Chapter 18 cardiac arrest Flashcards
chain of survival
5 elements
- recognition and activation of emergency response system
- immediate high quality CPR
- rapid defibrillation
- basic and advanced EMS
- ALS and post-arrest care
summarized by American heart association
percentage of cardiac arrest calls
in typical ambulance only 1-2% are cardiac arrest
odds of cardiac arrest saves over the last 20 years
has increased considerably
underlying theme of chain of survival
is teamwork
EMTs provide 2 elements of the chain of survival
- early high quality CPR
- early AED (rapid defibrillation)
2 ways to defibrillate
older method
-manual defibrillation
newer method
-automatic defibrillation
2 types of automatic defibrillators
semi-automatic : would call for a shock button to be pressed
automatic: shock is administered as soon as it is charged
2 types of shock (AED shock)
- monophasic defibrillator - sends a single shock from the negative pad to the positive pad
- biphasic - sends shock in both directions
the most common conditions of cardiac arrest
- ventricular fibrillation (VF)
- ventricular tachycardia (v-tach)
PEA pulseless electrical activity
- a condition in which the hearts electrical rhythm remains relatively normal. yet mechanical pumping activity fails to follow the electrical activity causing cardiac arrest
ventricular fibrillation
hearts electrical pulses are disorganized, preventing heart muscle to properly contracting.
ventricular tachycardia
rapid heart beat, that when the beat is too quick the heart is not able to fill full of blood. there fore pushing less blood out to the body.
is PEA a shockable rhythm?
No
asystole
a condition where the heart stops generating electrical charges used to contract (also known as flatline)
-not a shockable rhythm
AED can shock what percentage of cardiac patients?
at most
-6/7 out of 10 patients will have a shockable rhythm
monophasic units energy level
360 j (joules)
biphasic units energy level
between 120j and 200j depending on the unit
AED analyzing in moving vehicle
often the AED is unable to analyze a patients rhythm while in a moving vehicle.
-it is advised to stop to analyze and deliver shock
post resuscitation care
after AED protocol is run there will be 3 conditions that the patient will be in.
- patient has a pulse
- patient has no pulse after AED gives the no shock advised indication
- AED is analyzing for shockable rhythm,
AED contraindication
the only contraindications of using a AED is
-if the AED pads won’t fit on patient without touching each other.
AED during hypothermia
in cases of hypothermia, AED may not be effective.
until the body temperature is brought back up to at least 86degF before attempting AED
Ventricular assistance device (VAD)
a mechanical device that pumps blood for the heart
-consists of a pump, and power source (outside of patients body)
left ventricular ventilation device (LVAD)
more common outside of the hospital
- takes blood from the left ventricle and pumps it to the aorta and systematic circulation
patients with a VAD or LVAD
patients with these devices should not have CPR performed unless directed by med control.
-it is hard for ems to tell if the patient is alive, circulating blood, because there is no shutting or contracting of the left ventricle (where pulse is generated)
QI (defibrillation) review
- medical direction
- initial training
- maintenance of skills
- case review
- trend analysis
- strengthening the links in the chain of survival
mechanical CPR devices
- LUCAS CPR
- auto-pulse
3 criteria of resuscitation before CPR is terminated
- arrest was not witnessed by EMS personnel or first responders
- no return of spontaneous circulation after 3 rounds of CPR and AED
- AED does not detect a shockable rhythm
electrical charge of AED pad
electrical charge travels from negative terminal to positive terminal
side effects of nitro
headache
when should an emt be ready to administer single rescuer CPR?
en route to hospital
there are medications that can limit damage to heart muscle
yes
how should any chest pain be treated?
treated like cardiovascular emergency
syncope caused by cardiovascular
often a sign of myocardial infarction
