Future of Ultrasound in Cardiac Arrest Flashcards
Cardiac standstill on ultrasound?
Near 100% predictor of resuscitation failure.
Pseudo PEA
Low cardiac output state that cannot reach sufficient pressure to generate a palpable pulse.
Causes of PEA
Hypovolaemia
Cardiac Tampondae
Pulmonary Embolism
Tension Pneumothorax
Rough survival to discharge rates for ventricular arrthymia/OOHCA/PEA?
30%
8% and
3% respectively
What are the problems with assessing cardiac output by palpating a pulse?
Insensitive, non-specific and each person has different quality of sensation.
What are the benefits of US?
Quickly detect reversible causes of PEA arrest.
Small portable etc
PEA - narrow QRS indicates? Possible causes?
Mechanical (RV problem): Cardiac tamponade Tension Pneumothorax Mechanical hyperinflation PE MI - myocardial rupture
PEA - wides QRS indicates? Possible causes
Metabolic (LV) problem: Severe hypokalemia Sodium-channel blocker toxicity. Agonal rhythm Acute MI - pump failure
In narrow QRS PEA, what would US show?
LV hyperdynamic, pseudo-PEA
In broad-QRS PEA, what would US show?
LV hypokinetic
or akinetic true PEA
Big US trail? Most important findings?
REASON trial: cardiac activity on US is most important variable in survival to discharge.
Discrepancies with heart trace vs Us findings.
Pre-hospital trial of paramedic echo? Where?
Aims?
PUCA study: Edinburgh. Aims: how often paramedics can obtain US views within a 10 second window, what the effect on the hands off the chest time/quality of resus was.
Findings/problems of PUCA
Only 44% of views in 10 seconds.
Average off chest time 17 seconds - effected communication and reduced quality of ALS.
Paramedics using US on patients they were considering terminating resus.
Pericardial effusion and collapsed RV on echo?
Cardiac tamponade
Flat RV and Flat LV on echo?
Hypovolaemia
