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EMRG1300 > term 1 test > Flashcards

term 1 test Flashcards

1
Q

How to confirm cardiac arrest

A

Assess C-A-B to determine if pt is in cardiac arrest due to many presentations appearing initially as cardiac arrest

Check carotid/radial pulses and breathing in >10seconds

Is suspected apply pads immediately over chest leads

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2
Q

What does hypothermia present as

A

Cold, waxy skin, blanching of skin, locked extremities, not shivering

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3
Q

Medical TOR criteria in the ALS

A

Age >16 years old, altered LOA, arrest not witnessed by EMS and no ROSC 20 min of resuscitation and no defibrillation delivered

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4
Q

Trauma TOR conditions

A

> 16 years, no palpable pulses and no defibrillation delivered and rhythm asystole or no signs of life at any time since fully extricated, or signs of life when fully extricated with the closest ED >30 min transport time away, or rhythm PEA with the closest ED >30min away

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5
Q

Where do you transport a cardiac arrest

A

Closest ER, CTAS 1 code 4

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6
Q

What is the difference between a SCA and a heart attack

A

Patients die from the rhythm/arrhythmia that is unsustainable for the elctrophysiology of the heart not the STEMI

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7
Q

Medical cardiac arrest indications

A

Non-traumatic cardiac arrest

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8
Q

Airway obstruction in cardiac arrest

A

High instances in children, focus on high-quality CPR, consider very early transport (after 1 analysis and egress plan is organized), transport to closest ER since PT is CTAS 1

If airway obstruction is relieved prior to early transport, consider running a longer arrest on scene

TOR is contraindicated

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9
Q

Termination of resuscitation

A

Must call BHP and continue running arrest until receiving TOR order, ensure you recieve time of death from BHP

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10
Q

Causes of cardiac arrest

A

Atherosclerosis or underlying cardiac diseases, genetic disorders, cardiomyopathies, can occur after electrocution, drowning, trauma, drug overdose

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11
Q

SGA- King LT

A

Single lumen air device available in adult and peds sizes

Consists of a curved tube with ventilation ports between two inflatable cuffs

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12
Q

Medical cardiac arrest medical TOR contraindications

A

Known reversible cause of arrest unable to be addressed, pregnancy assumed to be >20 weeks’ gestation, suspected hypothermia, non-opioid drug overdose

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13
Q

Supraglottic airway medical directive conditions

A

Absent gag reflex

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14
Q

Advanced airways in cardiac arrest

A

Dont rush into advanced airways is BLS airways are adequate

King LT/ I Gel

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15
Q

What is the difference between a SAED and a manual defibrillation

A

Must pull over with a SAED, can stay enroute if able to analyze/defibrillate in that environment

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16
Q

What are the special cases of cardiac arrest

A

Trauma, pregnancy, hypothermia, airway obstruction, non-opioid toxicity, ROSC

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17
Q

Abnormal waveform- sudden increase in ETCO2

A

ROSC

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18
Q

Pre-arrival interventions with respect to TOR

A

Consult with BHP and advise them of interventions done by FD/other PTA and discuss

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19
Q

How to confirm placement for SGAs

A

ETCO2 reading, chest auscultation, chest rise, no wave form ETCO2, tube misting

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20
Q

Abnormal waveform- decreasing ETCO2

A

ET tube cuff leak

ET tube in hypopharynx

Partial obstruction

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21
Q

What is a vector change

A

Pads change from the front of the chest to the back

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22
Q

ETCO2 definition

A

Measures ventilation status- CO2 in the airway at the end of exhalation

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23
Q

Indications for the King LT

A

Alternative to bag-mask and OPA/NPA ventilation when an advanced airway device is required for airway management

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24
Q

Supraglottic airway medical directive contraindications

A

Airway obstruction by a foreign object, known esophageal disease (varices), trauma to oropharynx, caustic ingestion

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25
Q

What do you do if you obtain a ROSC

A

Complete assessment of CAB, 12 lead, full set of vitals, continually reassess and treat findings

