Chapter 1 - Basics

Question 1

Survival rates of cardiac arrest?

Answer 1

• For every minute of an untreated cardiac arrest, survival rates decrease by 10%.
• Arrests which occur due to VT / VF have a higher survival rate; and survival can be up to 90% if pt. is defibrillated in the first 1-2 minutes.
• Worse outcomes are seen with PEA or asystole arrests.

Question 2

How does it all work? The basic anatomy and physiology.

Answer 2

• The patient is unconscious due to inadequate cerebral perfusion – CPR is implemented to temporarily restore some form of cardiac output.
• Unless ventilation and circulation can be restored within four-five minutes after the onset of cardiac arrest, evidence suggests permeant brain damage and death can result.
  EVIDENCE : decrease in brain ATP + glucose occurs. And the failure of the membrane pump by release of arachidonic acid products causing irreversible cell death

Question 3

Predisposing factors (7)

Answer 3

1. Ischemic heart disease
2. Chronic respiratory disease and acute severe asthma
3. Drug overdose / toxicity
4. Drowning
5. Trauma
6. Electrolyte abnormalities
7. Peri-arrest arrythmias

Question 4

Ventilation and circulation - % compared to pre-arrest

Answer 4

• Effective external cardiac compressions, provides 20-30% of pre-arrest output.
• Expired air resuscitation provides ventilation of 15-18% of oxygen concentration.

Question 5

Chain of survival

Answer 5

early access, early CPR, early defib, early advanced care

Question 6

Situations of deterioration (3)

Answer 6

1. Resp. Failure – due to airway obstruction or acute pulmonary oedema.
2. Cardiovascular failure – due to acute myocardial infraction or massive haemorrhage.
3. Neurological failure – due to drugs or intracranial haemorrhage

Question 7

4 H’s 4 T’s

Answer 7

Hypo / Hyperkalaemia / metabolic disorders
Hypo / hyperthermia
Hypovolaemia
Hypoxia

Thrombosis (pulmonary and coronary)
Tamponade
Toxins / tablets
Tension pneumothorax

Question 8

COACHED

Answer 8

o Continue compressions
o Oxygen away
o All others away
o Charging – top clear, middle clear, bottom clear
o Hands off – the person performing chest compressions removes hands and states “I’m clear”
o Evaluate rhythm
o Defibrillate or dump charge

Question 9

Drugs during CPR

Answer 9

Shockable
- adrenaline 1mg after 2nd shock (then every 2nd cycle)
- amiodarone 300mg after 3rd shock

Non-shockable
- adrenaline 1mg immediately (then every 2nd cycle)

Question 10

Jules for shocking

Answer 10

200j for biphasic or 260 for monophasic defib