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EMPA Block 10 > Cardiac Resuscitation > Flashcards

Cardiac Resuscitation Flashcards

1
Q

Chest compressions

A

100-120/min,
5-6cm depth,
60-90 compression ratio

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2
Q

Most effective modality for ROSC?

A

Defib, the earlier the better

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3
Q

Oxygen settings

A

100% FIO2 during resus
>94% after ROSC

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4
Q

ETCO2

A

Low <10mmHg after 20 min - low survival chance
Higher >20mmHg better survival
Rise indicates rosc is coming

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5
Q

Targeted temp management temp goals

A

32-36C for 24hrs

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6
Q

Chain of survival components

A
  1. Recognition and activation of the Emergency response system
  2. Immediate high quality CPR
  3. Rapid defibrillation
  4. Basic and advanced EMS and ALS support
  5. Post care for out of hospital cardiac arrest OHCA
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7
Q

Based on chain of survival, cardiac arrest can be divided into 3 time sensitive phases, what are they?

A
  1. Electrical: first 5 min
    - most amenable to defib
  2. Circulatory: 5-20 min
    - chest compressions and epi are best
  3. Metabolic: >20 min
    - electrolyte and acid base disorders
    - epi greater than 20 min decreased cerebral blood flow, worsens neurologic outcomes and worsens cardiac ischemia
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8
Q

When should you start an advanced airway?

A

Secondary survey, not within 15 min if a shockable rhythm

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9
Q

Breath to compression ratio

A

30:2, no more than 10 sec break in compressions
If intubated, breath q 10sec

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10
Q

VF or pulseless VT need?

A

Defib

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11
Q

H/T H’s

A

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hyper/hypo K metabolic
Hypothermia

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12
Q

H/T T’s

A

Tablets/trauma
Tamponade
Tension pneumo
Coronary Thrombosis
Thrombosis
Pulmonary embolism

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13
Q

Best fluids for ACLS?

A

NS - not dextrose, LR, or bicarb

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14
Q

Drugs in ACLS

A

They are an adjunct therapy
CPR, ventilation and dfib are the cornerstones of managment

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15
Q

Do antiarrhythmic drugs help?

A

They may help “restart” the heart but they dont show better outcomes post ROSC

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16
Q

When to use EPI?

A

Used mainly to treat cardiac arrest from VF or pulsless VT, unresponsive to the initial shock, asystole, PEA and profoundly symptomatic bradycardia

17
Q

When do you need bicarb in ACLS?

A

Only for TCA overdose

18
Q

When do you need calcium in ACLS?

A

When CA is caused by:
hyper K,
Hypocalcemia
B-blocker OD
CCB OD

19
Q

What are the key symptoms of cardiac tamponade?

A

Dyspnea and chest pain

20
Q

Clinical presentation of cardiac tamponade

A

Becks triad (classic but uncommon)
- low BP, elevated JVP, muffled heart sounds
ECG:
- pulsus paradoxus

21
Q

Most sensitive sign for cardiac tamponade?

A

One source says US is best to ID it
- R sided collapse

Also says
ECG pulsus paradoxus >10mmHg has 82% sensitivity

22
Q

What will US show with cardiac tamponade?

A

Right sided collapse - rapid development of cardiac tamponade
- RA collapses before the RV

23
Q

Management of cardiac tamponade

A

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

24
Q

Pericardiocentesis indication

A

Hemodynamic compromise or pending collapse in cardiac arrest - do it emergently in the ED

25
Q

Pericardiocentesis approaches

A

Subxiphoid (traditional) (blind)
- Below the xiphoid and toward L/R shoulder

US guided approach:
- find and aim for the pint of max effusion with the fewest structures in the way
- “optimal approach” is the Left chest wall

ECG monitoring technique
- similar to blind approach, not really safer

26
Q

Drugs: main drug for cardiac arrest with persistent VT or VF after defib and Epi?

A

Amiodarone

27
Q

Drugs: initial treatment for torsades de pointes and CA from QTc prolongation or cardiac glycoside toxicity

A

Magnesium

28
Q

Magnesium dosing

A

VF/VT: 1-2g in 10mL over 1 min
VF/VT w pulse: 1-4g in 50mL over 60 min

29
Q

What med for cocaine toxicity?

A

Sodium bicarb - cocaine results in socidum channel blockade

30
Q

When to use bicarb?

A

Hyper K, TCA OD, and cocaine

Also post ROSC with persistent severe metabolic acidosis

31
Q

Magnesium dose for Torsades de pointes?

A

1-2g in 10mL over 1 min

32
Q

How to manage VF or pulseless VT?

A

Start CPR,
- prepare for cardioversion
Shock
1-2 min CPR
Rhythm check
Shock 200J
Drugs to lower defib threshold
- epi, amio, lido
Repeat

EMPA Block 10 (7 decks)

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