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CLASP - Sudden death > Resuscitation > Flashcards

Resuscitation Flashcards

1
Q

What is clinical death?

A

The period of respiratory, circulatory and brain arrest during which initiation of resuscitation can lead to recovery with pre-arrest central nervous system function

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2
Q

Under normal temperature, how long is the period between clinical and biologic death?

A

3-6 minutes

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3
Q

What is the most common cause of cardiac arrest?

A

Coronary heart disease which can be a reversible condition

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4
Q

What is biologic death?

A

An irreversible state of cellular destruction that sets in after clinical death

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5
Q

How do you confirm cardiac arrest?

A

Patient response, open airway, check for normal breathing, check for signs of life, check for pulse i.e. unresponsive and not breathing normally - take less than 10 seconds to assess

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6
Q

Describe high quality chest compressions

A

30 compressions: 2 breaths, centre of chest, 5-6cm depth, 2 per second, allow time for recoil maintain high quality compressions with minimal interruptions, continuous compressions once airway secured, switch CPR provider every 2 mins

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7
Q

What are the 2 shockable rhythms?

A

Ventricular fibrillation and pulseless ventricular tachycardia

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8
Q

Describe ventricular fibrillation

A

Bizarre irregular waveform, no recognisable QRS complexes, random frequency and amplitude, uncoordinated electrical activity, coarse/fine

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9
Q

Describe pulseless ventricular tachycardia

A

Moomorphic VT - broad complex rhythm, rapid rate, constant QRS morphology Polymorphic VT - torsade de pointes

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10
Q

Name 2 unshockable rhythms

A

Asystole and pulseless electrical activity

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11
Q

Describe asystole

A

Absent ventricular activity, atrial activity may persist, rarely a straight line trace - give adrenaline 1mg IV then every 3-5 min

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12
Q

Describe pulseless electrical activity

A

Clinical features of cardiac arrest, ECG normally associated with a output - give adrenaline 1mg IV then every 3-5 min

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13
Q

What is administered after 3 shocks?

A

Amiodarone and adrenaline

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14
Q

What are the reversible causes of cardiac arrest?

A

4 Hs - hypoxia, hypovolaemia, hyperkalaemia, hypothermia 4 Ts - toxins, cardiac tamponade, tension pneumothorax and thrombus

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15
Q

How do you treat hypoxia?

A

Ensure patent airway, give high flow supplemental oxygen - avoid hyperventilation

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16
Q

How do you treat hypovolaemia?

A

Seek evidence of hypovolaemia, control haemorrhage, give IV fluids

17
Q

How do you treat hypo/hyperkalaemia?

A

Near patient testing for K and glucose, check latest lab results, if hyperkalaemia give calcium chloride and insulin/dextrose

18
Q

How do you treat hypothermia?

A

Use low reading thermometer, treat with active rewarming techniques and consider cardiopulmonary bypass

19
Q

How do you treat tension pneumothorax?

A

Check tube position if intubated. Clinical signs include; decreased breath sounds, hyper-resonant percussion note and tracheal deviation. Initial treatment with needle decompression or thoracostomy

20
Q

How do you treat cardiac tamponade?

A

Difficult to diagnose with echocardiography, consider if penetrating chest trauma or after cardiac surgery. Treat with needle pericardiocentesis or resuscitative thoractomy

21
Q

How do you manage toxins?

A

Rare unless evidence of deliberate overdose. Review drug chart

22
Q

How do you treat thrombosis?

A

If high clinical probability for PE consider fibrinolytic therapy. If fibrinolytic therapy given continue CPR for up to 60-90 min before discontinuing resuscitation

23
Q

What do the P wave, QRS complex and T wave represent?

A

P wave = depolarisation of atria in response to SA node triggering QRS complex = depolarisation of ventricles, triggers main pumping contraction T wave = ventricular repolarisation

24
Q

What do the PR interval and ST segment represent on an ECG?

A

PR interval = delay of AV node to allow filling of ventricles ST segment = beginning of ventricle repolarisation, should be flat

25
Q

How do you calculate HR from an ECG?

A

R-R interval. Either 1500/small squares or 300/large squares

26
Q

What 6 things should be considered when reading a rhythm strip?

A
  1. Is there any electrical activity? 2. What is the ventricular rate? (QRS) 3. Is the QRS rhythm regular or irregular? 4. Is the QRS width normal or broad? 5. Is atrial activity present? 6. How is atrial activity related to ventricular activity?
27
Q

What condition is represented on this ECG?

A

Normal sinus rhythm - rate 60-100, regular P wave to each regular QRS, normal PR interval, normal P wave appearance

28
Q

What condition is represented on this ECG?

A

Sinus bradycardia - all features of normal sinus rhythm except HR <60bpm

29
Q

What condition is represented on this ECG?

A

Sinus tachycardia - all features of normal sinus rhythm except HR > 100bpm

30
Q

What condition is represented on this ECG?

A

Atrial flutter - atrial rate 250-350bpm, usually regular QRS, most commonly 2:1 conduction (atrial 300bpm:ventricular 150bpm), classic sawtooth appearance

31
Q

What condition is represented on this ECG?

A

Atrial fibrillation - irregularly irregular QRS, no P waves - atrial rate >350bpm, fast or slow AV conduction, irregular baseline

32
Q

What condition is represented on this ECG?

A

Ventricular tachycardia - rate 100-200bpm, regular, occasional dissociated P waves, wide bizarre QRS complexes

33
Q

What condition is represented on this ECG?

A

Torsades de Pointes - twisting of axis, rate 200-250bpm, regular or irregular, sinusoidal pattern, may revert to VF or back to SR, associated with electrolyte abnormalities

34
Q

What condition is represented on this ECG?

A

1st degree heart block - rate depends on underlying rhythm, regular, prolonged PR interval >0.2 secs, physiologic block in the AV node, caused by vagal stimulation, medication, disease

35
Q

What condition is represented on this ECG?

A

Mobitz type 1 second degree heart block - rate depends on underlying rhythm, regularly irregular, increasing PR interval, dropped beat, cycle starts over, diseased AV node with long refractory period

36
Q

What condition is represented on this ECG?

A

Mobitz type II second degree heart block - rate depends on underlying rhythm, same PR interval for all conducted beats, P waves usually regular, some P waves not conducted, usually progresses to complete heart block (CHB)

37
Q

What condition is represented on this ECG?

A

Complete heart block - atrio-ventricular dissociation, regular P waves, regular QRS complexes, no relationship between P waves and QRS, rate depends on intrinsic rhythm, needs pacemaker

CLASP - Sudden death (4 decks)

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