• Naloxone 400 – 2,000 mcg IV 2 – 3 minute intervals
• Non-responsive after 10mg, consider non-opioid cause

Question 12

what is the likely cause of death from a short drop hanging

Answer 12

asphyxiation or vagual reflux

Question 13

what is the likely cause of death from a suspension hanging

Answer 13

asphyxiation or vagual refex

Question 14

what is the likely cause of death from a standard drop hanging

Answer 14

asphysyxiation
vagual reflax
fracture to the spinal cord

Question 15

what is the likely cause of death from a long drop hanging

Answer 15

fracture to the spinal cord

Question 16

what is the mangament of a hanging when in cardiac arrest

Answer 16

• Reduce load from patient’s neck where possible
• Maintain C-Spine immobilisation, C-spine collar if necessary due to
difficulty of moving patient
• Cut rope/ligature whilst supporting patient and neck, gently lower patient to floor/stretcher/scoop
• Follow standard ALS protocols
• Consider early intubation due to airway trauma and potential swelling.

Question 17

what to do if the individual is in cardiac arrest due to a electrolyte disorder

Answer 17

follow standard als protocools

Question 18

what to do if pt is in cardiac arrest but have a left ventricular assist device

Answer 18

• Call LVAD Centre as soon as possible!
• Do not immediately start compressions – this can damage the LVAD and therefore make the problem worse. CPR is a last resort.
• Focus on troubleshooting and decide on care plan through VAD centre.
• Consider early transfer and HEMS if long-distance

Question 19

what to do if you think pt has had a traumatic cardiac arrest

Answer 19

be certian of the causee

standard als wont work

Question 20

when should you consider withholding resusitation

Answer 20

• No signs of life in preceding 15 minutes
• Massive trauma incompatible with life – ROLE criteria, penetrating heart
injury etc.
• Consider termination of resus after 20 minutes with likely reversible causes treated successfully.