Chapters 1-4 Flashcards
What are the four links in the chain of survival?
- Early recognition and call for help
- Early CPR
- Early defibrillation
- Post resuscitation care
By what percentage does each 1 minute delay to defibrillation reduce chances of survival?
10-12%
What are the first 2 mainstems of the ALS algorithm?
CPR 30:20
Assess rhythmn
What should be done immediately after a patient becomes unresponsive and is not breathing normally
Call resuscitation team/ambulance
What are the shockable rhythms?
VF/pulseless VT
What are the non-shockable rhytmns?
PEA/asystole
What follows identification of VT/pulseless vt
1 shock
What follows the delivery of a shock in the ALS algorithm?
Resume CPR for 2 minutes
What are the 4 H’s?
Hypoxia
Hypo/hyper-thermia
Hypo/hyper-kalaemia metabolic
Hypovolaemia
What are the 4 T’s?
Toxins
Tamponade- cardiac
Tension pneumothorax
Thrombosis-coronary/pulmonary
What should be considered to identify reversible causes?
Ultrasound imaging
What changes when an advanced airway is secured?
Continuous compressions
When should adrenaline be given?
Every 3-5 minutes
When should amiodarone be given?
After 3 shocks
What should be used after ROSC?
ABCDE approach
What is the aim SpO2 after ROSC?
94-98%
What should be performed after ROSC?
12 lead ECG
What are the four key non-technical skills?
- Situational awareness
- Decision making
- Team working and leadership
- Task management
What are the three elements of situational awareness in cardiac arrest?
Information gathering (what are the potential causes)
Interpretation (what steps are needed)
Future planning (What are the next steps)
What are the characteristics of a good resus team member?
- competence
- commitment
- communicates openly
- supportive
- accountable
- prepared to admit when help is needed
- creative
- participates in providing feedback
Who is responsible for completion of documentation after an arrest?
The team leader
What are the components of SBARD?
- Situation
- Background
- Assessment
- Recommendation
- Decision
What should be said in the ‘situation’ section of SBARD?
- Introduce yourself and check you are speaking to the right person
- Identify the patient you are calling about (who and where)
- say what you think the current problem is/appears to be
What should be said in the ‘background’ section of SBARD?
Background information on the patient.
Reason for admission.
Relevant PMHx.
What should be said in the ‘assessment’ section of SBARD?
Specific obs as per ABCDE approach
What should be said in the ‘recommendation’ section of SBARD?
What do you want the person you are calling to do and by when?
I am doing this…. I need you to come straight away…
What should be said in the ‘decisions’ section of SBARD?
Summarise what has been agreed.
Confirm what has been discussed.
What should be considered when allocating the team leader?
Skills and experience over seniority
What percentage of people who have in hospital cardiac arrests survive to go home?
24%
What makes a cardiac arrest more survivable?
- witnessed arrest
-VF/pVT
-primary cause is myocardial ischaemia
-successfully defibrillated immediately
What is the most likely arrest rhythm in hypoxia/hypotension?
PEA or asystole
What is the chance of survival rate to hospital discharge in a PEA/asystole in hospital cardiac arrest?
14%
What are the links in the chain of prevention?
- education
- monitoring
- recognition
- call for help
- response
What is the frequency of monitoring of a NEWS score of ‘0’?
Minimum 12 hourly
What is the frequency of monitoring of a NEWS score of ‘1-4’? What else should be done?
Minimum 4-6 hourly
- inform a registered nurse who must assess the patient and decide whether increased frequency/escalation is required
What is the frequency of monitoring of a NEWS score of ‘>/=3’ in a single parameter? What else should be done?
Minimum 1 hourly
Registered nurse should inform the medical team who should review.
What is the frequency of monitoring of a NEWS score of ‘5-6’? What else should be done?
Minimum 1 hourly
Registered nurse to immediately inform medical team
Registered nurse to request urgent asessment
Clinical care should be provided in an area where monitoring is possible
What is the frequency of monitoring of a NEWS score of ‘7 or more’? What else should be done?
Continous monitoring
Consider transfer of care to ICU/HDU
Emergency assessment by a team with critical care competencies.
What is the MET calling criteria in A?
Threatened
What is the MET calling criteria in B?
All respiratory arrests
Resps <5
Resps >36
What is the MET calling criteria in C?
All cardiac arrests
HR <40
HR >140
Systolic <90
What is the MET calling criteria in D?
Sudden decrease in the level of consciousness
GCS drop of > 2
Repeated or prolonged seizures
What is the MET calling criteria in E?
Any patient causing concern outwith the criteria of ABCD
What does partial airway obstruction cause?
Pulmonary/cerebral oedema
Exhaustion
Secondary apnoea
Hypoxic brain injury
Cardiac arrest
What can cause CNS depression leading to partial airway obstruction?
Head injury
Intracerebral disease
Hypercapnia
Depressant effects of metabolic disorders
Drugs- alcohol, opioids, general anaesthetics
What can occur with upper airway stimulation in a semi-conscious patient whose airway reflexes remain intact?
Laryngospasm
What are the causes of airway obstruction?
Foreign body
CNS depression
Blood
Vomitus
Direct trauma to face/throat
Epiglottitis
Pharyngeal swelling
Laryngospasm
Bronchospasm
Bronchial secretions
Blocked tracheostomy
What treatment should be administered to a patient who is conscious but struggling with their airway?
