resus

Question 1

what is external (transcutaneous) pacing? when used?

Answer 1

temporary way of pacing heart in emergency. delivers pulses of electric current through chest, which stimulates heart to contract. uncomfortable - consider sedation

main indication - bradycardia with signs + symptoms of shock
eg from - MI, SAN dysfunction, complete heart block
no longer indicated for asystole

method:
pads placed on chest, attached to a monitor/defib, HR selected, current increased til electrical capture (shown by wide QRS complex + tall, broad T wave), with corresponding pulse. pacing artefact on ECG + severe muscle twitching may disguise this - may need SpO2 monitor or bedside doppler to confirm mechanical capture.

Question 2

what is asystole?

Answer 2

cardiac arrest with a “flat line” on ECG

Question 3

what are shockable rhythms?

what are non-shockable?

Answer 3

VF + pulseless VT

PEA + asystole

Question 4

treatment of shockable rhythms (VF + pVT)

Answer 4

1) do 30:2, apply defib-monitoring pads + confirm VF/pVT
2) charge defib, stop compressions + SHOCK
3) 2 min 30:2 then check ECG
REPEAT if necessary

4) still not working - REPEAT + DRUGS: give 1mg adrenaline + 300mg amiodarone

so basically - shock 3 times then adrenaline + amiodarone, then adrenaline every 3-5min (ie during alternate 2min CPR cycles)

Question 5

what is synchronised electrical cardioversion?

Answer 5

electrical shock delivered in synchrony to the cardiac cycle

eg for sVT

Question 6

what is PEA? causes?

Answer 6

cardiac arrest in the presence of electrical activity, other than VTachys, that would normally have a palpable pulse.
pts oft have some mechanical myocardial contractions, but these are too weak to produce a detectable pulse or BP

can be caused by reversible conditions that can be treated if identified + corrected

survival following cardiac arrest with asystole or PEA is unlikely unless a reversible cause can be found and treated effectively.

Question 7

treatment of PEA + asystole

Answer 7

1) 30:2 + 1mg adrenaline + secure airway + ventilate
2) after 2 min, check ECG
a) if electrical activity compatible with pulse seen, check for pulse (done if present)
3) not present: continue CPR, recheck in 2min + proceed accordingly + give further adrenaline 1mg every 3-5min (alternate 2min CPR cycles)

b) if VF/pVT at check, change to shocking algorithm

if p waves present in asystole, pt may respond to pacing

Question 8

treating reversible causes in cardiac arrests

Answer 8

4 Hs - hypoxia, hypovolaemia, hyperkalaemia, hypothermia

4 Ts - thrombosis, tension pneumothorax, tamponade, toxic

Question 9

oxygen sats post-resus

Answer 9

94-98 - avoid harm from hyperoxaemia

Question 10

management of bradycardia acutely

Answer 10

500mcg atropine if:
features of shock, syncope
myocardial ischaemia, HF

2° - transvenous pacing