In-hospital resuscitation Flashcards
What is the risk of infection with CPR?
Much lower than perceived. There are rare reports of TB and SARS. The ARC claims that there are no demonstrated infections of HIV from CPR (This is technically true as stated but it does not line up with other high quality research statements on this topic)
For a collapsed patient, how do you check for response?
Ask: “are you all right?”
Shake and shout
If he responds, do what?
A-E, Monitor, O2, IVC, Bloods
If he does not respond, then what?
Turn patient on their back, head tilt / chin lift.
If chance of spinal injury, jaw thurst.
FOR less than 10 seconds! Look for breathing, chest movement, signs of life, listen for breath sounds, feel for air on your cheek, you can check carotid at the same time.
Start CPR if not breathing or agonal. DON’T stop CPR just because the patient moves limbs as this can occur without ROSC.
Can starting CPR on a very sick patient with low cardiac output cause significant harm?
NO
What is the compression ratio and where do you put your hands?
What is the rate of compressions?
30:2 and middle of the lower half of the sternum.
100-120 compressions per minute.
How much inspiratory time should be given on a breath?
1 second
Who and what principles should be followed in intubation?
Who? Trained and competent in the skill
Principles: Less than 5 seconds of interruption to chest compressions; waveform cap to confirm intubation + monitor success of CPR.
What are the shockable rhythms?
VF and pVT
How important is uninterrupted chest compressions?
KEY! Any interruption is disastrous for outcome.
If a patient is monitored with cardiac arrest, and is well oxygenated / perfused, and a manual defib is rapidly available (within 20 seconds), what can you do if VF/pVT?
Three stacked shocks that count as the first shock in the algorithm.
When can a precordial thump be used?
Can work with pVT. No evidence for VF. However, it can be done if cardiac arrest is confirmed + delivered within 20 seconds of arrest while waiting for defib and it does not delay help.
How do do precordial thump?
From 20cm, sharp impact to lower half of the sternum with ulnar edge of clenched fist then retract fist quickly to provide impulse.
