Cardiac Arrest - When to stop and what to do when you do.

Question 1

7 conditions unequivocally associated with death

Answer 1

Massive cranial and cerebral destruction; Hemicorporectomy or similar massive injury;
Decomposition/putrefaction;
Incineration;
Hypostasis;
Rigor mortis;
Foetal maceration.

Question 2

3 conditions when resuscitation can be discontinued without ALS

Answer 2

Resuscitation can be discontinued without ALS if any of the following are present, in all age groups:

The presence of a DNAR (Do Not Attempt Resuscitation) order or an
Advanced Decision to Refuse Treatment (Living Will) that states the wish
of the patient not to undergo attempted resuscitation. A DNAR decision
does not override clinical judgement in the event of a reversible cause of
the patient’s cardiac / respiratory arrest e.g. patient choking, anaphylaxis or
trauma.

Patient in the final stages of a terminal illness where death is imminent and
unavoidable and CPR would not be successful, but for whom no formal
DNAR decision has been made;

Efforts would be futile.

Question 3

5 conditions that need to be present that would render resuscitation futile

Answer 3

15 minutes since the onset of collapse;
No bystander CPR prior to arrival of the ambulance;
Absence of any exclusion factors (drowning, hypothermia, poisoning,
pregnancy);
Asystole rhythm for >30 seconds on the ECG monitor screen;
Submersion for longer than 1.5hrs.

Question 4

3 conditions when resuscitation should be commenced after submersion

Answer 4

Possibility of their patient being able to breathe from a pocket of air while
underwater.
Anyone showing any signs of life on initial rescue.
Those whose airway has been only intermittently submerged for the
duration of their immersion, e.g. Those wearing lifejackets but in whom
the airway is being intermittently submerged, provided the body still has a
reasonably fresh appearance

Question 5

3 conditions when resuscitation can be discontinued following ALS

Answer 5

Suspected medical/cardiac cause;
Patient remains in asystole or agonal rhythm for at least 20 minutes;
No exclusion criteria are present

Question 6

4 conditions when resuscitation cannot be discontinued

Answer 6

Maternity - Manage in accordance with JRCALC/Trust guidelines;
Trauma - Manage in accordance with JRCALC/Trust guidelines;
Hypothermia - Manage in accordance with JRCALC/Trust guidelines;
Suspected cause of drowning or drug induced cardiac arrest - Once
resuscitation has commenced, the patient must be conveyed to an
Emergency Department.

Question 7

ALS is defined as (6)

Answer 7

A registered clinician in attendance (Nurse, Paramedic, ECP, Doctor);
Reversible causes have been considered;
Airway is patent, using an airway device as necessary;
Ventilation is effective;
If indicated defibrillation has been delivered;
Drug therapy is administered in accordance with resuscitation guidelines.

Question 8

Define an agonal rhythm (4)

Answer 8

Rate: Pattern tends to slow as the myocardium progressively dies. Often
under 10 complexes per minute;
Rhythm: Regular or irregular;
Atrial conduction: P waves are usually not present;
Ventricular conduction: QRS complexes are wide and often bizarrely shaped.
The QRS complexes become broader with a decreasing amplitude over time.