Resuscitation Flashcards
define clinical death
the period of resp, circulatory and brain arrest during which initiation of resus can lead to recovery with pre-arrest CNS function
define biologic death
sets in after clinical death and is an irreversible state of cellular destruction
what is trans thoracic impedance?
the body’s resistance to current flow from the defibrillator
what are the known causes of trans thoracic impedance?
body mass age disease skin resistance tissue type and amount
describe ventricular fibrillation
Bizarre irregular waveform No recognisable QRS complexes Random frequency and amplitude Uncoordinated electrical activity Coarse/fine
describe pulseless ventricular tachycardia
Monomorphic VT – broad complex rhythm, rapid rate, constant QRS morphology
Polymorphic VT – torsades de pointes
if VF/PVT persists after shock…
Deliver 2nd shock
CPR for 2 mins
Deliver 3rd shock
CPR for 2 min and administer adrenaline 1mg IV and amiodarone 300mg IV
describe asytole
Absent ventricular (QRS) activity Atrial activity (P waves) may persist Rarely a straight trace line
treatment of asytole
Restart CPR then adrenaline 1 mg IV every 3 -5 mins
describe pulseless electrical activity
Clinical features of cardiac arrest
ECG normally associated with an output
treatment of PEA
Restart CPR then adrenaline 1 mg IV every 3-5 mins
treatment of hypoxia
airway patency, high flow supplemental oxygen
treatment of hypovolaemia
infuse IV fluids
treatment of metabolic causes
electrolyte infusions
treatment of hypothermia
active re-warming techniques
treatment of tamponade
needle pericardiocentesis or resuscitative thoracotomy
treatment of tension pneumothorax
check position of intubation, decompression or thoracotomy
treatment of toxins
case to case
treatment of thrombosis
thrombolytic drug therapy
normal QRS complex
<0.12s
P-R interval
0.12 - 0.20 sec
QT interval
0.35 - 0.43 sec
how to calculate HR when it looks irregular
300/no. of large squares between 2 R waves
how to calculate HR when it looks regular
- Number of cardiac cycles occurring in 6s (30 large squares) and multiply by 10
6 points to look for in an ECG
- Is there any electrical activity?
- What is the ventricular (QRS) rate? (bradycardia <60, tachycardia >100)
- Is the QRS rhythm regular or irregular?
- Is the QRS width normal or prolonged?
- Is atrial activity present?
- How is atrial activity related to ventricular activity?
describe normal sinus rhythm
Rate = 60-100bpm
Regular P wave to each regular QRS
Normal P wave appearance
Normal and constant PR interval
bradycardia
<60bpm
tachycardia
> 100bpm
describe atrial flutter
Atrial rate = 250-350bpm
Usually regular QRS
Classic sawtooth
describe atrial fibrillation
Irregularly irregular QRS
No P waves – atrial rate >350bpm
Fast or slow AV conduction
Irregular baseline
describe ventricular tachycardia
Rate 100-200bpm
Regular
Occasional dissociated P waves
Wide, bizarre QRS
describe torsades des pointes
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
describe first degree heart block
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
describe Mobitz I Second Degree Heart Block
Rate depends on underlying rhythm Regularly irregular Increasing PR interval Dropped beat Cycle starts over Decreased AV node with long refractory period
describe Mobitz 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 CHB
describe complete heart block
Atrio-ventricular dissociation Regular P waves Regular QRS No relationship Rate depends on intrinsic rhythm Needs pacemaker
