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ALS/GIC > Recognising deterioration and preventing cardiorespiratory arrest > Flashcards

Recognising deterioration and preventing cardiorespiratory arrest Flashcards

1
Q

Regarding in-hospital cardiac arrests - what percetnage (%) of cases will there be clinical signs in the hours prior to cardiac arrest?

A

80%

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2
Q

What 4 factors make it more likely a patient will survive a cardiac arrest?

A
  • If the arrest is witnessed and monitored
  • If the initial rhythm is VF/pVT
  • If the primary cause of myocardial ischaemia
  • If the patient is successfully defibrillated immediately (early as possible)
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3
Q

What ethos/chain should be adopted to help prevent cardiac arrests?

A

The chain of prevention. (add photo)

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4
Q

What are the 2 most common clinical warning signs of a deteriorating patient at risk of arrest?

A

Hypoxia and hypotension.

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5
Q

What do most hospitals use to help detect deteriorating patients?

A

NEWS

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6
Q

What should be the frequency of nurse monitoring and clinical response (escalation) for each of the following NEWS:

NEWS = 0
NEWS = 1-4
NEWS = 3 (in a single parameter)
NEWS = 5-6
NEWS = >= 7

A

NEWS = 0. 12hrly obs, continue routine monitoring
NEWS = 1-4. 4-6hrly obs and inform registered nurse whom decides escalation.
NEWS = 3 (in a single parameter). 1hrly obs. Nurses asks for medical review.
NEWS = 5-6. 1hrly obs. Nurses requests immediate medical review.
NEWS = 7. Continuous monitoring. Inform medical team (min registrar level). Consider T/F to level 2/3 care.

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7
Q

What do Medical emergency teams (METs) improve?

A
  • Reduce cardiac arrest rates, deaths and unanticipated ICU admissions
  • They may also help make decisions re. implementation of DNACPR
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8
Q

What is the different between cardiac arrest team and MET?

A

Cardiac arrest teams only attend once cardiac arrest is confirmed.

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9
Q

Considering ABCDE, what is the different cuts off for calling the MET?

A

Add photo

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10
Q

What does complete airway obstruction lead to?

A

Rapidly leads to cardiac arrest

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11
Q

What does partial airway obstruction lead to?

A
  • Cerebral and pulmonary oedema
  • Exhaustion
  • Secondary apnoea
  • Hypoxic brain injury
  • Eventually cardiac arrest
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12
Q

List common causes of CNS depression which can lead to loss of airway patency and protective airway reflexes

A

Head injury and intracerebral disease
Hypercapnia
Metabolic disorders e.g. diabetes
Drugs e.g. alcohol, opiates and GA’s

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13
Q

In a semi-concious patient can laryngospasm still occur when stimulating the upper airway i.e. putting in airway adjuncts ?

A

Yes! - their airway reflexes may still be intact

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14
Q

List different potential causes of airway obstruction

A

CNS depression
Blood
Vomitus
Foreign bodies e.g. tooth, food
Direct trauma to face or throat
Epiglottitis
Pharyngeal swelling e.g. infection, oedema
Laryngospasm
Bronchospasm - causes narrowing of small airways
Bronchial secretions
Blocked tracheostomy
OSA

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15
Q

What are the distinguishing features of partial vs complete airway obstruction?

A

In partial aiway obstruction - choking, noisy breathing
In complete airway obstruction - attempted breathing is silent and there is no air movement at their mouth. Respiratory efforts are usually strenuous with accessory muscle use seen.

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16
Q

What is the characterisitc breathing pattern seen in complete airway obstruction?

A

‘See-saw’ or ‘rocking horse’
[https://www.youtube.com/watch?v=gclVGJL36W4]

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17
Q

What are the main things you could do in an A-E scenario when dealing with potential airway obstruction ? and what is your overall priority when considering the airway ?

A

Main priority - Keep the airway patent!

  • Suction any gastric content/blood which can be seen (using yanker).
  • Put patient into left lateral position.
  • Give Oxygen
  • Use simple airway manoeuvres (head tilt/jaw thrust)
  • Insert nasopharyngeal or oropharyngeal airway. May ultimately need intubated or tracheostomy.
  • Consider inserting NGT to empty stomach
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18
Q

When should you assume actual or impending airway obstruction ?

A

In anyone with a reduced GCS

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19
Q

What will respiratory arrest lead to?

A

Cardiac arrest - rapidly

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20
Q

How will a cardiac arrest develop due to breathing inadequcy ?

A

Due to hypoxaemia and inability to perfuse vital organs (heart) and acidaemia (build up of CO2).

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21
Q

Spontaneous breathing cannot happen when a spinal cord lesion happens above what level?

A

C2 and above. (C3,4 & 5 keep the diaphragm alive).

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22
Q

What are the intercostal muscles innervated by ?

A

Intercostal nerves (T1-11)

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23
Q

What are the 2 main respiratory muscles ?

A

Diaphragm and intercostal muscles.

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24
Q

List common conditions which may result in inadequate respiratory effort due to muscle weakness or nerve damage

A

Myasthenia gravis
Guillian-barre syndrome
Multiple sclerosis
Chronic malnourishment
Chronic long-term illness (generalised weakness/frailty)

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25
Q

Give examples of restrictive chest wall abnormalities

A

Rib/sternum #’s
Kyphoscoliosis
Obesity

26
Q

How does a pnuemothorax lead to reduced cardiac output/BP?