Suck blood/gastric contents from mouth
Unless contraindicated turn patient on their side
Give O2 ASAP
What should be assumed in a depressed level of counsciousness
Impending airway obstruction
What can CNS depression abolish
Respiratory drive
At which level are intercostal muscles innervated?
Their respective levels
At which level is the diaphragm innervated?
C3-5
What conditions can cause inadequate respiratory effort via muscle weakness/nerve damage?
GBS
MG
MS
Chronic malnourishment
What impairs lung function?
Pneumothorax
Haemothorax
Severe lung disease- infection, aspiration, COPD, asthma, PE, contusion, ARDS, pulmonary oedema
What does a tension pneumothorax cause
Rapid failure of gas exchange
Reduction of venous return to the heart
Fall in cardiac output
Once Sp02 can reliably be recorded, aim for a Sp02 in the range of __-__%, or __-__% in hypercapnic respiratory failure
Once Sp02 can reliably be recorded, aim for a Sp02 in the range of 94-98%, or 88-92% in hypercapnic respiratory failure
What is the treatment for a tension pneumothorax?
Early needle decompression and insertion of chest drain
What can be used in patients who are having breathing difficulty or are becoming tired?
NIV
What is the most common cause of circulation problems in acutely unwell patients?
Hypovolaemia
What is the commonest cause of SCD
Arrhythmia caused by ischaemia or MI
What are the less common causes of SCD
- alternative forms of heart disease
- heart block
- electrocution
- drugs
- cardiac failure
- tamponade
- cardiac rupture
- myocarditis
- HOCM
What are the causes of VF
ACS
Hypertensive heart disease
Valve disease
Drugs (antiarrhythmic drugs, TCAs, digoxin)
Inherited cardiac diseases (LQTC)
Acidosis
Electrolyte abnormality
Hypothermia
Electrocution
What are the causes of secondary circulatory problems
Asphyxia
Tension pneumothorax
Acute severe blood loss
Severe hypoxia and anaemia
Hypothermia
Hypovolaemia
Septic shock
What features suggest a high probability of arrhythmic syncope?
- syncope in the supine position
- syncope occurring during or after exercise
- syncope with no or only brief prodromal symptoms
- repeated episodes of unexplained syncope
- syncope in individuals with a FHx of sudden death or inherited cardiac condition
In what position will most patients having an MI be more comfortable?
Sitting up
What is the first step of ABCDE approach?
Ensure personal safety
How long should the first “look, listen, feel’ last?
30 seconds
If the patient is breathing with occasional gasps what should you do?
Check for a pulse, if not present or there is any doubt of a pulses’ presence start CPR
What should be attached to a critically ill patient ASAP
pulse oximeter
ECG monitor
NI blood pressure monitor
What are the signs of airway obstruction?
Paradoxical chest and abdominal movements and the use of accessory muscles of respiration
Central cyanosis (late sign)
No/noisy breath sounds
How should you assess breathing?
Look listen and feel for signs of resp distress
- sweating, central cyanosis, use of accessory muscles, abdominal breathing
Count the respiratory rate
- Normal is 12-20
Assess the depth of each breath, the pattern or respiration and whether chest expansion is symmetrical
Note any chest deformity
- raised JVP (acute severe asthma, tension pneumothorax)
- presence and patency of any chest drains
Record SpO2
Listen to breathing a short distance from patients face
- rattling suggests airway secretions
- stridor/wheeze suggests partial but significant airway obstruction
Percuss the chest
- hyperresonance may suggest pneumothorax
-dullness may suggest consolidation or fluid
Auscultate the chest
- bronchial breath sounds may suggest consolidation
- absent or reduces sounds may suggest pneumothorax/consolidation/pleural fluid
Check the position of the trachea
Feel the chest wall to detect surgical emphysema/crepitus (pneumothorax until proven otherwise)
If the patients depth or rate of breathing is inadequate or absent what should be done?
Use bag-mask ventilation while calling for help
What should be given to any patient with a fast heart rate and cool peripheries
IV fluids
How should you assess circulation
- Colour of hands and digits
- Limb temperature
- CRT
- Assess state of veins
- Palpate pulses peripheral and centrally
(bounding pulse may suggest sepsis) - Measure BP
- Auscultate the heart
- Look for other signs
- low urine output, reduces consciousness, - Look for external haemorrhage
- Insert one or more large cannulae
- Take bloods
What does a narrow pulse pressure suggest
Arterial vasoconstriction (cardiogenic shock or hypovolaemia)
What should the treatment of cardiovascular collapse be targeted at?
Fluid replacement, haemorrhage control and restoration of tissue perfusion
What fluid should be given in cardiovascular collapse
500mL of a warmed crystalloid (Hartmann’s or NaCl over 15min
If there are signs of fluid overload in fluid resuscitation, what should be done?
Look for alternative means of maintaining tissue perfusion
- inotropes
- vasopressors
What does the immediate general treatment for ACS include?
Aspirin 300mg orally, crushed or chewed
Nitroglycerine as GTN
O2 if less than 94%
Morphine IV titrated to avoid sedation and resp depression
What are the common causes of unconsciousness
Hypoxia
Hypercapnia
Cerebral hypoperfusion
Sedatives/analgesics
How should you assess disability
Review ABCs
Check drug chart
Examine pupils
Rapid AVPU
Blood sugar
Nurse these patients in a lateral position if airway not protected
What should the treatment of hypoglycaemia in peri-arrest situation be?
Initial dose of 50mL of 10% glucose IV every minute until patient has regained consciousness or total 250mL has been given
How should you assess exposure?
Expose fully while maintaining dignity and preventing heat loss