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26
Q

Defibrillation in cardiac arrest

A

Heart is quivering but no blood is pumping so defib stuns heart muscles to allow the normal conduction to resume control

If not defibbed, VF/VT will deteriorate to asystole

Pt must be >24hrs

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27
Q

Why is there a shark-fin slope with a bronchospasm

A

The movement of the air at the alveoli is delayed and the rise to the plateau is more gradual and becomes sloped

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28
Q

SPO2 definition

A

Saturation of peripheral capillary oxygen- measures oxygen saturation levels

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29
Q

Supraglottic airway medical directive indications

A

Need for ventilatory assistance or airway control and other airway management is ineffective

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30
Q

Shockable rhythms in cardiac arrest

A

V tach, V fibb

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31
Q

ROSC- post arrest care

A

Fluid bolus- >2 years old

Ensure chest is clear and BP is hypotensive, 10ml/kg, max 1000ml, reassess every 100ml >2-<12 years and reassess every 250ml >12 years

Oxygenation- BVM ventilations are required, titrate SPO2 to 94-98%, avoid hyperventilation (ETCO2 30-40mmHg)

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32
Q

Monitoring CPR quality with ETCO2

A

Higher ETCO2: higher cardiac output (good CPR)

Lower ETCO2: change compressions or improve CPR quality

ETCO2 decreasing observe for chest compressor fatigue, hyperventilation, airway obstruction, or tracheal tube displacement

ETCO2 increasing: CPR is likely effective and ventilation appropriate; substantial rise can indicate ROSC

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33
Q

Where should the pt be during cardiac arrest

A

Hard flat surface with enough space- possibly stretcher and plan extrication

Move pt only if necessary and notify PD and document and do not move pt back

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34
Q

What causes high CO2 levels (hypoventilation)

A

Retaining CO2 due to the slow rate of breathing

Caused by overdose, sedation, intoxication, postictal states, head trauma, stroke, tiring CHF, fever, sepsis, SOB

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35
Q

What causes low CO2 levels (hyperventilation)

A

Blowing off large amounts of air from increased rate of breathing

Caused by anxiety, bronchospasm, pulmonary embolus, cardiac arrest, hypotension, decreased cardiac output, cold

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36
Q

Medical cardiac arrest manual defibrillation conditions

A

Age >24 hours, LOA altered, VF or pulseless VF

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37
Q

What are the signs of a ROSC

A

Sudden increase in ETCO2, spontaneous respirations, palpable pulses, change in colour, spontaneous movement

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38
Q

Oxygenation definition

A

Process of adding oxygen to the body system

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39
Q

DNR

A

Establish presence ASA, validity (if so, can be honoured without BHP call) if incomplete call BHP

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40
Q

What does a ETCO2 >45mmHg indicate

A

Hypoventilation/ hypercapnia

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41
Q

What is the life saving measures that are classified in a DNR in the BLS

A

Chest compressions, defibrillation, artificial ventilation, insertion of oropharyngeal/supraglottic airway, endotracheal tube, transcutaneous pacing, advanced resuscitation drugs- vasopressors, antiarrhythmic agents, and opioid antagonists

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42
Q

Medical cardiac arrest epinephrine contraindications

A

Allergy or sensitivity to epinephrine

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43
Q

What is cardiac arrest

A

Occurs when the heart unexpectedly and suddenly stops pumping often from a irregular heart rhythm

Blood stops flowing to the brain and other vital organs

44
Q

Joule settings

A

> 24hours to <8 years

Initial dose: 2J/kg

Subsequent doses: 4J/kg

Interval: 2 min

> 8 years

Zoll: 120J, 150J, 200J

Lifepack: 200J, 300J, 360J

45
Q

What are the reasons to prioritize an advanced airway

A

Vomit or airway full of secretions

Prolonged resuscitation or extrication

Poor seal with OPA/BVM

46
Q

Trauma TOR contraindications

A

Age <16, defibrillation delivered, signs of life at any time since fully extricated medical contact, rhythm PEA and closest ED <30min transport time, patients with penetrating trauma to the torso/neck/ and lead trauma hospital <30min transport time

