Resuscitation

Question 1

define clinical death

Answer 1

the period of resp, circulatory and brain arrest during which initiation of resus can lead to recovery with pre-arrest CNS function

Question 2

define biologic death

Answer 2

sets in after clinical death and is an irreversible state of cellular destruction

Question 3

what is trans thoracic impedance?

Answer 3

the body’s resistance to current flow from the defibrillator

Question 4

what are the known causes of trans thoracic impedance?

Answer 4

body mass 
age 
disease 
skin resistance 
tissue type and amount

Question 5

describe ventricular fibrillation

Answer 5

Bizarre irregular waveform 
No recognisable QRS complexes 
Random frequency and amplitude 
Uncoordinated electrical activity 
Coarse/fine

Question 6

describe pulseless ventricular tachycardia

Answer 6

Monomorphic VT – broad complex rhythm, rapid rate, constant QRS morphology
Polymorphic VT – torsades de pointes

Question 7

if VF/PVT persists after shock…

Answer 7

Deliver 2nd shock
CPR for 2 mins
Deliver 3rd shock
CPR for 2 min and administer adrenaline 1mg IV and amiodarone 300mg IV

Question 8

describe asytole

Answer 8

Absent ventricular (QRS) activity 
Atrial activity (P waves) may persist 
Rarely a straight trace line

Question 9

treatment of asytole

Answer 9

Restart CPR then adrenaline 1 mg IV every 3 -5 mins

Question 10

describe pulseless electrical activity

Answer 10

Clinical features of cardiac arrest

ECG normally associated with an output

Question 11

treatment of PEA

Answer 11

Restart CPR then adrenaline 1 mg IV every 3-5 mins

Question 12

treatment of hypoxia

Answer 12

airway patency, high flow supplemental oxygen

Question 13

treatment of hypovolaemia

Answer 13

infuse IV fluids

Question 14

treatment of metabolic causes

Answer 14

electrolyte infusions

Question 15

treatment of hypothermia

Answer 15

active re-warming techniques

Question 16

treatment of tamponade

Answer 16

needle pericardiocentesis or resuscitative thoracotomy

Question 17

treatment of tension pneumothorax

Answer 17

check position of intubation, decompression or thoracotomy

Question 18

treatment of toxins

Answer 18

case to case

Question 19

treatment of thrombosis

Answer 19

thrombolytic drug therapy

Question 20

normal QRS complex

Answer 20

<0.12s

Question 21

P-R interval

Answer 21

0.12 - 0.20 sec

Question 22

QT interval

Answer 22

0.35 - 0.43 sec

Question 23

how to calculate HR when it looks irregular

Answer 23

300/no. of large squares between 2 R waves

Question 24

how to calculate HR when it looks regular

Answer 24

• Number of cardiac cycles occurring in 6s (30 large squares) and multiply by 10

Question 25

6 points to look for in an ECG

Answer 25

1. Is there any electrical activity? 2. What is the ventricular (QRS) rate? (bradycardia <60, tachycardia >100) 3. Is the QRS rhythm regular or irregular? 4. Is the QRS width normal or prolonged? 5. Is atrial activity present? 6. How is atrial activity related to ventricular activity?

Question 26

describe normal sinus rhythm

Answer 26

Rate = 60-100bpm Regular P wave to each regular QRS Normal P wave appearance Normal and constant PR interval

Question 27

bradycardia

Answer 27

<60bpm

Question 28

tachycardia

Answer 28

>100bpm

Question 29

describe atrial flutter

Answer 29

Atrial rate = 250-350bpm Usually regular QRS Classic sawtooth

Question 30

describe atrial fibrillation

Answer 30

Irregularly irregular QRS No P waves – atrial rate >350bpm Fast or slow AV conduction Irregular baseline

Question 31

describe ventricular tachycardia

Answer 31

Rate 100-200bpm Regular Occasional dissociated P waves Wide, bizarre QRS

Question 32

describe torsades des pointes

Answer 32

``` Twisting of the axis Rate 200-250 bpm Regular or irregular Sinusoidal pattern May revert to VF or back to SR Associated with electrolyte abnormalities ```

Question 33

describe first degree heart block

Answer 33

``` Rate depends on underlying rhythm Regular Prolonged PR interval > 0.2secs Physiologic block in the AV node Caused by medication, vagal stimulation, disease If isolated may not require treatment ```

Question 34

describe Mobitz I Second Degree Heart Block

Answer 34

``` Rate depends on underlying rhythm Regularly irregular Increasing PR interval Dropped beat Cycle starts over Decreased AV node with long refractory period ```

Question 35

describe Mobitz II Second Degree Heart Block

Answer 35

``` Rate depends on underlying rhythm Same PR interval for all conducted beats P waves usually regular Some P waves not conducted Usually progresses to CHB ```

Question 36

describe complete heart block

Answer 36

``` Atrio-ventricular dissociation Regular P waves Regular QRS No relationship Rate depends on intrinsic rhythm Needs pacemaker ```