Principles of Resuscitation Flashcards
What is the most common natural cause of sudden death?
Ischaemic heart disease
Why is it important that compression reach an adequate depth?
If they are too shallow then they won’t eject blood out of the heart
What is the most common reason that there is no chest recoil during CPR?
Leaning on the patient in between compressions
How can CPR be monitored?
CPR meters = real time feedback on CPR parameters
Waveform canography = efficiency of CPR
What are the shockable rhythms?
Ventricular fibrillation and pulseless ventricular tachycardia
What are some features of ventricular fibrillation?
Bizarre irregular waveform
Random frequency and amplitude
No recognisable QRS complexes
Uncoordinated electrical activity
What are the two kinds of pulseless ventricular tachycardia?
Monomorphic VT = broad complex rhythm, rapid rate, constant QRS morphology
Polymorphic VT = torsades de pointes
When should drugs be given to treat shockable rhythms?
If persisting after three shocks = adrenaline 1mg and amiodarone 300mg given IV
What are the non-shockable rhythms?
Asystole and pulseless electrical activity
What are some features of asystole?
Absent QRS activity
May have P waves
Rarely straight line trace
How should non-shockable rhythms be treated?
Restart CPR then adrenaline 1mg IV every 3-5 minutes
What are some features of pulseless electrical activity?
Clinical features of cardiac arrest
ECG normally associated with an output
How is hypoxia treated?
By ensuring adequate ventilation and give oxygen if needed
What does the return of spontaneous circulation signal?
The beginning of post resuscitation care
What are some aspects of post resuscitation care?
Aim for normal PaCO2 and SpO2 of 94-98%
12 lead ECG and targeted temperature management
What is clinical death?
Period of respiratory, circulatory and brain arrest during which initiation of resuscitation can lead to recovery with pre-arrest CNS function
Is clinical death a reversible state?
Yes
What does the length of clinical death depend on?
Length of time the cerebral cortex survives in absence of circulation and respiration
What is the normal period of time between clinical death and biologic death under normal temperatures?
Doesn’t exceed 3-6 minutes
What is sudden cardiac death?
Death arising from abrupt loss of heart function = reversible condition
Why is prompt treatment of sudden cardiac death important?
If treated with defibrillation within a few minutes the heart may be restored to an organised rhythm
What is biologic death?
Sets in after clinical death = irreversible state of cellular destruction
What should be done to confirm cardiac arrest?
Check patient response and open airway
Check for normal breathing and signs of life
Pulse check
How long should assessment for cardiac arrest take?
Less than 10 seconds
What should be done once cardiac arrest is confirmed?
Call resus team
Start CPR and attach defibrillator
What are some features of high quality compressions?
Ratio of 30:2 with minimal interruptions
5-6cm depth at pace of 100-120 per minute
Allow chest recoil and switch provider every 2 mins
Continuous compressions once airway secured
In what time frame should the two breaths be given?
Within 10 seconds
What does transthoracic impedance depend on?
Energy selected, electrode size, distance between electrodes, size of chest, hairy chest, air trapping
What is transthoracic impedance?
The body’s resistance to current flow = varies from 25-180 ohms-
What is the determining factor of successful defibrillation?
Energy in respect to impedance
What are some reasons for the difference in transthoracic impedance from person to person?
Body mass, age, disease, skin resistance, tissue type and amount
How can vascular access be achieved?
Peripheral vs central veins
Intraosseous
What are some features of securing the airway?
Use supraglottic airway device or tracheal tube
Only attempt intubation if trained
Don’t interrupt compressions for ventilation
Avoid hyperventilation
When is adrenaline given?
Every 3-5 mins via IV access
When is amiodarone given?
After three shocks have been given = use IV access