47
Q

What do ETCO2 values indicate about a ROSC

A

ETCO2 values <10-15mmHG prompt close evaluation of CPR- if they remain low the prognosis of the ROSC is low

If the numbers rise into 20-30s the prognosis of the ROSC are high

If the numbers rise to extreme highs a ROSC is present so check rhythm and pulse at next rhythm check

48
Q

What are the signs of an obviously dead patient

A

Decapitation, transection, visible decomposition, putrefaction, absence of vital signs and grossly charred body, an open head/torso wound with gross outpouring of cranial or visceral contents, gross rigor mortis, or dependent lividity

49
Q

After 20mins what do ETCO2 levels indicate

A

ETCO2 levels <10mmHg are associated with futility (exceptions include hypothermia)

ETCO2 levels >25mmHg are associated with survival

50
Q

How to secure King LT

A

Thomas tie is compatible, ensure to note and document depth prior to securing, tape if needed

51
Q

Medical cardiac arrest manual defibrillation treatment

A

> 24 hours-<8 years: dose I defibrillation, initial dose 2j/kg, subsequent doses 4J/kj, dosing interval 2 min

> 8 years: dose 1 defibrillation, initial dose/ subsequent doses as per RBHP, dosing interval 2 min

52
Q

What does fire do in cardiac arrests

A

Assist with patient care, can accompany to ER

53
Q

What is PaCO2

A

Partial pressure of carbon dioxide in arterial blood gases thats measured by drawing the ABGs (also measure arterial PH)

54
Q

Pregnancy in cardiac arrest

A

Pregnancy presumed to be >20 weeks’ gestation

Run as regular medical arrest and consider very ealy transport after a minimum 1 analysis and egress plan is organized

TOR contraindicated

55
Q

Complications of King LT

A

Laryngospasm, vomiting, and possible hypoventilation may occur, trauma may also result from improper insertion technique, ventilation may be difficult if pharyngeal balloon pushes epiglottis over glottic opening

56
Q

How does a pt respiratory rate change in conjunction with CO2

A

A patient’s respiratory rate increases as CO2 rises and decrease as CO2 falls

57
Q

Definition of respiration

A

Process of oxygen and carbon dioxide diffuse in and out of the blood

58
Q

What is the fourth phase of wave form

A

D-E: (0) start of inspiration

59
Q

Medical cardiac arrest epinephrine conditions

A

Age >24 hours, LOA altered, anaphylaxis suspected as causative event

60
Q

Abnormal wave forms- decreased ETCO2

A

Apnea, sedation

61
Q

Pulse checks in cardiac arrest

A

Every 2 minutes and done in the last 15 seconds of the CPR cycle

Do not delay time off chest if unable to palpate pulse/ unsure of pulse presence

Also done if obvious signs of life is present

62
Q

Abnormal wave form- sudden loss

A

ET tube disconnected, dislodged, or obstructed

Loss of circulatory function

63
Q

Definition of ventilation

A

Pulmonary ventilation is the process by which oxygen enters, and carbon dioxide exits the alveoli ventilation is the process of in haling and exhaling- “movement of air”

64
Q

Non-opioid drug cardiac arrest

A

Prioritize scene safety, determine ingested substance used and dose, consider early transport (min 1 analysis and exit plan is organized), transport to closest ER since pt is CTAS 1

TOR is contraindicated

65
Q

I-Gel complications

A

Trauma to pharyngo-laryngeal framework, down-folding of epiglottis, gastric insufflation/ regurgitation and inhalation of gastric contents, nerve injuries, vocal cord paralysis, lingual or hypoglossal nerve injuries, if placed too high in the pharynx may result in poor seal and cause excessive leakage, laryngospasm

