Cardiac Resuscitation Flashcards
Chest compressions
100-120/min,
5-6cm depth,
60-90 compression ratio
Most effective modality for ROSC?
Defib, the earlier the better
Oxygen settings
100% FIO2 during resus
>94% after ROSC
ETCO2
Low <10mmHg after 20 min - low survival chance
Higher >20mmHg better survival
Rise indicates rosc is coming
Targeted temp management temp goals
32-36C for 24hrs
Chain of survival components
- Recognition and activation of the Emergency response system
- Immediate high quality CPR
- Rapid defibrillation
- Basic and advanced EMS and ALS support
- Post care for out of hospital cardiac arrest OHCA
Based on chain of survival, cardiac arrest can be divided into 3 time sensitive phases, what are they?
- Electrical: first 5 min
- most amenable to defib - Circulatory: 5-20 min
- chest compressions and epi are best - Metabolic: >20 min
- electrolyte and acid base disorders
- epi greater than 20 min decreased cerebral blood flow, worsens neurologic outcomes and worsens cardiac ischemia
When should you start an advanced airway?
Secondary survey, not within 15 min if a shockable rhythm
Breath to compression ratio
30:2, no more than 10 sec break in compressions
If intubated, breath q 10sec
VF or pulseless VT need?
Defib
H/T H’s
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hyper/hypo K metabolic
Hypothermia
H/T T’s
Tablets/trauma
Tamponade
Tension pneumo
Coronary Thrombosis
Thrombosis
Pulmonary embolism
Best fluids for ACLS?
NS - not dextrose, LR, or bicarb
Drugs in ACLS
They are an adjunct therapy
CPR, ventilation and dfib are the cornerstones of managment
Do antiarrhythmic drugs help?
They may help “restart” the heart but they dont show better outcomes post ROSC
When to use EPI?
Used mainly to treat cardiac arrest from VF or pulsless VT, unresponsive to the initial shock, asystole, PEA and profoundly symptomatic bradycardia
When do you need bicarb in ACLS?
Only for TCA overdose
When do you need calcium in ACLS?
When CA is caused by:
hyper K,
Hypocalcemia
B-blocker OD
CCB OD
What are the key symptoms of cardiac tamponade?
Dyspnea and chest pain
Clinical presentation of cardiac tamponade
Becks triad (classic but uncommon)
- low BP, elevated JVP, muffled heart sounds
ECG:
- pulsus paradoxus
Most sensitive sign for cardiac tamponade?
One source says US is best to ID it
- R sided collapse
Also says
ECG pulsus paradoxus >10mmHg has 82% sensitivity
What will US show with cardiac tamponade?
Right sided collapse - rapid development of cardiac tamponade
- RA collapses before the RV
Management of cardiac tamponade
If pericardial effusion compromises hemodynamics, pericardiocentesis is lifesaving. Tamponade from trauma is best treated with. Subxiphoid widow procedure, though a temporizing pericardiocentesis can aid while preparing for the definitive surgical repair
Pericardiocentesis indication
Hemodynamic compromise or pending collapse in cardiac arrest - do it emergently in the ED
