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Cardio > Managing Cardiac Arrest > Flashcards

Managing Cardiac Arrest Flashcards

1
Q

d: cardiac arrest

A

effective cessation of the heart, so no circulation and therefore no oxygen delivered

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2
Q

How is CA recognised?

A

unresponsive patient
not breathing normally
no pulse

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3
Q

O2 delivery equation?

A

DO2 = SaO2 x [Hb] x O2cc1 x CO (HR x SV2)

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4
Q

What is the presenting rhythm in most cases? and whgat does this mean?

A

VF/VT

shockable able to be defibrillated

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5
Q

In hospital what is CA more commonly shockable/non-shockable?

A

not shockable

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6
Q

Name 2 preceding symptoms that are common of CA

A

hypoxia

hypotension

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7
Q

Name the common causes of cardiac arrest

A

problems involving: breathing
airway
circulation

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8
Q

How can we improve O2 sats?

A

– ↑FiO2, Clear airway, Adequate breathing

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9
Q

How can improve O2 delivery factors in relation [Hb]?

A
  • Transfusion trigger, Treat anaemia - Gp&S / X-match, IV access, (Fe etc)
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10
Q

How can improve O2 delivery factors in relation BP/HR?

A

– Atropine or β-stimulant (e.g. ephedrine) for bradycardia, pace

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11
Q

hOW CAN WE INCREASE Cardiac preload?

A

– IV fluids, raise legs

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12
Q

How can we improve contractility CPR?

A

treat cause (e.g. PCI for MI)

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13
Q

How can we treat XS afterload? and eg

A

e.g. HBP) use vasodilators

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14
Q

How can we reduce afterload? and eg

A

e.g. septic shock) use vasoconstrictors

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15
Q

What approach do you use for CPR?

A

ABCDE

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16
Q

How is SaO2 assessed clinically?

A

), pulse oximetry, arterial blood gas (gold standard)

17
Q

How is haemoglobin concentration monitored clinically?

A

clinical (not reliable), part of FBC (full blood count), bedside (e.g. Hemocue)

18
Q

How is HR measured clinically?

A

pulse, pulse oximetry, ECG monitor with sound on or arterial BP monitor

19
Q

How do we assess BP?

A

BP = CO x TPR (total peripheral resistance main physiological “afterload”)
Once Heart Rate accounted for then BP determined by SV and/or TPR
SV depends on preload, contractility, afterload
BP change ALWAYS due to HR, preload, contractility or afterload change
Use clinical info to determine which

20
Q

Name some causes of cardiorespiratory arrest?

A

CNS depression - tongue

Lumen blocked - blood, vomit, foreign body

Swelling - trauma, infection, inflammation

Muscle - laryngospasm, bronchospasm

21
Q

how is airway obstruction recognised?

A

Talking
Difficulty breathing, distressed, choking
Shortness of breath
Noisy breathing
stridor, wheeze, gurgling
See-saw respiratory pattern, accessory muscles

22
Q

How is airway opbstruction treated?

A 
Airway opening
		- i.e. head tilt, chin lift, jaw thrust, suction
Simple adjuncts
Advanced techniques
		- e.g. LMA, tracheal tube
Oxygen! (increase FiO2)
23
Q

Name the causes of breathing problems?

A

Airway problems!

Decreased respiratory drive
CNS depression
Decreased respiratory effort
muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs
Lung disorders
pneumothorax, haemothorax, infection, acute exacerbation COPD, asthma, pulmonary embolus, ARDS

24
Q

How are breathing problems recognised?

A 
Look
respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, conscious level
Listen
noisy breathing, breath sounds
Feel
expansion, percussion, tracheal position
25
Q

How are breathing problems ttreated?

A 
Airway
Oxygen
Treat underlying cause to improve breathing
		- e.g. drain pneumothorax
Support breathing if inadequate
		- e.g. ventilate with bag mask
26
Q

Name the primary causes or circulatory problems?

A 
Acute coronary syndromes
Dysrhythmias
Hypertensive heart disease
Valve disease
Drugs
Hereditary cardiac diseases
Electrolyte / acid base  abnormalities
Electrocution
27
Q

Name the secondary causes of circulatory problems?

A 
Asphyxia
Hypoxaemia
Blood loss
Hypothermia
Septic shock
28
Q

Describe the ABCDE approach to ill circulation?

A

Recognition of circulation problems
([Hb], CO = HR x SV)

General exam – distress, pallor etc
Indicators of organ perfusion
chest  pain, mental state, urine output
Blood pressure
Pulse – tachycardia, bradycardia
Peripheral perfusion - capillary refill time (CRT)
Bleeding, fluid losses, JVP, CVP
29
Q

How are circulatory problems treated ABCDE?

A 
1st ensure Airway, Breathing, O2
IV / IO access, take bloods
Treat cause
Fluid challenge
Inotropes/vasopressors
Oxygen/Aspirin/Nitrates/ Morphine for ACS
Haemodynamic monitoring
30
Q

Describe the ABCDE approach to critically ill for disability?

A

Recognition – AVPU or GCS + pupils

Treatment - ABC

Treat underlying cause
Blood glucose
if < 3 mmol l-1 give glucose
Consider lateral (recovery) position
Check drug chart
31
Q

Describe the ABCDE approach to ill exposure?

A 
Remove clothes to enable thorough examination (to avoid missing causes of problems)
		- e.g. injuries, bleeding, rashes 
BUT!
Avoid heat loss
Maintain dignity
32
Q

If there’s no response what do you do?

A

shout help

33
Q

describe ECG for VF?

A 
Bizarre irregular waveform
No recognisable QRS complexes
Random frequency and amplitude
Unco-ordinated electrical activity
Coarse / fine
Exclude artifact 
movement
electrical interference
34
Q

Describe the VT ECG? both the monomorphic and polymorphic type

A 
Monomorphic VT
Broad complex rhythm
Rapid rate
Constant QRS morphology
Polymorphic VT
Torsade de pointes
35
Q

When is a precordial thump only used?

A

Only used if defibrillator not immediately available in witnessed and monitored VF/VT cardiac arrest

36
Q

When is VT shockable?

A

if it pulses

37
Q

describe how manual defibrillator is used?

A 
Diagnose VF/VT from ECG and signs of cardiac arrest
Select correct energy level
Charge paddles on patient
Shout “stand clear/O2 away”
Visual check of area
Check monitor
“Stand clear” to CPR provider
Deliver shock
Resume CPR immediately
Minimise pause 5 secs by planning/communicating actions

Cardio (28 decks)

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