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Bachelor of Paramedic Science > Resuscitation > Flashcards

Resuscitation Flashcards

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1
Q

General principles of resuscitation

A
  • Continuous high-quality compressions
  • Correct pad placement & replacement
  • Early airway management
  • Appropriate ventilation
  • Minimise interruptions & keep to five seconds or less
  • Refined pharmacological prioritisation
  • Emphasis on non-technical skills: communication, planning, & teamwork
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2
Q

CPR Indications

A

There are no signs of life:
* unresponsive
* not breathing normally
* carotid pulse cannot be confidently palpated within 10 seconds, OR
There are signs of inadequate perfusion:
* unresponsive
* pallor or central cyanosis
* inadequate pulse, evidenced by:
* <40bpm in adult or child one year or older
* <60bpm in an infant less than one year old
* <60bpm in newborn following appropriate ventilation strategy

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3
Q

CPR Contraindications

A

Nil

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4
Q

CPR Complications

A
  • Using the presence or absence of a pulse as the primary indicator of cardiac arrest is unreliable
  • Injury to the chest can occur in some Pts
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5
Q

What mode is the first rhythm analysis done in?

A

AED

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6
Q

Do you still need to confirm the rhythm in AED mode?

A

yes

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7
Q

What are the steps in continuous high-quality compressions?

A
  • Rate of 100 per minute
  • Depth of 1/3 chest
  • Rotate operators every 2 mins
  • Minimise interruptions & keep them <5 seconds
  • Anticipatory defib charging: hit CHARGE at 1:45
  • Immediately recommence compressions post-shock or rhythm check
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8
Q

Steps in correct pad placement/adhesion

A
  • Dry the skin to remove excess sweat/moisture
  • Shave body hair beneath pad locations
  • Ensure good adhesion without creases or bubbles
  • Replace pads after 3+ shock cycles and consider alternating locations (antero-posterior)
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9
Q

What is the correct antero-lateral pad placement?

A
  • Sternal pad: right of sternum below the clavicle
  • Apex pad: over 5th intercostal space mid-axillary line (where V6 precordial lead usually goes)
  • Place pads under breast tissue, never on top
  • Keep pads >8cm away from implanted defibrillators
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10
Q

What is the correct antero-posterior pad placement?

A
  • Anterior: left side chest immediately below nipple/breast
  • Posterior: left of spine below left scapula
  • Place pads under breast tissue, never on top
  • Keep pads >8cm away from implanted defibrillators
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11
Q

Steps in successful early airway management

A
  • iGel can be placed early in cardiac arrest
  • Do not allow airway management to interrupt compressions
  • Once iGel is sited - 10 breaths per minute with uninterrupted compressions
  • Good BVM technique
  • Low threshold for gastric decompression (swelling in LUQ)
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12
Q

Hs & Ts

Reversible Causes

A
  • Hypoxia
  • Hypothermia / hyperthermia
  • Hypokalaemia / hyperkalaemia (or other electrolyte derangements)
  • H+ (acidosis)
  • Toxicity
  • Tension pneumothorax
  • Tamponade
  • Thrombus (coronary / pulmonary)
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13
Q

What is the procedure for a witnessed cardiac arrest?

A
  • Pads on
  • 3 stacked DCCS unless delay of 20s (if delayed give single shock)
  • Check rhythm between shocks
  • Then 2 min CPR cycle
  • Single shocks thereafter
  • Amiodarone after 5th shock
  • If Pt has >2 mins ROSC can give another set of three stacked shocks
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14
Q

What is the procedure for unwitnessed VF/VT cardiac arrest?

