Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular (Annie) > Managing cardiac arrest > Flashcards

Managing cardiac arrest Flashcards

1
Q

what is a cardiac arrest?

A

effective cessation of the heart

- no circulation & no oxygen delivered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how do you recognise somebody is having a cardiac arrest?

A

1) unresponsive
2) not breathing normally
3) no pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why is the majority of cardiac rhythm shockable (i.e. able to be defibrillated?

A
  • as presenting rhythm in most cases is VF/VT

= majority is potentially reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what 2 things commonly precede cardiac arrest?

A
  • hypotension

- hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when should defibrillation be given, if appropriate?

A

= within 3 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are most problems of cardiac arrest caused by?

A

1) airway
2) breathing
3) circulation
= oxygen delivery problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how can you improve SaO2 oxygen delivery factors?

A

1) SaO2

= clear airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how can you improve [Hb= for oxygen deliver?

A

= transfusion trigger, treat anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how can you alter heart rate for oxygen delivery?

A

= atropine or B-stimulant (e.g. ephedrine) for bradycardia, pace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how can you alter stroke volume to improve oxygen delivery?

A

1) preload = IV fluids, raise legs

2) afterload
= excess afterload (HBP) use vasodilators
= reduce after load (e.g. septic shock) use vasoconstrictors

3) contractility = treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what other factors affect oxygen delivery?

A

= BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how would you manage a cardiac arrest patient?

A

ABCDE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how can you check for SaO2 and [Hb] levels?

A

SaO2
= pulse oximetry on finger
= arterial blood fas (GOLD STANDARD)

[Hb]
= part of full blood count
- bedside (e.g. hemocue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how would you check heart rate?

A
  • pulse
  • pulse oximetry
  • ECG monitor with sound
  • arterial BP monitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how would you calculate B{?

A

BP = CO x TPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are 4 causes of obstruction which causes AIRWAY problems?

A

1) CNS depression = tongue
2) lumen blocker = blood, vomit, foreign body
3) swelling = trauma, infection, inflammation
4) muscle = laryngospasm., bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how would you recognise airway obstruction (SpO2)?

A
  • talking
  • difficult breathing, distressed, choking
  • shortness of breath
  • noisy breathing = stridor, wheeze, gurgling
  • see saw respiratory pattern using accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how would you treat airway obstruction (SpO2)?

A
  • airway opening
    e. g. head tilt, chin lift, jaw thrust, suction
  • simple adjuncts
  • advanced techniques
    e. g. LMA, tracheal tube
  • oxygen (increase FiO2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are causes of BREATHING problems (SpO2)?

A

1) airway problems

2) decreased respirator drive
- CNS depression

3) decreased respiratory effort
- muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs.

4) lung disorders
- pneumothorax, haemothorax, infection, acute exacerbation COPD, asthma, PE, ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how would you recognise breathing problems (SpO2)?

A

1) look - respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, consciousness level
2) listen - noisy breathing, breath sounds
3) feel - expansion, percussion, tracheal position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how would you treat breathing problems (SpO2)?

A
  • oxygen
  • airway
  • treat underlying cause to improve breathing
    e. g. drain pneumothorax
  • support breathing
    e. g. ventilate with bag mask
22
Q

what are primary and secondary causes of circulatory problems ([Hb]/CO)?

A

Primary

  • Acute coronary syndromes
  • Dysrhythmias
  • Hypertensive heart disease
  • Valve disease
  • Drugs
  • Hereditary cardiac diseases
  • Electrolyte / acid base
  • abnormalities
  • Electrocution

Secondary Asphyxia

  • Hypoxaemia
  • Blood loss
  • Hypothermia
  • Septic shock
23
Q

how would you recognise circulatory problems?

A

[Hb], CO = HR x SV

  • general exam = distres, palor
  • indications of organ perfusion
    = chest pain, mental state, urine output
  • blood pressure
  • pulse, tachycardia, bradycardia
  • peripheral perfusion = capillary refit time
  • bleeding, fluid losses, JVP, CVP
24
Q

how do you treat circulatory problems?

A

1) ensure airway, breathing O2
2) IV/IO access, take bloods
3) treat cause
- fluid challenge
- inotropes/vasopressors
- oxygen, aspiring, nitrates, morphine for ACS
4) haemodynamic monitoring

25
Q

how do you recognise disability?

A 
Treatment - ABC
= treat underlying cause
= blood glucose
- if < 3mmol-1 give glucose
= consider lateral (recovery) position 
= check drug chart
26
Q

what heart rhythm is shockable and non-shockable?

A

SHOCKABLE
= VF
= pulseless VT

NON-SHOCKABLE
= asystole
= pulseless electrical activity (PEA)

27
Q

why is ventricular fibrillation shockable, whats its ECG appearance?

A
  • bizarre irregular waveform
  • no recognisable QRS complex
  • random frequency and ampltitude
  • uncoordinated electrical activity
  • coarse/fine
28
Q

describe ventricular tachycardia, whats its ECG appearance?

