Ch. 44 CPR Flashcards
Why do you check for breath before checking for pulse?
Pulse is sometimes difficult to assess
What is the maximal amount of time you should check for a pulse?
10sec
If rhythm is not shockable, how long should you continue CPR until checking again if rhythm is shockable?
2min
After delivering shock, what is the next step?
Immediately resume CPR for 2 minutes (5 cycles)
If patient is unresponsive but has a definite pulse, what should you do?
Give one breath every 5-6sec
By how much should the sternum be compressed in an adult?
2 inches
What is the ratio of compressions/breaths for 1 man CPR? 2 man CPR?
30:2 for both
What might assist in creating a patent airway?
oral/nasal airway
Where should the defibrillators be placed?
R - R of upper sternal border below clavicle, L of nipple w/ center in midaxillary line; L - at apex of heart
What are the two types of defibrillators? Which type is more effective in terminating VT/VF?
monophasic and biphasic; biphasic
What is the difference between monophasic and biphasic?
monophasic - directs energy unidirectionally; biphasic - directs energy bidirectionally
How much energy is used for monophasic and biphasic defibrillation?
mono - 360J, biphasic - 120-200J
Survival rates after VF cardiac arrest decrease by __% per minute.
7-10% (3-7% w/ chest compressions)
What are three acceptable methods of ventilation during CPR?
mouth-to-mouth, bag-mask, advanced airway
Are chest compressions performed during endotracheal intubation?
No. Thus, the need for such an airway needs to be measured against continuing compressions.
When should epinephrine be given within the algorithm?
After CPR, after testing for shockable rhythm (administer both after shock and if shock is not advised)
What are the first and second drugs to be given in the ACLS algorith and what are the doses?
First - epi 1mg; second amiodarone 300mg
What are the 5 H’s of reversible cardiac arrest?
hypovolemia, hypoxia, hydrogen ion, hypo-hyperkalemia, hypothermia
What are the 5 T’s of reversible cardiac arrest?
tension PTX, tamponade, toxins, thrombosis (pulm), thrombosis (coronary)
What drug can replace the second dose of epi? What dose?
vasopressin 40 units
Why give atropine for bradycardia instead of glyocpyrrolate?
atropine has an onset time of about 30s vs glyco
How does an esophageal detector device work?
It has a self-inflating bulb. If in the esophagus, the bulb will be compressed and will not inflate. In the trachea, the bulb will inflate because the tracheal wall won’t compress like the esophagus.
At what rate should breaths be delivered with an advanced airway? Should compressions stop?
One breath should be given every 6-8 seconds without synchonization with compressions.
Which drugs can be given via ETT?
epi, lido, vaso, atropine, naloxone
Explain the dose/preparation of an ETT dose of a drug.
ETT dose is 2-10x larger than IV dose. Drug should be diluted in 5-10mL sterile water before instillation.
What is the dose difference between IV and IO?
none
What is the definition of bradycardia?
HR lower than 60bpm
What drugs can be given for symptomatic bradycardia and in what doses?
atropine 0.5mg, dopamine infusion 2-10mcg/kg/min, epi 2-10mcg/min
What might symptomatic bradycardia consist of?
HoTN, severely altered mental status, shock, ischemic chest discomfort, acute heart failure
What are the signs of symptomatic tachycardia?
The same as symptomatic bradycardia - HoTN, severely altered mental status, shock, ischemic chest discomfort, acute heart failure
What is the difference between defibrillation and cardioversion?
Defibrillation is a nonsynchronized delivery of energy during any phase of the cardiac cycle, whereas cardioversion is the delivery of energy that is synchronized to the large R waves or QRS complex.
What are the different doses of shock for cardioversion and when are they used?
narrow regular - 50-100J; narrow irregular - 120-200J; wide regular - 100J; wide irregular - defibrillation dose
When might adenosine be used?
unstable regular narrow-complex tachycardia
If the tachycardia is irregular narrow-complex, it is probably (atrial/ventricular) in origin?
atrial
Why should vasopressin only be given once during resuscitation efforts?
the half life is 10-20min
What is amiodarone’s method of action?
Ca & K channel blocker, alpha & beta agonist
Cardiac events in children are generally due to what?
arterial hypoxemia and respiratory compromise
Where is the pulse palpated in infants? in children?
infants - brachial or femoral artery, children carotid or femoral (same as adults)
How do you deliver CPR with infants?
using the two-finger technique
How many J should be used to defibrillate a child?
2-4J/kg, then at least 4J/kg but never to exceed 10J/kg
What PaCO2 should a patient be hyperventilated to following resuscitation following cardiac arrest?
Hyperventilation does not protect the brain following cardiac arrest, in fact it can cause respiratory problems. There is no data to support targeting a specific PaCO2.
What are the major causes of cardiovascular collapse in the perioperative period (8 H’s)?
Hypovolemia, Hypoxia, H+ (acidosis), Hyper/hypokalemia, Hypoglycemia, Hypothermia, malignant Hyperthermia, Hypervagal response
What are the major causes of cardiovascular collapse in the perioperative period (8 T’s)?
Toxins (anaphylaxis/anesthesia), Tamponade, Tension PTX, Thrombosis in coronary artery, Thrombus in pulmonary artery, Trauma, QT interval, pulmonary hyperTension