A

Increased thoracic pressure ==> compresses blood vessles draining into heart (SVC/IVC) which reduces venous return ==> this reduces stroke volume and therefore cardiac output (CO = SV x HR) ==> This in turn reduced BP (BP = CO x SVR)

27
Q

List common lung conditions which will impair gas exchange

A

Pneumothorax
Infection
Aspiration
ARDS
PE
Asthma/COPD
Pulmonary oedema
Lung contusion

28
Q

Is pulse oximetry a reliable indicator of ventilation?

A

No

29
Q

What is a better measure of ventilation?

A

ABG

30
Q

What is often a late sign on a ABG of severe respiratory problems?

A

A rising PaCO2 and decrease in pH (increase in H+)

31
Q

What should you give to all acutely unwell hypoxaemic patients ?

A

initally 15L O2 via trauma mask (resevoir mask)

32
Q

What are the target O2 sats for acutely unwell patients ?

A

SpO2 of 94-98% unless known T2RF then aim 88-92%

33
Q

If O2 therapy alone is insufficent respiratory support what might someone need?

A

NIV or intubation & ventilation.

34
Q

What are circulatory problems in acutely unwell patients most commonly due to ?

A

Hypovolaemia - resulting in either indaequate CO/BP prior to cardiac arrest or sudden cardiac arrest.

35
Q

What is the most common cause of sudden cardiac death (SCD)?

A

An arrhythmia caused by either IHD/MI.

36
Q

List other primary heart disease (circulatory) causes of sudden cardiac arrest

A

Heart failure
Cardiac tamponade
Cardiac rupture
Myocarditis
HOCM
Hypertensive heart disease
Aortic valve disease

37
Q

List potential causes of VF/SCD

A

ACS
Hypertensive heart disease/Ischaemic cardiomyopathy
Non-ischaemic cardiomyopathy
Valvular disease
Drugs e.g. anti-arrhytmics , TCA’s, digoxin
Inherited cardiac diseases e.g. long & short QT syndromes, Brugada syndrome, HOCM, arrhytmogenic right venticular cardiomyopathy
Acidosis
Abnormal electrolytes - K+, Mg2+, Ca2+
Hypothermia
Electrocution

38
Q

List other secondary causes of circulatory problems (not primary heart disease) leading to cardiac arrest

A

Airway obstruction - hypoxaemia/acidosis
Tension pnuemothorax
Hypovolaemia - e.g. acute blood loss, septic shock.
Severe anaemia
Hypothermia

39
Q

Who do most SCD’s occur in?

A

Patients with unrecognised cardiac disease. Although risk of SCD is greater in those with known severe cardiac disease

40
Q

What is the single most key independant risk factor for SCD?

A

Syncope

41
Q

What syncope features indicate a high probabilty of arrhytmogenic (cardiac) cause?

A

Occurs in supine position
Occurs during or after exercise (however after exercise is often vasovagal)
Syncope without or only brief prodrome
Repeated unexplained episodes
Family history of SCD or inherited cardiac conditions.

42
Q

What are survivors of SCD/VF at risk of ?

A

A further episode unless preventative treatment given

43
Q

What are the potential preventative tx of SCD/VF?

A

Depends on the cause for IHD - PCI/CABG
For others may require ICD.

44
Q

What is the general mx for circulation (cardiac) support in acutely unwell patinets

A

IVF
Correct acid-base balance
Cardiac monitoring +/- ECHO (bedside)
Manipulation of cardiac filling i.e. vasoactive drugs (inotropes and vasoconstrictors)

45
Q

Read over A-E assessment

A
46
Q

Read over A-E assessment (part 2)

A
47
Q

Read over A-E assessment (part 3)

A
48
Q

Read over A-E assessment (part 4)

A
49
Q

How long should the first look, listen & feel of a patient take in A-E assessment ?

A

30 secs

50
Q

What other mode of access can you get if you are unsuccessful in getting IV access?

A

Intraosseous cannula

51
Q

What is a late sign of airway obstruction?

A

Central cyanosis

52
Q

In critically unwell patients what does reduced GCS often lead to?

A

Airway obstruction

53
Q

In the presence of an acutely unwell patient with a normal PaO2 what is it important to remember could be seen on their ABG re. Acid-base balance ?

A

Despite a normal PaO2 they could have a very high PaCO2

54
Q

Describe the difference between bronchial and vesicular breath sounds

A

Bronchial breath sounds - loud, harsh breathing sounds that are usually heard when a person is exhaling (only normal when heard over trachea)

Vesicular breath sounds - soft, low-pitched sounds (normal breath sounds).

55
Q

What might bronchial breath sounds indicate ?

A

Consolidation or collapse

56
Q

What does chest wall surgical emphysema or crepitus suggest until proven otherwise ?

A

Pneumothorax

57
Q

If a patients depth or rate of breathing is indaequate what should you use to improve both oxygenation and ventilation?

A

Bag and valve mask (remember attached to 15L O2).

58
Q

Whats the most likely cause of shock until proven otherwise ?

A

Hypovolaemia

59
Q

In a shocked patient what does a low diastolic BP suggest ?

A

Arterial vasodilatation e.g. anaphylaxis or sepsis

60
Q

In a shocked patient what does a narrow pulse pressure (difference between systolic and diastolic which is usually 35-45mmHg)

A

Suggests arterial vasoconstriction e.g. cardiogenic shock or hypovolaemia

Note may also occur in non-shocked patients with a rapid tachyarrhytmia

ALS/GIC (14 decks)

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