Cardiorespiratory Arrest Flashcards
What are the two types of arrhythmias in cardiac arrest?
- Shockable (VF/pulseless VT)
2. Non-shockable (asystole and PEA)
What are the reversible causes of cardiorespiratory arrest?
- Hypoxia, hypothermia, hypo/hyperkalaemia, hypovolaemia.
2. Tension pneumothorax, cardiac tamponade, thrombosis (cardiac/pulmonary), toxins.
What is PEA?
Pulseless electrical activity:
Absence of any palpable pulse in the presence of cardiac electrical activity expected to produce cardiac output.
When you assess the rhythm of an individual who is in cardiorespiratory arrest after CPR, what do you do in each of these scenarios?
- Patient is in VF or pulseless VT
- There is a return of spontaneous circulation
- Patient is in PEA or asystole
- 1 shock, minimise interruptions, resume CPR for 2 mins, reassess.
- Immediate treatment - A-E, aim SpO2 94-98%, aim normal PaCO2, 12-lead ECG, treat cause, targeted temperature management.
- Immediately resume CPR for 2 mins, reassess.
What is the emergency management in cardiopulmonary arrest up to the first assessment of rhythm?
- Ensure safety of patient and yourself
- Head tilt and chin lift
- Look, listen and feel for breathing for 10 seconds
- Confirm diagnosis - check for signs of breathing and pulse.
- Shout for help, call resus team (2222)
- Perform chest compressions and rescue breaths (30:2)
- Adhesive defibrillation/monitoring pads placed (right clavicle and V6)
- Plan actions before pausing CPR for rhythm analysis
- Assess rhythm for <5s
After assessing the rhythm in cardiopulmonary arrest and determining it is VF or pulseless VT, what are the next steps?
- Once confirmed resume uninterrupted compressions.
- Designated person selects appropriate energy.
- Warn others to stand clear and remove oxygen delivery devices.
- Once charged, ask rescuer to stand clear and delivery shock.
- Restart CPR immediately, continue for 2 mins
- Pause to reassess rhythm, if no change, repeat.
- Give adrenaline 1mg IV after 3rd shock and every other shock after.
- Give amiodarone 300mg IV after 3rd shock.
After assessing the rhythm in cardiopulmonary arrest and determining it is PEA or asystole, what are the next steps?
- Start CPR 30:2
- Give adrenaline 1mg as soon as IV access
- Continue CPR
- Recheck pulse/rhythm after 2 mins
- If no pulse and no change in ECG continue CPR
- Adrenaline 1mg IV after every other pulse check
- If VF/VT, continue CPR as per shockable rhythm.
During a rhythm check in cardiopulmonary resuscitation, what should you do if organised electrical activity compatible with cardiac output is seen?
- Seek evidence of return of spontaneous circulation (ROSC)
- Check central pulse and end-tidal carbon dioxide trace if available.
- Start post-resuscitation care (induced hypothermia and PCI).
- Note if organised rhythm is seen during CPR, do not interrupt compressions to palpate pulse.
What is ventricular fibrillation?
- Ventricles attempt to contract up to 500bpm
- Rapid and irregular electrical activity renders ventricles unable to contract in a synchronised manner.
- Immediate loss of cardiac output.
What is this describing?
Chaotic, no identifiable P waves, QRS complex to T wave. Rate 150-500bpm. Amplitude decreases with duration, coarse to fine.
Ventricular fibrillation
What is this describing?
Any features common to broad complex tachycardia, rapid HR >100bpm. QRS >120ms (3 small squares).
Pulseless ventricular tachycardia
What are the factors deciding a DNACPR to be put in place?
- CPR unlikely to be successful.
- Legally valid advanced directive if they lack capacity.
- Resuscitation not in the best interests of the patient.
