Complex CAM and POST-ROSC care Flashcards
How is “sustained ROSC” defined?
Sustained ROSC is deemed to have occurred when chest compressions are not required for 20 consecutive minutes and signs of circulation persist
What is the most common cause of Traumatic cardiac arrest?
Hemmorrhage
What are the top priorities in TCA management?
Prioritizing the underlying cause of arrest over CPR.
- Hypovolemia
- Hypoxemia
- Tension pnx
When should early discontinuation be. considered in TCA?
- Blunt traumatic arrest.
- Transport times exceeding 15minutes.
When should rapid transport be considered in traumatic cardiac arrest?
Less than 15 min transport time and penetrating traumatic arrest.
Describe the HOTTT Drill
Systematic approach to identifying and treating the most common and easily correctable causes of arrest in trauma patients.
- Hemorrhage
- Control deadly bleading
- Oxygenate
- Ensure intact airway, ventilation, oxygenation
- Tension
- Decompress
- Tourniquet (Pelvis binder)
- Transfuse
What are reasonable goals for ACP-led pre-hospital traumatic cardiac arrest care?
- Stop massive hemorrhage
- Solo intubation
- Immediate bilateral needle decompression (4)
- Apply pelvic binder
- 2L infused–>bilateral humeral IO.
Special considerations in crush injury patients
- calcium, sodium bicarb,
- N/S loading
- Tourniquets.
What does the dicrotic notch on an arterial pressure waveform represent?
- Closure of the aortic valve
What is the significance of the total area under the curve of an arterial pressure waveform?
represents MAP
What is represented by the difference between the top and bottom of an arterial pressure waveform?
pulse pressure
What does a widening vs. narrowing arterial pressure waveform represent?
- Widening = greater SVR, indicates vasoconstriction
- Narrowing = lower SVR, indicates fluid depletion or vasodialtion
Which takes precedence in treatment of traumatic Cardiac arrest? Treatment of reversible causes or chest compressions?
treatment of reversible causes!
Use the HOTTT drill
What are the three leading field-treatable (by ACP)causes of traumatic cardiac arrest
- Hypovolemia
- stop the bleeding
- Hypoxia
- oxygenate/ventilate
- Tension pneumothorax
- Decompress the chest
Which two cadiac rhythms in traumatic cardiac arrest are most associated with poor outcomes?
- Asystole (duh)
-
BRADYCARDIC PEA (HR<40bpm)
- non-bradycardic PEA does not carry as poor of a prognosis and the patient should be agressively resuscitated
Compare/contrast the terms “ROC”, “sustained ROSC”, and “survived event”
- ROSC
- A brief (approximately 30 seconds or greater) restoration of spontaneous circulation that provides evidence of more than an occasional gasp, occasional fleeting palpable pulse, or arterial waveform
- Sustained ROSC
- ROSC with no need for re-initation of compressions >20 consecutive minutes
- Survived event
- Sustained ROSC to transfer of care at receiving facility
Define Ischemia-reperfusion Injury (IRI) or reperfusion syndrome
paradoxical exacerbation of cellular dysfunction and death, following restoration of blood flow to previously ischaemic tissues.
What are CPG-supported priorities in post-ROSC mangement
ABC!
- Manage airway
- include waveform etCO2 to confirm ETT/SGA integrity
- Manage respiratory parameters
- Target SpO2 92-98%
- Initial RR=10bpm, titrate to EtCO2 of 35-45mmHg
- Manage hemodynamic parameters
- SBP >90mmHG or MAP>65mmHg
- Consider fluids/vasopressors/inotropes
Hs and Ts in Cardiac Arrest
Hypovolemia
Hypoxia
Hydrogen ion or acidosis (respiratory or metabolic)
Hypo or hyperkalemia
Hypothermia
Tension pneumothorax
Cardiac tamponade
Toxins
Pulmonary thrombosis
Coronary thrombosis
Describe effects of hyper/hypocapnia and hypoxemia in the Cerebral, Systemic, and Pulmonary Circulation
- Cerebral
- Hypercapnia = vasodilation = increased CBF
- Hypocapnia = vasoconstriction = decreased CBF
- Hypoxemia = vasodilation = increased CBF
- Systemic (same as in brain)
- Hypercapnia = vasodilation
- Hypocapnia = vasoconstriction
- Hypoxemia = vasodilation
- Pulmonary (opposite!)
- Hypercapnia = vasoconstriction
- Hypocapnia = vasodilation
- Hypoxemia = vasoconstriction++++
Describe situations where permissive hypercapnia or hypocapnia may be acceptable in the post-ROSC setting
- Hypercapnia: patients with acute lung injury or high airway pressures
- Hypocapnia: temporizing of patients with suspected cerebral edema
Describe neuro-protective