Recognising Deterioration and Preventing Cardiorespiratory Arrest Flashcards
In which situation do most people survive a cardiac arrest?
Initial primary myocardial ischaemia
Then VF arrest
Successful resuscitation in CCU
What are to two most common vital signs that are noticed in patients who deteriorate during the few hours before a cardiac arrest?
Hypoxia and hypertension (I.e. ABC)
What are the five rings in the chain of prevention of a cardiac arrest?
Education, monitoring, recognition, call for help, response
If a COPD patient has a SpO2 of 93 and over on oxygen, is their EWS score 0 and why?
No, it is 1,2 or 3 as patient is on oxygen and therefore hypercapnic respiratory failure is occurring due to hypo ventilation
What is the role of the critical care outreach team?
Usually highly qualified and experienced nurses
Prevent ward admissions to ITU
Identify when admission to ITU is necessary and look after patients who move from ITU back to wards
Share experienced knowledge with ward staff
Name five causes of airway obstruction.
CNS depression Epiglottitis Foreign body Laryngospasm Pharyngeal swelling Vomitus Blood Bronchial secretions Bronchospasm Blocked tracheostomy or laryngectomy Obstructive sleep apnoea
Name 4 things that can be done to prevent airway obstruction.
- suck blood or gastric contents from airway
- place patient on side unless contraindicated
- give oxygen to reach sats of between 94-98%
- airway manoeuvres and adjuncts may be necessary (such as head tilt,chin lift, nasopharyngeal/oropharygeal airway and if expert is present, ET tube)
- consider Ng tube insertion to clear stomach and prevent aspiration
Name 3 diseases that can cause respiratory arrest.
- Guillian Barre syndrome
- myasthenia gravis
- multiple sclerosis
- fractured rib or sternum
- chronic malnourishment
- kyphoscolliosis
- COPD exacerbation
- pulmonary embolism
- asthma
- ARDS
- pulmonary oedema
- pneumothorax/haemothorax
- tension pneumothorax (also Dec venous return to heart and lowers BP)
Name three ways to recognise breathing problems
Resp rate of over 25/min
Pulse oximetry
ABG!!
Note that cyanosis, hypercarbia and low PH are late signs
How do you treat an acutely ill patient with hypoxaemia?
Give oxygen via a high concn reservoir mask at 15L per min, measure O2 and then change mask. Aim for range of 94-98%
Treat underlying cause
How do you treat patients with hypoxaemia who have pneumonia or asthma?
- IV abx asap
- bronchodilators (salbutamol nebs) and steroids
In acutely unwell patients, what’s the most common cause of circulatory problems?
Hypovolaemia
Which primary heart problem most commonly causes cardiac arrest and through what avenue?
Myocardial ischaemia secondary to MI causing VF
What 2 things indicate that a patient is suffering from a STEMI?
- sustained chest pain for 20-30mins
- ST elevation on ECG
If patients present with chest pain, and other ECG changes such as ST depression or T wave inversion, what test can be done and what does this indicate?
Troponin levels and high levels are suggestive of NSTEMI
What is the initial treatment for an MI?
MONA
M-morphine given with anti emetics
O-oxygen (aim for 94-98% and 88-92% for COPD patients)
N-nitrates (GTN spray)
A-aspirin (300mg orally crushed or chewed)
What is the preferred definitive treatment step of an MI and name 2 other long term treatments.
Primary PCI
- antithrombotics (clopidogrel)
- anticoagulation
Name the top 3 causes of out of hospital sudden cardiac death (SCD).
- coronary artery disease
- non ischaemic cardiomyopathy
- valvular disease
Name 5 signs or symptoms of cardiac disease.
- chest pain
- SOB
- tachypnoea
- bradycardia or tachycardia
- syncope
- hypotension
- poor peripheral perfusion
- oliguria
- altered mental state
What are the 2 most common treatments for secondary heart problems?
Oxygen to treat hypoxia
IV fluids to treat hypovolaemia
What should you do if a patient is unresponsive, unconscious and not breathing normally?
Commence CPR
Which mask should be used to treat COPD patients with cardiac arrest? (B)
Venturi mask 4L/min
In an emergency, what is the most likely cause of shock? (C)
Hypovolaemia
What is the treatment for patients with cool peripheries and tachycardia? (C)
IV fluids
What does a barely palpable pulse indicate and what does a bounding pulse indicate? (C)
Barely palpable=poor cardiac output
Bounding=SEPSIS
What are the first 5 things that need to be done if circulatory compromise is suspected? (C)
- Look at the colour of hands (blue, mottled, pale, pink)
- Check capillary refill
- Check pulse rate
- Cool or warm peripheries?
- Measure BP
In circulatory compromise, if BP is normal, does this signify that the patient is well? (C)
No, peripheral resistance increases to compensate so normal BP does not signify that patient is well
What does a low diastolic pressure indicate and give 2 examples. (C)
Arterial vasodilation which occurs in anaphylaxis and sepsis
What does a narrow pulse pressure indicate in circulatory compromise(I.e. arterial vasoconstriction)? (C)
Cardiogenic shock (issue stems from hearts inability to pump blood efficiently) or hypovolaemia
Name 3 things you’re listening for when auscultating the heart, to determine whether there is circulatory compromise. (C)
- Pericardial rub indicating pericarditis
- Murmurs/unequal heart rate and pulse rate=valvular disease
- Diminished/quiet heart sound
Apart from auscultation, BP and other vital signs, what 2 other factors signify reduced cardiac output? (C)
Reduced consciousness and oliguria
What two sizes of cannula are suitable for circulatory restoration? What do you do before administering IV fluids?
Wide bore 14 or 16G for highest flow
Take routine haematological, biochemical, coagulation and cross match bloods first
When administering emergency fluids (500ml of NaCl over 15ml) , in which situation would you give 250ml? What do you do to monitor this? (C)
Heart failure patients
Listen for crackles after every bolus
If patients normal BP is unknown, what value should you aim for? (C) if patient does not improve through multiple bolus infusions, what could be happening?
> 100mmmg systolic
Bleeding
What 5 things should you do to treat disability (D) in the ABCDE protocol?
- Treat ABC such as hypoxia hypotension
- Reverse any drug toxicity (e.g naloxone for opiates)
- Check status using AVPU (alert, voice response, painful stimuli response or unresponsive)
- Check pupil reactions, size
- Give glucose for hypoglycaemia (boluses of 10% glucose in 50ml)
If an unconscious patients has a compromised airway, what position should you look after them in?
Lateral position
