Chapter 14: Pre-hospital Cardiac Arrest Flashcards

1
Q

What interventions offer the best chance of survival after OHCA?

A
  1. Bystander CPR
  2. AED before ambulance arrives
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2
Q

Positions of team during OHCA:

A

Position 1: Head of patient - Airway

Position 2: Pt’s left side - Compressions, defib, drugs

Position 3: Pt’s right side - Compressions, drugs

Position 4: Stand back & oversee - Team Leader

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3
Q

What is the aim of pre-hospital airway Mx?

A
  1. Maintain patent airway
  2. Adequate oxygenation
  3. Adeqaute ventilation
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4
Q

Stepwise approach to airway Mx:

A
  1. No interventions
  2. Mouth-to-mouth
  3. BMV
  4. SGA
  5. ETT
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5
Q

What are the practical considerations in pre-hospital intubation?

A
  1. 360° access
  2. All equipment available in “kit dump”
  3. Check all equipment
  4. Pateint positioning - trolley at knee level of airway person
  5. Don’t use cricoid pressure routinely
  6. Use bougie
  7. Use correct size blade - Size 4 in adults
  8. Secure tube immediately after insertion: 22-23 cm males; 21-22 cm females
  9. Minimise interruptions to compressions
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6
Q

Cx of pre-hospital intubation:

A
  1. Hypoxaemia
  2. Unrecognised oesophageal intubation
  3. Endobronchial intubation
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7
Q

When not to start resus in pre-hospital arrest?

A
  1. DNACPR
  2. Refusal of CPR in ADRT
  3. Decapitation
  4. Hemicorporectomy
  5. Massive cranial & cerebral destruction
  6. Incineration - > 95% full thickness burns
  7. Decomposition / putrefaction
  8. Rigor mortis & hypostasis
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8
Q

What is safest option when unsure of facts of when not to start resuscitation?

A
  1. Start resus
  2. Continue until facts known
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9
Q

When to stop CPR in asystolic patient in pre-hospital setting?

A
  1. Persistent & continuous asystole
  2. > 20 min
  3. All reversible causes have been identified & corrected
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10
Q

Which patients with asystole should be transported to nearest facility with ongoing resus as “priority” cases regardless of time?

A
  1. < 18 years
  2. Drowning
  3. Hypothermia
  4. Poisoning
  5. Pregnant
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11
Q

When to stop CPR in PEA patient in pre-hospital setting?

A
  1. More difficult to determine
  2. Recommend involving senior clinician to support decision
  3. When PEA > 20 min
  4. All reversible causes have been identified & corrected
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12
Q

General priniciples of pre-hospital post-resus care:

A
  1. Sats: 94-98%
  2. Capnography: 4.6-6.0
  3. BP
  4. ECG
  5. Blood glucose
  6. Temp: Prevent fever < 37.7
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13
Q

How to give fluids in pre-hospital setting post ROSC?

A
  1. 250 ml IV bolus of 0.9% NaCl
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14
Q

How to give adrenaline in pre-hospital setting post ROSC?

A
  1. Boluses of ADR 0.05-0.1 mg IV
  2. Titrated against BP
  3. Keep SBP > 100
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15
Q

Position to transport patient in to optimise cerebral perfusion:

A
  1. Supine
  2. Feet-first if coming down stairs
  3. Head up slightly - 30° position
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16
Q

How to pre-alert hospital for medical case?

ATMIST

A
  1. Age
  2. Time of onset
  3. Medical complaint / Hx
  4. Investigations (exam findings)
  5. Signs (vital)
  6. Treatment + ETA + resources needed on arrival
17
Q

How to pre-alert hospital for trauma case?

ATMIST

A
  1. Age
  2. Time of incident
  3. Mechanism of injury
  4. Injuries (head-toe)
  5. Signs (vital)
  6. Treatment + ETA + resources needed on arrival