Resuscitation

Question 1

At what length should the ET tube be located at the lips?

Answer 1

23-25cms in Males

22-24cms in Females.

Question 2

What are the 4 H’s and 4 T’s of reversible cardiac arrest causes?

Answer 2

Hypothermia
Hypovolaemia
Hypoxia
Hyperkalaemia

Tamponade
Toxins
Tension pneumothorax
Thromboembolism

Question 3

What 7 conditions are unequivocally associated with death?

Answer 3

Decapitation

Massive cranial and cerebral destruction

Hemicorporectomy or similar massive injury

Decomposition/ putrefaction

Incineration

Hypostasis

Rigor mortis

Question 4

What following conditions can resuscitation be discontinued?

Answer 4

The presence of a DNAR or other advanced decision

Patient is in the final stages of a terminal illness where CPR would be unsuccessful

There would be no realistic chance that CPR would be successful if ALL of the following exist together:
•15 mins since onset of cardiac arrest
•no bystander CPR prior to ambulance arrival
•the absence of any exclusion factors
•asystole for >30 seconds on ecg Monitor screen.

Submersion for longer than 60 mins

Question 5

In what conditions should resuscitation be continued?

Answer 5

Drowning

Hypothermia

Poisoning or overdose

Pregnancy

Question 6

Discuss your ALS management of cardiac arrest:

Answer 6

ABCDE - recognise patient in cardiac arrest.

Get a quick history- assistant will start compressions. Back up if required

Attach Defib- assess rhythm

Window 1 - Airway, secure airway

Assess rhythm after 2 mins

Window 2 - circulation, gain access either IV or IO.

Assess rhythm after 2 mins

Window 3 - adrenaline 1:10,000 and 300mg amiodarone if after 3rd shock.

Assess rhythm

Reassess airway, circulation, fluid. Consider 4 H’s and 4 T’s. Think about extraction route.

Assess rhythm

Adrenaline and 150mg of amiodarone if after 5th shock.

Question 7

You gain ROSC on a patient. What is your management now?

Answer 7

Continue to oxygenate and ventilate the patient, aim for normal ETCO2 (4.6-6kpa)

Full set of observations including ECG and blood glucose)

Provide passive cooling of the patient.

Give fluids if required and post ROSC adrenaline

Question 8

You are called to a male with an foreign body obstructing the airway, what is your management?

Answer 8

In mild obstructions, encourage the patient to cough.

In complete obstructions, if conscious provide 5 back blows followed by 5 abdominal thrusts. Continue until blockage is dislodged or lately becomes unconscious

In unconscious patients start CPR. Check for any foreign body that had been partially expelled every time you open the airway

Question 9

What is important during maternal resuscitation?

Answer 9

Effective resuscitation of the mother will provide effective resuscitation of the fetus.

Resuscitation of the mother is priority.

You MUST not terminate or withhold CPR during maternal resuscitation.