Chapter 14: Pre-hospital Cardiac Arrest Flashcards
What interventions offer the best chance of survival after OHCA?
- Bystander CPR
- AED before ambulance arrives
Positions of team during OHCA:
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
What is the aim of pre-hospital airway Mx?
- Maintain patent airway
- Adequate oxygenation
- Adeqaute ventilation
Stepwise approach to airway Mx:
- No interventions
- Mouth-to-mouth
- BMV
- SGA
- ETT
What are the practical considerations in pre-hospital intubation?
- 360° access
- All equipment available in “kit dump”
- Check all equipment
- Pateint positioning - trolley at knee level of airway person
- Don’t use cricoid pressure routinely
- Use bougie
- Use correct size blade - Size 4 in adults
- Secure tube immediately after insertion: 22-23 cm males; 21-22 cm females
- Minimise interruptions to compressions
Cx of pre-hospital intubation:
- Hypoxaemia
- Unrecognised oesophageal intubation
- Endobronchial intubation
When not to start resus in pre-hospital arrest?
- DNACPR
- Refusal of CPR in ADRT
- Decapitation
- Hemicorporectomy
- Massive cranial & cerebral destruction
- Incineration - > 95% full thickness burns
- Decomposition / putrefaction
- Rigor mortis & hypostasis
What is safest option when unsure of facts of when not to start resuscitation?
- Start resus
- Continue until facts known
When to stop CPR in asystolic patient in pre-hospital setting?
- Persistent & continuous asystole
- > 20 min
- All reversible causes have been identified & corrected
Which patients with asystole should be transported to nearest facility with ongoing resus as “priority” cases regardless of time?
- < 18 years
- Drowning
- Hypothermia
- Poisoning
- Pregnant
When to stop CPR in PEA patient in pre-hospital setting?
- More difficult to determine
- Recommend involving senior clinician to support decision
- When PEA > 20 min
- All reversible causes have been identified & corrected
General priniciples of pre-hospital post-resus care:
- Sats: 94-98%
- Capnography: 4.6-6.0
- BP
- ECG
- Blood glucose
- Temp: Prevent fever < 37.7
How to give fluids in pre-hospital setting post ROSC?
- 250 ml IV bolus of 0.9% NaCl
How to give adrenaline in pre-hospital setting post ROSC?
- Boluses of ADR 0.05-0.1 mg IV
- Titrated against BP
- Keep SBP > 100
Position to transport patient in to optimise cerebral perfusion:
- Supine
- Feet-first if coming down stairs
- Head up slightly - 30° position