Foundational Concepts Flashcards by Michael Kootstra

What is the significance of Surveillance and Prevention for the adult in-hospital cardiac chain of survival?

Hospitalized patients often show changes in vital signs and other clinical parameters in the minutes and hours leading up to cardiac arrest.

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What action is in the in-hospital cardiac chain of survival that is not included in the out-of-hospital chain of survival?

Surveillance and Prevention

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What action is in the out-of-hospital chain of survival that is not included in the in-hospital cardiac chain of survival?

Advanced life support (early support provided by EMS at the scene and en route)

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What actions are included in the in-hospital chain of survival?

Surveillance and Prevention
Recognition of a cardiac emergency and activation of the emergency response system
Early high-quality CPRl
Early defibrillation
Integrated post-cardiac arrest care
Recovery

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What are the actions included in the out-of-hospital chain of survival?

Recognition of cardiac emergency and activation of the emergency response system
Early high-quality CPR
Early defibrillation
Advanced life support
Integrated post-cardiac arrest care
Recovery

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What are the first two steps to providing high quality CPR?

Position the patient appropriately
Expose the chest

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What is the proper rate and depth for providing chest compressions?

Rate: 100-120 compressions per minute
Depth: 2-2.4 inches (5-6 cm)

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How long does it take to complete 30 compressions at a rate of 100-120 compressions per minute?

15-18 seconds

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Why is it important to let the chest recoil fully after each compression?

To prevent impeding venous return, which prevents the heart from filling completely, which decreases cardiac output.

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What is Coronary Perfusion Pressure (CPP)?

A reflection of coronary blood flow.
The difference between the pressure in the aorta and the pressure in the right atrium during diastole.

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The maintenance of what CPP value has been shown to increase the likelihood of ROSC & survival?

CPP > 20 mmHg

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How long should it take to administer each ventilation?

About 1 second.

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What is a normal tidal volume in adults?

400-700 mL (about half a squeeze on the BVM)

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What is the concern with provide excessive ventilation during CPR?

Excessive ventilations leads to…
Increased intrathoracic pressure, which leads to…
Decreased venous return, which leads to…
Decreased cardiac output, which leads to…
Decreased likelihood of ROSC

Also leads to gastric insufflation, which leads to…
Regurgitation and aspiration

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How often should providers switch off giving compressions?

Every 2 minutes.
Earlier if compressor is fatigued.

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What is the Chest Compression Fraction?

A key indicator of CPR quality.
A representation of the percentage of time during the resuscitation effort that is spent performing compressions.
Compression time divided by total resuscitation time.

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What is the Chest Compression Fraction (CCF) goal?
What is the minimum CCF needed to promote improved outcomes?

Goal: 80%
Minimum: 60%

If invasive hemodynamic monitoring is in place, what Arterial Diastolic Pressure and Coronary Perfusion Pressure should be maintained?

Arterial diastolic pressure: > 25 mmHg
Coronary perfusion pressure: > 20 mmHg

What does capnography measure?
What does the measurement provide?

Measures end-tidal carbon dioxide level.
An assessment of ventilation and compression quality.

What is the normal range of end-tidal carbon dioxide?
What is the targeted range during high quality CPR?

Normal: 35-45 mmHg
During high quality CPR: 15-20 mmHg

What are the 5 key components of high quality CPR?

Minimize interruptions to chest compressions.
Provide compressions at the proper rate.
Provide compressions at the proper depth.
Allow full chest recoil.
Avoid excessive ventilations.

What concept describes the ongoing process of gathering ingredients data about the patient’s condition?

Assess, Recognize, Care.

What is included in the Rapid Assessment?

Assessment of…
Scene safety.
Responsiveness.
The need for additional resources.
ABCs (10 sec).
Life threatening bleeding.

What is included in the Primary Assessment?

A focused assessment of…
Airway.
Breathing.
Circulation.
Disability.
Exposure

What is included in the Secondary Assessment?

A broader assessment… Differential diagnoses. Discover underlying causes. Includes a focused Hx, physical exam, and diagnostic testing.

What airway adjunct may be used on the unconscious patient during the Primary Assessment?

Oropharyngeal Airway (OPA)

What airway adjunct may be used on the conscience patient, or the patient with an intact gag reflex, during the Primary Assessment?

Nasopharyngeal Airway (NPA)

How do you size an OPA or NPA?

OPA: From the corner of the mouth to the angle of the jaw. NPA: From the nostril to the angle of the jaw.

What is the gold standard of advanced airway management?

Endotracheal Tube

What are two Supraglottic Airways for advanced airway management?

Laryngeal Mask Airway Laryngeal Tube

What are 4 ways to confirm advanced airway placement?

Bilateral chest rise Bilateral breath sounds No gurgling over the epigastrium Use of capnography (3 four-point square wave forms)

What is a likely cause of absent breath sounds on the patient’s left side despite the presence of 4-point capnography wave forms?

Right main-stem bronchi intubation

How should oxygen saturation be maintained during the Primary Assessment?

Provide the minimal level of oxygen needed to maintain an oxygen saturation of 94-99%.

What actions must me taken when addressing circulation during the Primary Assessment?

Assess pulse rate, quality, rhythm, blood pressure, and adequacy of perfusion. Ensure the delivery of high-quality CPR if CPR is in progress. Establish cardiac monitoring and provide electrical therapy as needed. Establish vascular access for administrating fluids/meds.

What are common sites for IO needle insertion?

Anterior proximal tibia Proximal humerus

What can be administered using IO access?

Medications Fluids Blood products

For patients in cardiac arrest, what should all medications be followed with?

10-20 mL normal saline flush.

How can Disability be assessed during the Primary Assessment?

AVPU (Alert, Verbal responsive, Pain responsive, Unresponsive) Orientation to person, place, and time PERRLA Measure the blood glucose level and correct hypoglycemia if needed

How is Exposure evaluated during the Primary Assessment?

Assess body for obvious signs of illness/injury Note skin color, appearance, temperature Remove clothing

What is accomplished during the Secondary Assessment?

Focused Hx (Signs & Symptoms, Allergies, Meds, Past med Hx, Last intake/output, Events) Focused physical exam & complete head-to-toe assessment Diagnostic tests

What are common diagnostic tests ordered during the Secondary Assessment?

Blood tests: ABGs, CBC, electrolyte panel, blood glucose, coagulation studies, lipid profile, serum cardiac markers, toxicology screen. Imaging studies: Chest radiograph, chest/brain CT, MRI of brain, vascular imaging of the brain, chest ultrasound. Electrocardiography