Cardiac arrest- special circumstances Flashcards
what circumstances may you mdofiy als guidlines
- Drowning
- Hypothermia
- Asthma
- Anaphylaxis
- Maternity
- Hanging - asphyxiation
- Electrolyte imbalances (hypokalaemia etc)
- Trauma
- Poisoning/Overdose
what are the 3 serveratiy of hyperthermia
- Mild = 35-32oC
- Moderate = 32-28oC
- Severe = <28oC
what are the complicationsin hyperthermia
Difficult/inaccurate recording of core body temperature
• Beware of; slow, weak pulses; slow, shallow breathing; dilated pupils and increased muscle tone
what to do if the core body temperture is bellow 30
• 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
what to do if pt body temperture is between 30-35
Between 30–35 °C, the intervals between drug doses should be doubled
what to do if pt body temperture is abover 35
• Above >35 °C, standard drug protocols should be used
if pt is drowning what to do before starting cpr
- 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
what should you beware of in cpr when pt has drowned
Massive amounts of foam can sometimes come out of the victim’s
mouth
• Consider hypothermia and modify algorithm accordingly.
what do to if are in cardiac arrest due to astma
• 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
what do to if are in cardiac arrest due to anaphylaxis
- Follow standard ALS guidelines
- If IV or IO access cannot be established rapidly, give IM adrenaline
- Adrenaline is of high importance
what do to if are in cardiac arrest due to opioid overdose
- Index of suspicion
- Naloxone 400 – 2,000 mcg IV 2 – 3 minute intervals
- Non-responsive after 10mg, consider non-opioid cause
what is the likely cause of death from a short drop hanging
asphyxiation or vagual reflux
what is the likely cause of death from a suspension hanging
asphyxiation or vagual refex
what is the likely cause of death from a standard drop hanging
asphysyxiation
vagual reflax
fracture to the spinal cord
what is the likely cause of death from a long drop hanging
fracture to the spinal cord
what is the mangament of a hanging when in cardiac arrest
• 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.
what to do if the individual is in cardiac arrest due to a electrolyte disorder
follow standard als protocools
what to do if pt is in cardiac arrest but have a left ventricular assist device
- 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
what to do if you think pt has had a traumatic cardiac arrest
be certian of the causee
standard als wont work
when should you consider withholding resusitation
• 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.
