Cardiology Lecture 3 Flashcards
time is tissue
the longer you are pulselesss, the harder it is to revive
chain of survival
- recognition/activation of EMS
- immediate high-quality CPR
- rapid defibrilation
- basic and advanced EMS
- ALS and postarrest care
- reocvery
components of cardiopulmonary resuscitation (CPR)
- primary survey
- chest compressions
- automated external defibrilator application and use
- respiratory support
primary survey
- scene size-up
- AVPU (if unresponseive, call ALS)
- open the airway
- assess circulation (5-10 seconds)
- simultaneously assess chest rise
coronary perfusion
measure the perfusion of the heart
aortic diastolic pressure
left ventricular end-diastolic pressure
quality compressions maintain and increase
a high coronary perfusion pressure, chances of return of spontaneous circulation (ROSC)
key components of quality compressions
- high chest compression fraction
- proper depth (2 inches)
- quality training
- limited interruptions
- proper space to treat the patient
chest compressions in adults
- placement: heel of the hand, sternum, nipple line
- depth: 2 inches
- rate: 100 - 120 bpm
- ratio: 30:2
chest compressions in child/infant
- 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)
key differences in infant chest compressions
- placement: one or two handed, sternum, nipple line
- ratio: 30:2, 15:2
- depth: 1/3 patient’s chest
airway and ventilation
- health-tilt chil-lift or jaw thrust
- C-E grip or two recuer method
- two ventilations vetween compressions
- asynchronous ventilations with advanced airway
automated external defibrilator (AED)
- a device used to shock the heart
- two pads placed on patient’s chest
- clear the patient
when do you use AED in witnessed arrest
use AED first
when do you use AED in unwitnessed arrest
do compressions first
what is a semi-automatic AED
will charge before shock
what is an automatic AED
will immediately shock
not shockable
- pulseless electrical activity (P.E.A)
- asystole: “flatline”
shockable
- ventricular tachycardia (V-Tach)
- ventricular fibrilation (V-Fib)
ventricular tachycardia (V-Tach)
- non-perfusing
- fast ventricular rate
ventriular fibrillation (V-Fib)
disorganized electrical firing
special considerations
- pacemakers
- automated internal defibrillators
- medication patches
- wet patients
- chest hair
return of spontaneous circulation (ROSC)
- if pulses return to your patient
- patients are critically ill and at high risk of re-arrest
- transported to a STEMI receiving facility
when not to do CPR
- 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
obvious signs of death
- rigor mortis
- dependent lividity
- decomposition
- decapitation
- dismemberment
- burnt beyond recognition
concscious adult foreign body airway obstruction (FBAO)
adominal J-Thrusts or go unconscious
unconscious adult foreign body airway obstruction (FBAO)
- chest compressions
- call for ALS
- check airway prior to ventilation
- remove abvious object
conscious infant foreign body airway obstruction (FBAO)
five back blows, five chest compressions
unconscious infant foreign body airway obstruction (FBAO)
- call for ALS
- check airway prior to ventilation
- remove obvious object
- check pulse after two successful ventilations
rescue breathing
- adult breath: every 6 seconds
- child breath: one breath every 2-3 seconds
- look for equal chest rise and fall
- avoid hyperventilation
pit crew CPR
- one person supervises, everyone has a role
- triangle positioning
- advanced airway, continuous compressions with pulse checks
- minimizes interruptions to chest compressions
position 1 (pit crew CPR)
assess patient and start CPR, alternating compressions with position 2
position 2 (pit crew CPR)
attach monitor/defibrilator pads, alternating compressions with position 1
position 3 (ALS) (pitt crew CPR)
- apply oxygen
- rhythm check. shock immediately after 200 compressions
- monitor capnography, if ventilating
position 4 (pitt crew model)
ALS Team Leader
