Cardiopulmonary resusitation Flashcards
Compression: breath ratio 1) neonate 2) paediatric 3) adult
Neonate = 3:1 Paediatric = 15:1 Adult = 30: 1
Shock in joules
Paediatric = 4 J/kg Adult = 200 J
Adjuncts during CPR
LMA/ETT
Oxygen
Waveform capnography
IV/IO access
Shockable rhythm drugs
Adrenaline 1mg after 2nd shock. Then every 2nd loop (every 4 minutes)
Amiodarone 300mg after 3rd shock
Non-shockable rhythm drugs
Adrenaline 1mg immediately. Then every 2nd loop.
What are the 4 H’s
Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hyper/hypothermia
What are the 4 T’s ?
Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary, coronary)
Post resuscitation care
Re-evalauate ABCDE
12 lead ECG
Treat precipitating cause
Ideal respiratory rate once ETT or LMA placed in CRP?
10
When should you give 3 stacked shocks?
Monitored and witnessed arrest in a patient
Well perfused and oxygenated patient
When defibrillation can be provided within 20 seconds
Defibrillation instructions
1) Compressions continue, everyone else stand clear. Oxygen away.
2) charge check everyone and oxygen away
3) “Hands off”
4) Deliver or dump charge
How many shocks will have been delivered before giving 300mg amiodarone for VF/pVT
3
How many shocks will have been given in VF/pVT before adrenaline is given?
2
When do you check pad position?
Refractory VT/VF
When would you consider giving a 150mg dose of amiodarone?
After the 5th shock
If there is no amiodarone, what dose of lignocaine would you give for VF/pVT?
1mg/kg
When do you feel for a pulse during CPR?
During the rhythm check only if electrical activity consistent with possible cardiac output is seen (not asystole, VF or VT –> presumed pulseless VT if patient tolernating CPR
Indication for precordial thump?
Witness and monitored pVT if there is a delay in getting defibrillator
No evidence for VF
What should you do with the ECG leads if you see asysole?
Check placement. Ensure gain is appropriate.
What should you do if you see P waves only (ventricular standstill) in an unconscious person?
Try pacing
Does using an ETT over a SGA improve survival in an arrest?
No
When is it appropriate to pause chest compression during ETT placement?
Only when passing tube through vocal cords. Pause must be < 5 seconds.
Can end tital CO2 monitoring be used with SGA and bag mask?
Yes, but less reliable than with ETT
You suspect ROSC. That patient is due adrenaline. Do you give it?
No. 1mg adrenaline could be harmful if ROSC. Withold till rhythm check.
What is the role of end tidal capnography in CRP?
1) Ensure ETT placement
2) Ensure good quality CPR
3) Identify ROSC
4) Prognostication and indication of cause of arrest (higher in asphyxial arrest and with good CPR, declines over time) Higher CO2 = better prognosis
What type and how much calcium would you give in severe hyperkalaemia
10ml of 10% calcium chloride
How much glucose and insulin would you give in severe hyperkalaemia?
50ml 50% glucose = 25g
10 units short acting insulin (novorapid)
When would sodium bicarbonate be useful in hyperkaelamia? How much would you give?
In setting of acidosis. 50 mmol IV
What is the difference between calcium gluconate and calcium chloride? Why would calcium chlroide be preferable in an arrest?
Calcium gluconate = 8.9mg/ml elemental calcium
Calcium chloride = 27.2mg/ml elemental calcium = 3 x more calcium
Calcium gluconate needs to be hepatically metabolised to release its calcium. In setting of arrest and poor liver function this may be an issue.
How much potassium and magnesium would you give in an arrest if the patient has hypokalaemia?
5 mmol potassium IV push
2g magnesium sulfate IV push
What is dantrolene used for ?
Malignant hypertherthermia due to anaesthetic agents.
Can be useuful in MDMA and amphetamine overdose with hyperthermia also.
A patient had witnessed cardiac arrest, with good bystander CPR. They initially had a shockable rhythm and at one point had ROSC. Would you consider transport for PCI or thrombolysis?
Yes
Is routine use of fibrinolytic therapy for an out of hospital cardiac arrest recommended in most cases?
No
A patient has a cardiac arrest, you suspected massive PE and provided thrombolysis. How long should you continue CPR for?
At least 30 minutes. Up to 60 - 90 minutes (good outcomes still documented)
What are the clues pointing towards a tension pneumothoroax during CPR?
1) High pressure felt on manual ventilation
2) Abnormal chest rise/fall on affected side
3) decreased breath sounds on affected side
4) hyper-expanded chest with increased percussion note on affected side
5) Tracheal deviation away from affect side - late sign
You’ve used a 14 G long needed to decompression a tension pneumothorax but it hasn’t seemed to help.
Name 3 reasons why.
1) Obstruction (blood, tissue, cannula kinked/compressed
2) Missing a localised pneumothorax e.g cannula too short
3) Inability to drain large air leak
4) Moving, dislodging and falling out
What is Beck’s triad in regards to pericardial effussion?
1) JVP distension
2) Muffled/distant heart sounds
3) Narrow pulse pressure
signs may only be briefly present, at at all prior to arrest
In the case of arrest due to toxins. Is there any evidence for providing antidotes the antidotes naloxone, flumazenil, digoxin specific antibodies fragments, phentolamine, glucagon?
No
Name two toxic cause of arrest where providing an antidote is effective
1) Cyanide poisoning. Provide IV 5mg hydroxycobalmin. Repeat dose up to max of 15mg
2) TCA overdose: provide sodium bicarbonate boluses
What reversible cause of cardiac arrest can an USS be used for?
1) Cardiac tamponade
2) Tension pneumothorax
3) aortic dissection
4) Hypovolaemia
