In-hospital resuscitation

Question 1

What must the 1st person who has noticed or responded to a cardiac arrest do ?

Answer 1

Ensure help is coming i.e. emergency buzzer and start CPR.

Then team can phone 2222 and get arrest trolley

Question 2

What are manual defibrillators used by trained staff in rhythm recognition associated with when compared to the use of AED’s ?

Answer 2

Increased survival

Question 3

Note that wave capnography is often available on newer defibrillator devices

Question 4

Is covid-19 infection a contraindication to mouth-mouth ventilation ?

Answer 4

Yes

Question 5

Go over the initial 1st responder ALS algorithm

Answer 5

Question 6

How long should you take when assessing an unconcious patients breathing and pulse ?

Answer 6

Look, listen and feel + feel carotid pulse
Should take less than 10 secs

Question 7

1st responder ALS steps (part 1)

Answer 7

Question 8

1st responder ALS steps (part 2)

Answer 8

Question 9

1st responder ALS steps (part 3)

Answer 9

Question 10

1st responder ALS steps (part 4)

Answer 10

Question 11

Is agonal breathing common in cardiac arrest?

Answer 11

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)

Question 12

If there is doubt about the presence or absence of signs of life or a pulse what should you do?

Answer 12

Start CPR immediately - delays adversely affect outcome and you will unlikely do any harm if patient hasnt actually arrested.

Question 13

What is the ratio of compressions:ventilations? (when you do not have definitive airway access)

Answer 13

30:2

Question 14

What is the rate and depth which chest compressions should be ?

Answer 14

Rate 100-120
Depth 5-6cm (always ensure chest is allowed to recoil completely after each compression)

Question 15

What if available should be used to measure quality of chest compressions?

Answer 15

A feedback device

Question 16

How often should the rescuer carrying out chest compressions be changed?

Answer 16

Every 2 mins. (sooner if unable to maintain adequate compressions)

Question 17

What inspiratory time should each ventilation breath be >

Answer 17

1 sec, ensuring visible rise of chest wall

Question 18

How quickly and whom should only carry out tracheal intubation?

Answer 18

Only those experienced and competent. Need to be able to do it in < 5 seconds with minimal interuptions to compressions.

Question 19

Once a definitive airway (intubated or I-gel) has been inserted what is the rate at which the lungs should be ventilated ?

Answer 19

10 breaths/min.

Question 20

What does using manual defibrillators do to the pause between stopping and starting compressions again?

Answer 20

It reduces it to < 5 secs

Question 21

When carrying out a rhythm check should you pause the person doing compressions?

Answer 21

Yes - but aim for the pause to be < 5 secs.

Question 22

If after rhythm check its shockable what should the person doing compression do and what should everyone else do?

Answer 22

Restart compressions whilst the defibrillator charges.

Everyone else should stand back

Question 23

What does every 5 second increase in the pre-shock pause do to the chances of a successful shock?

Answer 23

It almost halves the chance

Question 24

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 ?

Answer 24

x3 successive (stacked) shocks

Check for rhythm change, pulse/signs of life after each shock

Question 25

When should a precordial thump be considered in a cardiac arrest ?

Answer 25

Only when it can be used without delay whilst awaiting a defibrillator in a monitored shockable arrest (VF/pVT)

Question 26

How do you perform a precordial thump?

Answer 26

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