66
Q

ETCO2 with a ROSC in cardiac arrest

A

Spikes are caused by large amount of acidic blood returning to the lungs and high amounts of CO2 diffuse into alveoli causing a sharp rise in ETCO2 levels that are higher than normal

If present complete pulse check and full assessment

67
Q

ETCO2 in cardiac arrest

A

No CO2 production unless effective CPR, capnography gives feedback of CPR, ETCO2 <10mmHg indicates compressions are slow/deep enough, once circulation is restored there is a spike in ETCO2, ETCO2 <10mmHg suggests patients will not survive

68
Q

Medical cardiac arrest medical TOR conditions

A

Age >16 years, LOA altered, arrest not witnessed by paramedic and no ROSC after 20 min of resuscitation and no defibrillation delivered

69
Q

Interventions prior to EMS arrival

A

Pre-arrival interventions are not counted into patient care- it can be considered and documented

70
Q

Sizes of King LTs

A

Yellow- size 3, 4-5ft tall, cuff volume 60ml, cuff pressure 60cmH20

Red- size 4, 5-6ft tall, cuff volume 80ml, cuff pressure 60cmH20

Purple- size >6ft tall, cuff volume 90ml, cuff pressure 60cmH20

71
Q

I Gel- SGA

A

Medical grade thermoplastic elastomer that doesn’t require inflation

3 adult and 4 pediatric sizes- can be used between 2-90+kg, high seal pressures resulting in reduced trauma to the airway on insertion, alternative to OPA/BVM is unsuccessful or need for advanced airway, tip is designed to fit into proximal esophagus

72
Q

Dead air space

A

Ventilated areas that do not participate in gas exchange

Total dead space= anatomic dead space (airways leading into alveoli) + alveolar dead space (ventilated areas in the lungs without blood flow) + mechanical dead space (artificial airways including ventilator circuits)

73
Q

What are the causes of PEA

A

Hypovolemia, hypoxia, hyper/hypokalemia, hypothermia, H+ (acidosis), trauma, tension, tamponade, toxins, thrombosis

74
Q

Airway management of cardiac arrest

A

OPA and BVM (15 LMP) ventilations, ETCO2 applied and aim for 45mmHg, suction as needed, SPO2 of 94-96
When advanced airway is placed compressions become asynchronous at a rate of 1 every 6 seconds (10 bpm)

75
Q

Medical cardiac arrest epi treatment

A

dose 0.01mg/kg, max single dose 0.5mg, max # of doses 1

76
Q

When do you insert an SGA

A

When BLS airways are ineffective or definitive need for a more advanced airway like prolonged extrication or ineffective management with other devices

77
Q

Trauma cardiac arrest

A

Cardiac arrest secondary to severe blunt trauma

Treat the same as a medical cardiac arrest but maximum one shock/analysis

78
Q

Medical cardiac arrest primary clinical considerations

A

Consider early transport after a minimum one analysis (and defib if indicated) once egress plan is organized: pregnancy >20weeks gestation, hypothermia, airway obstruction, non-opioid drug overdose/toxicology, or other known reversible cause of arrest

79
Q

ROSC summary

A

A- Advanced airway if needed

B- provide optimal ventilation with waveform capnography (ETCO2 35-40mmhg and O2 sat 94-98%)

C- provide optimal perfusion what SBP >90 mmHg and treat hypotension with IV crystalloids, 12 with signs of ST elevation

D- consider raising the head of the bed by 30 degrees

80
Q

Medical cardiac arrest CPR contraindications

A

Obviously dead, meet conditions of DNR standard

81
Q

What do the police do in cardiac arrests

A

Manage spectators, protect scene, notify MD if TOR, notify coroner if needed, can help with family support

82
Q

What is the second phase of the waveform

A

B-C: exhalation upstroke (deadspace gas mixes with lung gas)

83
Q

What do you do if you have a ROSC then a re-arrest enroute

A

Resume CPR immediately, pull over, initiate immediate rhythm interpretation, treat accordingly, continue transport to closest ER, ensure rhythm analyses/ defibrillation can be done safely while enroute

