Cardiology Lecture 3

Question 1

time is tissue

Answer 1

the longer you are pulselesss, the harder it is to revive

Question 1

chain of survival

Answer 1

1. recognition/activation of EMS
2. immediate high-quality CPR
3. rapid defibrilation
4. basic and advanced EMS
5. ALS and postarrest care
6. reocvery

Question 2

components of cardiopulmonary resuscitation (CPR)

Answer 2

• primary survey
• chest compressions
• automated external defibrilator application and use
• respiratory support

Question 3

primary survey

Answer 3

• scene size-up
• AVPU (if unresponseive, call ALS)
• open the airway
• assess circulation (5-10 seconds)
• simultaneously assess chest rise

Question 4

coronary perfusion

Answer 4

measure the perfusion of the heart

Question 5

aortic diastolic pressure

Answer 5

left ventricular end-diastolic pressure

Question 6

quality compressions maintain and increase

Answer 6

a high coronary perfusion pressure, chances of return of spontaneous circulation (ROSC)

Question 7

key components of quality compressions

Answer 7

• high chest compression fraction
• proper depth (2 inches)
• quality training
• limited interruptions
• proper space to treat the patient

Question 8

chest compressions in adults

Answer 8

• placement: heel of the hand, sternum, nipple line
• depth: 2 inches
• rate: 100 - 120 bpm
• ratio: 30:2

Question 9

chest compressions in child/infant

Answer 9

• placement: one of two handed sternum, nipple line
• depth: 1/3 patient’s chest
• rate: 100 - 120 bpm
• ratio: 30:2 (single) and 15:2 (multiple)

Question 10

key differences in infant chest compressions

Answer 10

• placement: one or two handed, sternum, nipple line
• ratio: 30:2, 15:2
• depth: 1/3 patient’s chest

Question 11

airway and ventilation

Answer 11

1. health-tilt chil-lift or jaw thrust
2. C-E grip or two recuer method
3. two ventilations vetween compressions
4. asynchronous ventilations with advanced airway

Question 12

automated external defibrilator (AED)

Answer 12

• a device used to shock the heart
• two pads placed on patient’s chest
• clear the patient

Question 13

when do you use AED in witnessed arrest

Answer 13

use AED first

Question 14

when do you use AED in unwitnessed arrest

Answer 14

do compressions first

Question 15

what is a semi-automatic AED

Answer 15

will charge before shock

Question 16

what is an automatic AED

Answer 16

will immediately shock

Question 17

not shockable

Answer 17

• pulseless electrical activity (P.E.A)
• asystole: “flatline”

Question 18

shockable

Answer 18

• ventricular tachycardia (V-Tach)
• ventricular fibrilation (V-Fib)

Question 19

ventricular tachycardia (V-Tach)

Answer 19

• non-perfusing
• fast ventricular rate

Question 20

ventriular fibrillation (V-Fib)

Answer 20

disorganized electrical firing

Question 21

special considerations

Answer 21

• pacemakers
• automated internal defibrillators
• medication patches
• wet patients
• chest hair

Question 22

return of spontaneous circulation (ROSC)

Answer 22

• if pulses return to your patient
• patients are critically ill and at high risk of re-arrest
• transported to a STEMI receiving facility

Question 23

when not to do CPR

Answer 23

• patient has adequate pulse
• valid DNR
• obvious signs of death
• local protocol allows for determination of death upon arrival (DOS/DOA)
• STOP: signs of life, transfer care, out of strength, physician’s order

Question 24

obvious signs of death

Answer 24

* rigor mortis * dependent lividity * decomposition * decapitation * dismemberment * burnt beyond recognition

Question 25

concscious adult foreign body airway obstruction (FBAO)

Answer 25

adominal J-Thrusts or go unconscious

Question 26

unconscious adult foreign body airway obstruction (FBAO)

Answer 26

* chest compressions * call for ALS * check airway prior to ventilation * remove abvious object

Question 27

conscious infant foreign body airway obstruction (FBAO)

Answer 27

five back blows, five chest compressions

Question 28

unconscious infant foreign body airway obstruction (FBAO)

Answer 28

* call for ALS * check airway prior to ventilation * remove obvious object * check pulse after two successful ventilations

Question 29

rescue breathing

Answer 29

* adult breath: every 6 seconds * child breath: one breath every 2-3 seconds * look for equal chest rise and fall * avoid hyperventilation

Question 30

pit crew CPR

Answer 30

* one person supervises, everyone has a role * triangle positioning * advanced airway, continuous compressions with pulse checks * minimizes interruptions to chest compressions

Question 31

position 1 (pit crew CPR)

Answer 31

assess patient and start CPR, alternating compressions with position 2

Question 32

position 2 (pit crew CPR)

Answer 32

attach monitor/defibrilator pads, alternating compressions with position 1

Question 34

position 3 (ALS) (pitt crew CPR)

Answer 34

* apply oxygen * rhythm check. shock immediately after 200 compressions * monitor capnography, if ventilating

Question 35

position 4 (pitt crew model)

Answer 35

ALS Team Leader