In-hospital resucitation

Question 1

What are the features of high-quality chest compressions?

Answer 1

• 30:2 compressions to ventilations
• Hands at the middle of the lower half of the sternum
• Depth of 5–6cm
• Rate of 100–120bpm
• Allow chest to completely recoil after each compression
• Equal compression and relaxation time
• Minimise interruptions

Question 2

How do you manage the airway in a cardiac arrest?

Answer 2

• Self-inflating bag-mask ventilation or supraglottic airway and bag
• Tracheal intubation by trained staff only in <5s

Question 3

What are the uses of waveform capnography in cardiac arrest?

Answer 3

• Confirm tracheal tube in patient’s airway
• Monitor quality of CPR
• Indicator of ROSC
• Prognostic indicator

Question 4

Once the patient has an endotracheal tube, how do you manage compressions and ventilations?

Answer 4

• Continuous uninterrupted chest compressions
• Ventilate the lungs at roughly 10 breaths/min
  Consider this with a supraglottic airway too

Question 5

How do you manage a monitored and witnessed cardiac arrest in VF/pVT?
What is important to note?

Answer 5

• Consider precordial thump when used without delay in awaiting arrival of a defibrillator in a monitored VF/pVT patient
• Three quick successive (stacked) shocks
• The three shocks are considered as giving the first shock but amiodarone is still given after 3 shocks

Question 6

How do you manage defibrillation during a shockable cardiac arrest?

Answer 6

• Stop compressions and analyse monitor
• Resume compressions whilst charging defibrillator, inform colleagues to stand-clear and remove open-circuit oxygen
• Initial shock 120–150J with subsequent the same or higher
• When charged, tell all staff to stand clear
• Immediately resume CPR after shock

Question 7

What is the overall management of a shockable rhythm cardiac arrest?

Answer 7

• Rhythm check every 2 minutes
• 3 shocks
• After third shock, give adrenaline 1mg 1:10,000 IV/IO and amiodarone 300mg IV/IO
• Now give adrenaline after alternate shocks (3–5m)
• After fifth shock, give amiodarone 150mg IV/IO
• Lidocaine 1mg/kg is alternative to amiodarone
• Consider changing pads to AP in shock-refractory VF/pVT

Question 8

What are some indicators of ROSC?

Answer 8

• Signs of life
• Electrical activity compatible with cardiac output WITH a pulse (without is PEA)
• Sudden increase in end-tidal CO2

Question 9

What is the overall management of a non-shockable rhythm cardiac arrest?

Answer 9

• Adrenaline 1mg 1:10,000 IV/IO then repeat every 3–5m
• If change to VF/pVT then change to shockable algorithm

Question 10

What are the reversible causes of cardiac arrest?

Answer 10

• Hypoxia
• Hypovolaemia
• Hyper/hypokalaemia
• Hypothermia
• Thrombosis (coronary/pulmonary)
• Tamponade
• Tension pneumothorax
• Toxins

Question 11

What is end-tidal CO2?
What are the values like during CPR?

Answer 11

• Partial pressure of CO2 at the end of an exhaled breath, reflecting cardiac output and pulmonary blood flow
• Low as this reflects the low cardiac output generated by chest compressions

Question 12

What are the 3 main sites for IO access in adults?

Answer 12

• Proximal humerus
• Proximal tibia
• Distal tibia