A

Monomorphic VT

  • broad complex rhythm
  • rapid rate
  • constant QRS morphology

Polymorphic VT
- torsade de pointes

29
Q

what is pre-cordial thump?

A

= only use if defibrillator is not immediately available AND monitored VF/VT cardiac arrest

30
Q

what is a defibrillator?

A

use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur.

31
Q

why are pads used in defibrillation?

A

to minimise interruptions

32
Q

After delivery of shock, then immediate CPR, check for 2 minutes. If VF/VT persists what would you do?

A

1) deliver 2nd shock
2) CPR for 2min
3) deliver 3rd shock
4) CPR if VF/VT persists
Adrenaline 1mg IV

33
Q

when should adrenaline and amiodarone be given?

A

ADRENALINE
- after 3rd shock then after alternate shocks (every 3-5mins)

AMIODARONE
- after 3rd shock

34
Q

why is asystole non shockable, describe its ECG appearance?

A

= effectively flat line

  • absent ventricular QRS activity
  • atrial activity (P wave) may persist
  • rarely a straight line trace, its a wave line
35
Q

how should you treat asystole?

A
  • adrenaline 1mg IV soon as

- every 3-5mins thereafter (every 2 CPR cycles)

36
Q

why are pulseless electrical activity non-shockable? describe its ECG appearance?

A
  • ECG normally associated with an output
37
Q

how would you treat pulseless electrical activity?

A
  • exclude/treat reversible causes
  • adrenaline 1mg IV as soon as possible
  • every 3-5mins thereafter, every 2 cycles
38
Q

what dose of adrenaline and amiodarone should be given?

and what does adrenaline act as?

A

Adrenaline 1mg
Amiodarone 300mg

  • alpha vasoconstrictors
  • B inotropic
39
Q

what are the 4Hs and 4Ts?

A

= potential reversible causes

H’s

  • hypoxia
  • hypovolaemia
  • hypo/hyperkalaemia/metabolic
  • hypothermia
T's
= thrombosis - coronary/pulmonary
= tension pneumothroax
= tamponade - cardiac
= toxins
40
Q

how would you treat hypoxia?

A

= airway and ventilation

1) secure airway
- tracheal tube
- suprglottic airway device, e.g. LMA/iGel

2) once airway is secured, don’t interrupt chest compressions for ventilation
3) avoid hyperventilation

41
Q

what are advantages & disadvantages of mouth to mask ventilation?

A

ADVANTAGES;

  • avoids direct person to person contact
  • decreases potential for cross infection
  • allows oxygen enrichment

LIMITATIONS:

  • maintenance of airtight seal
  • gastric inflation
42
Q

advantages and disadvantages of self-inflating bag?

A

ADVANTGES;

  • avoids direct person to person contact
  • all O2 supplementation = up to 85%
  • can be used with facemark, LMA, combitube, tracheal tube
DISADVANTAGES
- when used with a facemark; 
= risk of inadequate ventilation 
= risk of gastric inflation 
= need 2 persons for optimal use
43
Q

advantages of disadvantages of laryngeal mask airway (LMA)?

A

ADVANTAGES ;

  • Rapidly and easily inserted
  • Variety of sizes
  • More efficient ventilation than facemask
  • Avoids the need for laryngoscopy

DISADVANTAGES

  • No absolute guarantee against aspiration
  • Not suitable if very high inflation pressures needed
  • Unable to aspirate airway
44
Q

what are problems of insertion of tracheal tube?

A
  • incorrect placement

- delays CPR or defibrillator

45
Q

how would you treat hypovolaemia?

A

IV fluids

46
Q

how would you treat hypo/hyperkalaemia/metabolic?

A
  • correct accordingto U&Es/blood gases
47
Q

how would you treat thrombosis, tension pneumothorax, cardiac tamponade and toxins?

A

thrombosis
= thrombolysis

tension pneumothorax
= needle thoracentesis

cardiac tamponade
= needle cardiocentesis

toxins;
= specific treatment/antidote

48
Q

when should you stop CPR?

A

= when return of spontaneous circulation (ROSC)

- when seems useless, time, diagnosis, pre-arrest conditions or DNR/DNAR

49
Q

what are 4 factors of post-cardiac arrest syndrome?

A

1) post cardiac arrest brain injury
2) post cardiac arrest Myocardial dysfunction
3) systemic ischaemia / re-perfussion response
4) persistant precipitating pathology

50
Q

what should be done immediately after post resuscitation?

A

1) 12 lead ECG
2) reliable IV access
3) intra-arterial BP monitor
4) target SBP > 100mmHg
5) fluid (crystalloid) normovolaemia
6) consider inotrope/vasopressor

51
Q

in unconscious adults with risk of spontaneous circulation after arrest be temperature managed to?

A

32-36degrees.

Cardiovascular (Annie) (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions