Cardiopulmonary Resuscitation

Question 1

Which arrhythmias are associated with cardiac arrest? (4)

Answer 1

1. Ventricular fibrillation (VF)
2. Pulseless ventricular tachycardia
3. Asystole
4. Pulseless electrical activity (PEA)

Question 2

Which arrhythmias associated with cardiac arrest are considered ‘shockable?’ (2)

Answer 2

1. VF

2. Pulseless VT

Question 3

Which arrhythmias associated with cardiac arrest are considered ‘non-shockable?’ (2)

Answer 3

1. PEA

2. Asystole

Question 4

What is the first step in assessing someone with suspected cardiac arrest?

Answer 4

(After personal safety is insured)

ABC - assess airway and breathing, feel pulse

Question 5

What is the second step in assessing someone with suspected cardiac arrest?

Answer 5

If patient is confirmed to be unresponsive and not breathing normally, call resuscitation team/ambulance

Question 6

After calling the resuscitation team/ambulance, what is the next step in ALS protocol?

Answer 6

Begin CPR and attach defibrillator/monitor

Question 7

What is the ratio of chest compressions to rescue breaths in adult CPR?

Answer 7

30:2

Question 8

After initiating CPR and attaching the defibrillator/monitor, what is the next step in ALS?

Answer 8

Assess the rhythm to decide next step

Question 9

If the individual is in VF or pulseless VT, what is the next step of ALS?

Answer 9

Administer 1 shock (shockable rhythms) and immediately resume CPR for 2 minutes
Then reassess rhythm and repeat

Question 10

If the individual is in PEA or asystole, what is the next step of ALS?

Answer 10

Immediately resume CPR for 2 min, then reassess rhythm

Question 11

How often is adrenaline administered when administering ALS?

Answer 11

Every 3-5 min

Question 12

When is amiodarone administered during ALS?

Answer 12

After 3 shocks have been given

Question 13

What are the reversible causes of cardiac arrest? (8)

Answer 13

Hypoxia
Hypovolemia
Hypo/hyperkalemia
Hypo/hyperthermia
Thrombosis 
Tension pneumothorax 
Tamponade (cardiac)
Toxins 

*consider U/S to identify reversible causes; these should always be identified and treated

Question 14

What is the approach to individuals who return to spontaneous circulation in the course of administering ALS? (5)

Answer 14

After ROSC (return of spontaneous circulation):

• use an ABCDE approach
• aim fr SpO2 of 94-98% and normal PaCO2
• perform a 12-lead ECG
• identify and treat cause
• targeted temperature management

Question 15

What is the recommended dose of adrenaline in treatment of cardiac arrest?

Answer 15

Adrenaline 1mg solution of 1 in 10,000 (100 micrograms/mL) by IV injection every 3-5 min if necessary

*vs anaphylaxis in adults, where 500 micrograms (1 in 1,000) is administered IM under expert supervision OR 300 micrograms for self-administration

Question 16

For which rhythms is adrenaline indicated in cardiac arrest?

Answer 16

All of them (VF, pulseless VT, PEA, asystole), to be given every 3-5 min if necessary

Question 17

When is amiodarone indicated in the treatment of cardiac arrest?

Answer 17

Used to treat VF or pulseless VT in cardiac arrest refractory to defibrillation (given after 3 shocks have been attempted without success)

Question 18

How is amiodarone administered in the treatment of cardiac arrest?

Answer 18

IV injection, initially 300 mg over at least 3 minutes to be given from a pre-filled syringe or diluted in 20 mL 5% glucose, then 150 mg if required

Question 19

For which cardiac arrest rhythms can amiodarone be used?

Answer 19

VF and pulseless VT unresponsive to defibrillation ie only shockable rhythms

(Unlike adrenaline, which is given for all cardiac arrest rhythms)

Question 20

What is the difference between synchronized DC cardioversion and defibrillation?

Answer 20

Synchronized direct current cardioversion is used in cases of sustained supraventricular or ventricular arrhythmia (eg stable ventricular tachycardia) in patients who still have a pulse but are hemodynamically unstable OR patents who are hemodynamically stable but have not responded to chemical cardioversion; it utilizes a shock that is synchronized with the QRS complex

In contrast, defibrillation is a non-synchronized shock that is utilized in cases of cardiac arrest with VF or pulseless VT in hemodynamically UNSTABLE patients (no pulse)

**a DC shock applied without synchronization to a QRS complex is DC defibrillation

Question 21

When is lidocaine indicated in the treatment of cardiac arrest?

Answer 21

Lidocaine as an alternative to amiodarone if the later is not available or a local decision is made to use lidocaine instead

1mg/kg IV, do not exceed 3 mg/kg over the first hour

Question 22

During cardiopulmonary arrest, if intravenous access cannot be obtained, what can be used instead?

Answer 22

Intraosseous access

Question 23

What is intraosseous (IO) vascular access?

Answer 23

Placement of a specialized hollow-bore needle through the cortex of a bone and into the medullary space for infusion of medical therapeutic agents and laboratory testing

This can be used in cases where intraveous access is not possible or not rapidly achieved (require >90 seconds) eg in cases of cardiopulmonary arrest, burns, medication infusions