A
  • CPR
  • Pads on
  • Analyse in AED mode: shockable rhythm
  • Safety checks
  • Shock (1)
  • CPR
  • sitrep
  • A: suction/igel
  • B: EtCO2 to BVM
  • Attach Corepatch (if using Corpuls3)
  • Charge at 1:45
  • Shock (2)
  • Plan your positioning & rotation of CPR operators (bystanders/QPS/QFRS)
  • IV access
  • Charge at 1:45
  • Shock (3)
  • Amiodarone 300mg IV slow push
  • Plan your positioning & rotation of CPR operators (bystanders/QPS/QFRS)
  • Charge at 1:45
  • Shock (4)
  • Plan your positioning & rotation of CPR operators (bystanders/QPS/QFRS)
  • Charge at 1:45
  • Shock (5)
  • Amiodarone 150mg IV slow push (last dose of amiodarone)
  • Plan your positioning & rotation of CPR operators (bystanders/QPS/QFRS)
  • Charge at 1:45
  • ** Shock (6)**
  • Adrenaline: 1mg IV & 10-20mL flush (1)
  • Replace pads, applying new pads anterior-posterior
  • And so on…*
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15
Q

What are the resuscitation special circumstances for asthma/COPD Pts management?

A
  • Reduce the respiratory rate, apply a smaller tidal volume and prolonged expiratory time:
    • adult: 6–8 per minute
    • paediatric: 8–15 per minute
  • Use the largest ETT appropriate to decrease airway resistance.
  • Permissive hypercapnia is usually well tolerated by patients.
  • For asthmatics in cardiac arrest, when ventilation is difficult, consider the potential of tension pneumothorax and treat as appropriate.
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16
Q

What are the resuscitation special circumstances for CPR Induced consciousness (CPRIC) management?

A
  • Manage the patient’s awareness and/or pain so as to facilitate CPR and defibrillation, and other resuscitation interventions to occur safely, effectively and humanely
  • Critical Care Paramedics may consider sedation
  • Advanced Care Paramedics QAS Clinical Consultation and Advice Line to discuss treatment option.
17
Q

What are the resuscitation special circumstances for decompression illness management?

A

high flow oxygen and provide rapid transport to a definitive care facility with hyperbaric unit if available

18
Q

What are the resuscitation special circumstances for hypothermic pts management?

A
  • prolonged resuscitation until core temperature
  • close to normal.
  • Consider transfer to a hospital capable of Extra-corporeal
  • warming (i.e. ECMO)
  • If PEA and the patient’s temperature is less than 30°C feel for a pulse for at least 60 seconds and consider EtCO2/ultrasound to determine if there is any cardiac output, prior to commencing CPR as compressions can precipitate VF
  • Withhold adrenaline (epinephrine) and other resuscitation
    drugs until the patient’s temperature is approximately 30°C
  • Between 30°C and 35°C drug intervals should be doubled
  • If temperature is less than 3o°C and they are in VF/VT give up to three DCCS at maximum energy setting then withhold further DCCS until their temperature is greater than 30°C
19
Q

What are the resuscitation special circumstances for pregnant pts management?

A
  • > 20 weeks or greater, position to avoid aortocaval compression by moving the graviduterus to the patient’s left side. If this is not possible or successful, tilt the patient 15° to 30° to the left, supporting the pelvis and thorax with suitable firm padding and ensuring the chest remains supported on a firm surface.
  • A higher hand position may be required for chest compressions to overcome elevation of the diaphragm and abdominal contents
    *
20
Q

What are the resuscitation special circumstances for pregnant pts management?

A
21
Q

What are the newborn CPR indications?

A

No signs of life:
- Limp muscle tone
- Slow (< 30/min) or irregular respirations (e.g. gasping)
- Pulse cannot be confidently auscultated or identified on palpation of the umbilical cord

Signs of inadequate perfusion:
- Centrally pale or blue (cyanosed)
- Pulse less than 100 BPM

Inadequate respiratory effort:
- Rib/sternal recession
- Retraction or indrawing
- Persistent expiratory grunting

22
Q

What is the post ROSC management?

A

12 Lead
treat dysrhythmias
consider and manage reversible causes
maintain Sp02 over 94%
maintain EtCO2 of 30-40 mmHg (if no EtCO2 ventilate at 8-12 per minute)
aim for SBP 100 mmHg or greater in adults and 8 or greater in children
consider:
appropriate posturing
adrenaline
transport
pre-notify

Bachelor of Paramedic Science (19 decks)

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