Sudden Cardiac arrest

Question 1

what to do after a shockable and non-shockable rhythm?

Using the Resuscitation Council (UK) ALS algorithm, can you complete the blank boxes in the following process?

Answer 1

1. shockable - immediately resume CPR for 2 minutes
2. non-shockable - immediately resume CPR for 2 minutes

Question 2

Aspects to consider with a collapsed child:

(When resuscitating a child player following a collapse, which one of the following statements is not correct?)

Answer 2

The sequence ABCDE remains the same

Children as young as 12 years old can suffer a sudden cardiac arrest

After opening the airway, five rescue breaths should be administered

Children lose heat faster than adults and so should be kept warm

Incorrect: Due to the narrower airway, it is important to exhale as hard as possible during breathing

Question 3

Concerning the use of an automated external defibrillator (AED) with a player with an ICD, which one of the following statements is correct?

Answer 3

If a player’s ICD has not fired, the AED must be applied and used as normal

Question 4

At a training session, if CPR is already in progress, what is the correct sequence when performing defibrillation using an automated external defibrillator (AED)?

Answer 4

Switch on the AED immediately and expose the chest. Attach the electrode pads and allow the machine to analyse. If a shock is advised, ensure everyone is standing clear and press the shock button. Continue CPR for two minutes.

Question 5

Name as many benefits of asynchronous CPR and igel (9 total):

When referencing the purpose and use of an iGel to provide asynchronous CPR, which one of the following statements is incorrect?

Answer 5

Once the iGel is inserted, it requires time to warm up and seal. Continue 30:2 for one to two rounds (or wait until the next analysis cycle i.e. up to two minutes) to allow the seal to form, then switch to asynchronous CPR

If significant leakage occurs once the iGel is inserted, revert back to 30:2

If CPR continues as per the 30:2 ratio due to leakage, the same oxygen precautions are taken as in normal 30:2 without the iGel. Oxygen is removed for the shock to be delivered

A good seal is denoted by adequate bilateral chest movement and normal resistance on the bag

Asynchronous CPR is required as soon as possible (once enough rescuers are present) because it aids in maintaining myocardial perfusion pressure (which will drop each time you stop applying chest compressions to give the rescue breaths)

It can take up to approximately four rounds of CPR (30:2) for myocardial perfusion pressure to get it back to where it needs to be (equating to almost two minutes of chest compressions) if using synchronous CPR

Perfusion pressure does not drop when asynchronous CPR is provided

The iGel provides a sealed unit. Therefore, oxygen does not have to be removed for a shock to be applied (unless there was air leakage)

A catheter mount attached between the iGel and BVM allows a more flexible unit, meaning the BVM can rest safely when the AED advises: “do not touch the patient, analysing”

Question 6

According to the Resuscitation Council (UK) 2001 guidelines, what is the correct depth for chest compressions during CPR of an adolescent (U12) footballer?

Answer 6

4-5cm

Question 7

Signs and symptoms of cardiac arrest (4 answers)

Which one of the following would not be considered a sign or symptom of sudden cardiac arrest?

Answer 7

1. witnessed sudden collapse
2. seizure
3. Agonal breathing
4. Arrhymia

wrong: paradoxical breathing

Question 8

Describe agonal breathing:

(Which one of the following statements best describes agonal breathing?)

Answer 8

An unconscious player with an abnormal, slow, gasping, irregular and labored breathing pattern with abdominal movement

Question 9

On assessment, the player is U on AVPU. You are uncertain as to the presence of a carotid pulse. His respiratory rate is 1rpm.

What is your next immediate action?

Answer 9

The player requires urgent attention. Go to the main building, attract attention for help and ask the receptionist to call 999. Return to the player and commence resuscitation at a rate of 30:2. Apply AED as soon as it arrives

Question 10

UNwitnessed collaspe and possible cardiac arrest, Imagine the scenario now involves a U12 player, rather than a senior. In this case, what is your next immediate action?

There are two correct answers

Answer 10

1. Commence CPR at a rate of 15:2 for one minute after initially providing five rescue breaths. Then leave the player to get help. Attract the receptionist’s attention and ask them to phone 999 while you get further help and request an AED. Return to the player and apply the AED as soon as it arrives
2. Commence CPR at a rate of 30:2 for one minute after initially providing five rescue breaths. Then leave the player to get help. Attract the receptionist’s attention and ask them to phone 999 while you get further help and request an AED. Return to the player and apply the AED as soon as it arrives

Question 11

Now imagine that you witnessed the U12 player collapse. In this case, what would change about your course of action?

Answer 11

Witnessing a sudden collapse in a child is the exception to performing one minute of CPR before going for help

Question 12

Thinking back to the original scenario, what is wrong with the club’s emergency action plan?

Answer 12

The player and medic are left alone and thus at risk. The EAP should have procedures in place to prevent players or medical staff being essentially left alone when all other staff, but 1 in another building, have left

Question 13

Steps for high quality chest compressions:

Answer 13

• Ensure high-quality chest compressions
• Minimise interruptions to compressions
• Give oxygen
• Use waveform capnography
• Continuous compressions when
  advanced airway in place
• Vascular access (intravenous or intraosseous)
• Give adrenaline every
  3-5 minutes
• Give amiodarone after the third shock

Question 14

When delivering BLS to an adult, which one of the following represents the desired outcome measures?

Answer 14

A compression depth of 5-6 cm (about 2 to 2.4 inches) for chest compressions.

A compression rate of 100-120 compressions per minute.

Minimizing interruptions to chest compressions.

Allowing full chest recoil between compressions to let the heart refill with blood.

Providing rescue breaths at a ratio of 30 compressions to 2 breaths (if trained and able to do so).

Question 15

Essential component of a successful pre-hospital resuscitation attempt?

Answer 15

Early recognition

Early BLS

Early application of the AED

Early 999 call

Question 16

Adult CPR is 30 compressions to two breaths. Paediatric CPR is 15 compressions to two breaths.

What is the predominant reason for this difference outside of the football setting?

Answer 16

The majority of paediatric arrests are usually secondary to respiratory insufficiency

Question 17

You are covering an academy match. During half-time, just as the players are returning to the pitch, you notice a lot of commotion near the boundary sideboards. People are shouting “help doc”, and the referee asks you to go and investigate. When you arrive, you notice an elderly man lying on his back. He is very pale and clearly unresponsive. Someone states they couldn’t feel a pulse. You complete a mini primary assessment and cannot establish any signs of life.

What is your immediate course of action?

Answer 17

1. Open the gentleman’s airway using a head-tilt/chin-lift manoeuvre
2. Initiate chest compressions and continue CPR at a ratio of 30:2
3. Apply an automated external defibrillator

Question 18

You are completing BLS with an AED on a player who collapsed during a match in heavy rain. You are leading the incident with two assistants. The player is about to receive their first shock, and already has an i-Gel in-situ (as the AED arrival was delayed).

Which one of the following would be considered unsafe practice?

Answer 18

Unsafe practice: Leaning across a player to shock them

Question 19

When delivering BLS to an adult, which one of the following represents the desired outcome measures?

Answer 19

Rate: 100-120cm | Depth: 5-6cm | Hand placement: centre of chest | Recoil: allow adequate | Compression to ventilation ratio: 30:2