Resus - Special circumstances

Question 1

What are the issues & mamagement when presented with a asthmatic or COPD arrest?

Answer 1

Issue
• Ventilation in reactive airways can be difficult
• Positive pressure ventilation can trigger further
bronchoconstriction & breath stacking which
is caused by incomplete expiration, air-trapping
& build-up of positive-end-expiratory pressure
(intrinsic or auto-PEEP)
• Tension pneumothorax can result

Mx
 • reduce RR, smaller tidal volume & prolonged
   expiratory time
    - Adult: 6-8/min
    - Paed: 8-15/min

Question 2

What is the issue and appropriate management of CPR induced consciousness?

Answer 2

• CPR can provide a cerebral perfusion pressure
sufficient enough to allow the pt to regain some
level of consciousness

• Consult immediately for Rx options to manage
pts awareness or pain

Question 3

Outline the issue and appropriate management of decompression illness in arrest

Answer 3

Issue
• Ventilation is difficult - consider the potential
for tension pneumothorax

Mx
• Following ROSC, continue high flow O2 & tx to
hyperbaric unit if available

Question 4

Outline the issues & appropriate management of hypothermia in an arrest

Answer 4

Issue
• Lack of vitals cannot reliably be used for ROLE
• As body temp decreases, bradycardia tends to
give way to AF, VF & then asystole

Mx
• Withold drug therapy until pt warmed to > 30°
• Double the interval between drug therapies
until pt >35°
• DCCS maximum J setting of < 30°
- after 3 shocks delay DCCS until temp > 30°

Question 5

What should be considered in the management of morbid obesity in an arrest

Answer 5

• Early activation of additional resources

* Potential airway Mx difficulties

Question 6

Outline the issues & appropriate management of an arrest in pts with a pacemaker/ICD

Answer 6

• Device can interfere with pad placement
- place pads ≥ 8cm from device on chest wall
• If VF or VT persists in the unconscious pt
external DCCS should be delivered

Question 7

Outline the appropriate management of a witnessed arrest suspected to be cardiac in aetiology

Answer 7

• If DCCS cannot be performed within 20sec
commence CPR & deliver a single shock (if
indicated) immediately
• If shock can be delivered within 20sec & VF or
pulseless VT deliver up to 3x stacked shocks
checking rhythm after each
- revert to single shock protocol after
• If ROSC for > 2min & pt rearrests with
shockable rhythms deliver another 3 stacked
shocks if indicated

Question 8

Outline the issues and management of pts who are pregnant in an arrest

Answer 8

Issue
• There are two pts - best hope of foetal survival
is mother survival

Mx
• > 20wks gestation position mother to relieve
aortocaval compression
- move graviduterus to LHS; OR tilt 30° to left
supporting pelvis & thorax
• Higher hand position due to gravid uterus
elevation of diaphragm & contents
• Early ETT to overcome > intra-abdo
pressure

Question 9

Outline the issues and management of pts who have a tracheostomy in an arrest

Answer 9

Issue
• Cannot be effectively ventilated with BVM or
face mask

Mx
• If possible attach BVM to trachy OR use
neonate face mask/LMA to create a seal over
stoma; occlude mouth & nose if upper airway
leaks
• If upper airway leaks when ventilating through
stoma revert to normal practices & occlude
stoma