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aha guidelines 2010 > Part 12: Cardiac Arrest in Special Situations > Flashcards

Part 12: Cardiac Arrest in Special Situations Flashcards

0
Q

What may increased wheezing indicate clinically?

A

A positive response to bronchodilator therapy

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1
Q

What are the 3 key abnormalities in the pathophysiology of asthma?

A

Bronchoconstriction

Airway inflammation

Mucous plugging

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2
Q

What may the absence of wheezing indicate?

A

Critical airway obstruction

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3
Q

Why may the SaO2 fall initially during bronchodilator therapy with B2-agonist?

A

Beta2 agonists produce both bronchodilation and vasodilation and initially may increase intrapulmonary shunting.

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4
Q

What are the other possible causes of wheezing? (name 8)

A 
Pulmonary oedema
Chronic obstructive pulmonary disease (COPD)
Pneumonia
Anaphylaxis
Foreign bodies
PE
Bronchiectasis
Subglottic mass
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5
Q

Which out of the three key abnormalities in asthma are amendable to drug treatment?

A

Only bronchoconstriction and

inflammation

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6
Q

Which drug is used to treat the inflammation in asthma?

A

Corticosteroids

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7
Q

What complications can arise during positive pressure ventilation of a patient with severe bronchoconstriction?

A

Breath stacking (auto-PEEP)
Hyperinflation
Tension pneumothorax
Hypotension

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8
Q

What respiratory rate and tidal volume should be used during normal or mechanical ventilation of a patient with severe bronchoconstriction?

A

Smaller respiratory rate
Smaller TV (6-8ml/kg)
Shorter inspiratory time (eg. adult inspiratory flow rate 80 to 100ml)
Longer expiratory time (eg, inspiratory to expiratory ratio 1:4 or 1:5)

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9
Q

How can one quickly reduce high-end expiratory pressure when using mechanical ventilation of a patient with severe bronchoconstriction?

A

By separating the patient from the ventilator circuit; this will allow PEEP to dissipate during passive exhalation

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10
Q

What measure can a paramedic take to dissipitate auto PEEP during cardiac arrest of a patient with severe bronchoconstriction?

A

During arrest a brief disconnection from the bag mask or ventilator may be considered, and

compression of the chest wall to relieve air-trapping can be effective

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11
Q

What possible diagnosis should be considered for all asthmatic patients with cardiac arrest, especially in whom ventilation is difficult?

A

Tension pneumothorax

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12
Q

What does the term classic anaphylaxis refer to?

A

Refers to hypersensitivity reactions mediated by the immunoglobins IgE and IgG

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13
Q

What are the most common causes of anaphylaxis? (Name 4)

A

Pharmacological agents
Latex
Foods
Stinging insects

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14
Q

What is the most common physical finding in anaphylaxis?

A

Urticaria

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15
Q

What is the common early sign of respiratory involvement due to anaphylaxis?

A

Rhinitis

16
Q

What physical findings can suggest more severe respiratory compromise due to upper airway edema and lower airway edema?

A

Stridor

Wheezing

17
Q

What is the recommended target pressure for volume resuscitation in anaphylaxis according to AHA 2010?

A

90mmHg

18
Q

What other drugs may be considered according to AHA 2010 besides adrenaline in patients with anaphylaxis?

A

Antihistamines
Beta-adrenergic agents
IV corticosteroids

19
Q

What interventions are the standard of care for treating the critically ill pregnant patient according to AHA 2010?

A

Place the pt in the full left-lateral position
Give 100% oxygen
IV access above the diaphragm
Assess for hypotension
Consider reversible causes of critical illness an
treat condition that may contribute to clinical deterioration as early as possible

20
Q

What BP is considered as maternal hypotension, that requires therapy?

A

SBP < 100mmHg

or < 80% of baseline

21
Q

Why is full left-lateral position recommended in AHA 2010 for pregnant patient?

A

Pregnant uterus can compress the inferior vena cava,

impending venous return and thereby

reducing SV and CO

22
Q

What degree of tilt should be applied during management of critically ill pregnant patient?

A

27 to 30 degrees using a firm wedge to support the pelvis and thorax

23
Q

Why can pregnant patients develop hypoxemia rapidly?

A

Because of decreased functional residual capacity and

increased oxygen demand

24
Q

Where on the chest should compression be performed in a pregnant patient in cardiac arrest?

A

Chest compressions should be performed slightly higher on the sternum

25
Q

Why may airway management of the pregnant patient be more difficult than airway management of the nonpregnant patient?

A

Due to changes in airway mucousa, including:

edema
friability
hypersecretion
hyperemia

26
Q

What is significant about saturation in pregnant patient during apnea?

A

Desaturation in pregnant patients is significantly faster than in nonpregnant patients.

27
Q

What BLS airway management is especially important in a pregnant patient before intubation?

A

BVMR ventilation with 100% oxygen

28
Q

How are current medications or doses altered during management of cardiac arrest in pregnancy?

A

There is no evidence that these should be altered

Current recommended drug dosages for use in resuscitation of adults should also be used in resuscitation of the pregnant patient

29
Q

Is Cardioversion and defibrillation of a pregnant patient safe for the fetus?

A

Although there is a small risk of inducing fetal arrhythmias, cardioversion and defibrillation on the external chest are considered safe at all stages of pregnancy

30
Q

What cardiac effects may present in patients with magnesium toxicity?

A 
ECG interval changes (prolonged PR, QRS, and QT interval)
AV nodal block
bradycardia
hypotension
cardiac arrest
31
Q

What neurological effects may present in patients with magnesium toxicity?

A

Loss of tendon reflexes
Sedation
Severe muscular weakness
Respiratory depression

32
Q

What other signs may present in pts with magnesium toxicity besides cardiac and neurological?

A

GIT (nausea and vomiting)
skin changes (flushing)
electrolyte/fluid abnormalities

aha guidelines 2010 (5 decks)

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