Resuscitation Flashcards
General principles of resuscitation
- 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
CPR Indications
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
CPR Contraindications
Nil
CPR Complications
- 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
What mode is the first rhythm analysis done in?
AED
Do you still need to confirm the rhythm in AED mode?
yes
What are the steps in continuous high-quality compressions?
- 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
Steps in correct pad placement/adhesion
- 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)
What is the correct antero-lateral pad placement?
- 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
What is the correct antero-posterior pad placement?
- 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
Steps in successful early airway management
- 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)
Hs & Ts
Reversible Causes
- Hypoxia
- Hypothermia / hyperthermia
- Hypokalaemia / hyperkalaemia (or other electrolyte derangements)
- H+ (acidosis)
- Toxicity
- Tension pneumothorax
- Tamponade
- Thrombus (coronary / pulmonary)
What is the procedure for a witnessed cardiac arrest?
- 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
What is the procedure for unwitnessed VF/VT cardiac arrest?
- 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…*
What are the resuscitation special circumstances for asthma/COPD Pts management?
- 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.
What are the resuscitation special circumstances for CPR Induced consciousness (CPRIC) management?
- 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.
What are the resuscitation special circumstances for decompression illness management?
high flow oxygen and provide rapid transport to a definitive care facility with hyperbaric unit if available
What are the resuscitation special circumstances for hypothermic pts management?
- 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
What are the resuscitation special circumstances for pregnant pts management?
- > 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
*
What are the resuscitation special circumstances for pregnant pts management?
What are the newborn CPR indications?
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
What is the post ROSC management?
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
