Cardiopulmonary arrest (CPCR)

Question 1

What is cardiopulmonary arrest (CPA)?

Answer 1

• Sudden unexpected cessation of functional circulation and ventilation, which results in decrease O2 levels
• Causes multiple organ failure

Question 2

What are some common causes of CPA?

Answer 2

• Hypoxaemia
• Hypercapnia
• Hypothermia
• Hypovolaemia
• Hypotension
• Pre-existing cardiac disease
• Anaesthetic overdose

Question 3

What are the clinical signs of CPA?

Answer 3

• Cyanotic MMs
• Hypotension
• Tachycardia
• Hypothermia
• Agonal gasping or absent ventilation
• Loss of pulses or no audible heartbeat

Question 4

What should you do with an unresponsive patient?

Answer 4

• Call for help
• Shake and shout
• If response, carry out primary survey
• If no response but breathing, carry out primary survey
• If no response and not breathing, carry out more recovery depending on number of rescuers

Question 5

What recovery should be done if only 1 rescuer available?

Answer 5

• Check airway is clear
• If yes, start single rescuer BLS
• If no, clear airway before BLS

Question 6

What recovery should be done if 2 or more rescuers?

Answer 6

• Rescuer 1 should start compressions 100-120/minute
• Rescuer 2 should check airway while intubating and then ventilate every 6 seconds

Question 7

What are the survival rates of CPA?

Answer 7

• 6-7%

Question 8

What should be done to prevent and be ready for CPA emergency?

Answer 8

• Monitoring for hypoxaemia, hypercapnia, hypovolaemia, hypotension and hypothermia
• Fully stocked emergency trolley
• Dosage wall charts

Question 9

What is basic life support (BLS)?

Answer 9

• Chest compressions
• Ventilation

Question 10

• How are chest compressions done?

Answer 10

• 2 minutes interrupted
• 100-120 min compressions
• 1/3- 1/2 depth of chest
• Allow full recoil of chest
• Acts as an external pump

Question 11

How is ventilation done?

Answer 11

• Clear airway and intubate
• Ventilate at 1 breath/6 secs
• Usually put patient on a very high O2 flow rate (6-8litres/min)

Question 12

What is advanced life support (ALS)?

Answer 12

• Monitor using ECG
• Get IV access
• Reversals
• Pause for 10 secs and check rhythm diagnosis and pulse palpation
• If no pulse, shockable. Then carry BLS and charge defib
• Pause and shock
• Refractory shockable (2 or more shocks), use adrenaline and antiarrthymics
• If still no pulse, no longer shockable and use atropine

Question 13

What should be done if CPR prolonged?

Answer 13

• Shockable or non-shockable, bicarbonate should be used

Question 14

What is the minimum requirement in a crash box?

Answer 14

• Syringes and needles pre-made
• Ambubag
• Adrenaline
• Atropine
• Drug chart and CPR algorithm
• Airway equipment

Question 15

What should be done if return of spontaneous circulation (ROSC) is evident?

Answer 15

• Continuous ECG/BP monitoring
• Slow warming patient
• Watch for seizures
• Monitoring vitals
• TLC