In-hospital resuscitation Flashcards
What must the 1st person who has noticed or responded to a cardiac arrest do ?
Ensure help is coming i.e. emergency buzzer and start CPR.
Then team can phone 2222 and get arrest trolley
What are manual defibrillators used by trained staff in rhythm recognition associated with when compared to the use of AED’s ?
Increased survival
Note that wave capnography is often available on newer defibrillator devices
Is covid-19 infection a contraindication to mouth-mouth ventilation ?
Yes
Go over the initial 1st responder ALS algorithm
How long should you take when assessing an unconcious patients breathing and pulse ?
Look, listen and feel + feel carotid pulse
Should take less than 10 secs
1st responder ALS steps (part 1)
1st responder ALS steps (part 2)
1st responder ALS steps (part 3)
1st responder ALS steps (part 4)
Is agonal breathing common in cardiac arrest?
yes - common in early stages of cardiac arrest. It is not a sign of life. It can also occur during good CRP (alongside limb movement)
If there is doubt about the presence or absence of signs of life or a pulse what should you do?
Start CPR immediately - delays adversely affect outcome and you will unlikely do any harm if patient hasnt actually arrested.
What is the ratio of compressions:ventilations? (when you do not have definitive airway access)
30:2
What is the rate and depth which chest compressions should be ?
Rate 100-120
Depth 5-6cm (always ensure chest is allowed to recoil completely after each compression)
What if available should be used to measure quality of chest compressions?
A feedback device
How often should the rescuer carrying out chest compressions be changed?
Every 2 mins. (sooner if unable to maintain adequate compressions)
What inspiratory time should each ventilation breath be >
1 sec, ensuring visible rise of chest wall
How quickly and whom should only carry out tracheal intubation?
Only those experienced and competent. Need to be able to do it in < 5 seconds with minimal interuptions to compressions.
Once a definitive airway (intubated or I-gel) has been inserted what is the rate at which the lungs should be ventilated ?
10 breaths/min.
What does using manual defibrillators do to the pause between stopping and starting compressions again?
It reduces it to < 5 secs
When carrying out a rhythm check should you pause the person doing compressions?
Yes - but aim for the pause to be < 5 secs.
If after rhythm check its shockable what should the person doing compression do and what should everyone else do?
Restart compressions whilst the defibrillator charges.
Everyone else should stand back
What does every 5 second increase in the pre-shock pause do to the chances of a successful shock?
It almost halves the chance
If a patient has a monitored and witnessed cardiac arrest in a cath lab, CCU or ITU, or after cardiac surgery and the initial rhythm is shockable (VF/pVT) then what can be done ?
x3 successive (stacked) shocks
Check for rhythm change, pulse/signs of life after each shock
When should a precordial thump be considered in a cardiac arrest ?
Only when it can be used without delay whilst awaiting a defibrillator in a monitored shockable arrest (VF/pVT)
How do you perform a precordial thump?
Using ulnar edge or tight fist, deliver a sharp impact to the lower half of the sternum from a 20cm height, retracting the fist immediately to create an impulse like stimuli