84
Q

Supraglottic airway medical directive treatment

A

Max number of attempts is 2

Primary method: ETCO2 (waveform capnography)

Secondary method: ETCO2 (non-waveform), auscultation, chest rise

85
Q

Abnormal wave form- hypo/hyper ventilation

A

Hypoventilation: long slow wave forms

Hyperventilation: short fast wave forms

86
Q

What is the first phase of the wave form

A

A-B: inspiratory baseline (low CO2 as its inspired air)

B is the start of alveolar exhalation

87
Q

How does downtime in cardiac arrest management affect ETCO2

A

Short down time cause ETCO2 to give an accurate indication of quality of CPR

Long downtimes cause ETCO2 to remain low regardless of quality of CPR (vasodilation and sluggish blood flow prevent buildup of cardiac output)

88
Q

Medical cardiac arrest manual defibrillation contraindications

A

Rhythms other than VF or pulseless VT

89
Q

Medical cardiac arrest CPR conditions

A

LOA altered, performed in 2 min intervals

90
Q

Abnormal waveform- bronchospasm

A

Shark-fin appearance

Asthma, COPD

91
Q

Unshockable rhythms in cardiac arrest

A

Asystole, PEA (organized rhythm with no pulse)

92
Q

When does the capnogram start and end

A

Begins before exhalation and ends with inspiration

93
Q

Why is capnography important

A

Verification of proper tube placement

No waveform= no tube

94
Q

5 main uses of ETCO2 in cardiac arrest

A

Verify tracheal tube placement, identify tracheal tube displacement, evaluate CPR quality, identify ROSC, determine when ROSC is unlikely

95
Q

Definition of internal respiration

A

Gas exchange across the respiratory membrane in the metabolizing tissues like skeletal muscles

96
Q

Definition of external respiration

A

Gas exchange across respiratory membrane in the lungs

97
Q

What are the most common errors in prehospital defibrillation

A

Improper pad placement and poor adhesive contact

98
Q

What is the third phase of waveform

A

C-D: continuation of exhalation (gas is alveolar now, rich in CO2)

D is the end tidal value at peak concentration

99
Q

What does a ETCO2 <35mmHg indicate

A

Hyperventilation/ hypocapnia

100
Q

How does a King LT work

A

Distal and proximal balloon to occlude esophagus and oropharynx (occludes esophagus to prevent gastric inflation/ aspiration), creates a direct route for ventilation/oxygen to the trachea and lungs

101
Q

Abnormal waveform- CPR assessment

A

Attempt to maintain minimum of 10mmHg

102
Q

ACR documentation for a cardiac arrest

A

CPR, PPV (BVM/rate), OPA (size/toleration), suction (how much/response), rhythm interpretations, advanced airway if placed (size/ tolerated), BHP patch (orders received), extrication (what was used), delays to CPR, scene delays, anything of note on scene, pt movement

103
Q

Supraglottic airway medical directive clinical considerations

A

An attempt at an insertion is defined as the insertion of the supraglottic airway into the mouth, confirmation of SGA should use ETCO2 if unavailable/ not working then at least 2 secondary methods must be used

104
Q

Contraindications for the King LT airway

A

Does not eliminate risk of vomiting and aspiration, high airway pressure can cause air to leak into stomach or out of mouth, do not use in patients with intact gag reflex, esophageal disease, or who have ingested caustic substance, airway obstructions

105
Q

How does ETCO2 and cardiac output relate

A

when cardiac output is normal ETCO2 measures ventilation, when cardiac output is decreased ETCO2 measures cardiac output

106
Q

Hypothermia in cardiac arrest

A

Consider environment and exposure time (remove pt from cold environment), consider early transport to closest ER as pt is CTAS 1

TOR contraindicated

Pulse checks every 10 sec

Focus on passive rewarming and gentle handling (excessive handling can cause lethal arrhythmias) and minimize movement of pt

Manage airways as needed (OPA/BVM over ETT)

EMRG1300 (3 decks)

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