Test 3: 32: CPR

Question 1

clinical signs of arrest

Answer 1

• Loss of palpable pulse
• No auscultable heart sounds
• Apnea or gasping
• Mucous membranes (cyanotic, grey, pink, pale)
• Capillary refill time (deceiving)→ May be normal for several minutes
• Pupils→ Fixed and dilated within 30 sec

Question 2

what makes CPR successful

Answer 2

reason for arrest
size of patient
skill- trained personnel (TEAM)
support staff
response time

Question 3

airway

Answer 3

check ET tube- make sure O2 in and CO2 out

ET-CO2

Question 4

breathing for anesthetized pt

Answer 4

turn off vaporizer and reverse drugs

• Flush system free of inhalant anesthetic
• Ventilate using re-breathing bag
• Ventilate 8-10 breaths/minute
• Peak airway pressure < 20 cm H2O
• Overventlilating causes hypocarbia and decrease cerebral perfusion (poorer outcome)
• Monitor ET-CO

Question 5

breathing for non anesthetized pt

Answer 5

Ventilate using ambu-bag
* Ventilate 8-10 breaths/minute
* Monitor ET-CO2
* Overventlilating causes hypocarbia and decrease cerebral perfusion (poorer outcome)
* Precious in evaluating effectiveness of compressions & return to spontaneous circulation

• Careful with peak airway pressure
• NO manometer on ambu-bag

Question 6

circulation one cycle is how long

Answer 6

2 mins

Question 7

cardiac pump theory

Answer 7

pt under 15 kg
compressions performed over the heart

Question 8

thoracic pump theory is used for what size pt

Answer 8

over 15 kg

compressions over widest part of chest
lateral recumbency 5-6th intercostal space
dorsal recumbency at the caudal sternum

Question 9

compression rate for CPR

Answer 9

100-120 compressions/min

change person every 2 mins

Question 10

how to do chest compressions

Answer 10

• 100-120 compressions/min
• switch every 2 mins
• 40-50% of compression relaxation cycle
• Depth of compression 25-35% chest width
• External compressions achieve only 20% of cardiac output

Question 11

what does ETCO2 tell you about circulation

Answer 11

CO2 drops during arrest

if CO2 below 14 mmHg need stronger chest compressions

if CO2 starts to build that is sign that circulation is improving

Question 12

should you give fluids during CPR

Answer 12

if arrest from shock/ blood loss or hypovolemia then yes.

if arrest from something else, no. Coronary perfusion pressure= Diastolic BP- right artrial pressure (CVP)

increasing CVP if CVP is normal will decrease coronary perfusion

Question 13

when to shock pt

Answer 13

not asystole

Vfib, pulseless Vtach

Question 14

how to give CPR meds

Answer 14

IV if no IV can be given intratracheally except sodium bicarbonate

if you give intratracheally you need to bouble dose

Question 15

what is a 1st line CPR med

Answer 15

epinephrine

used for any type of arrest: asystole, Vfib and pulseless VT (if prolonged and not responsive to defibrillation)

⍺: will cause vasoconstriction which improves cerebral and coronary perfusion

give every other cycle

Question 16

when to use atropine during CPR

Answer 16

asystole
slow pulseless electrical activity (PEA)

Question 17

how does atropine work

Answer 17

anti muscarinic ACh receptors

crosses BBB → mydriasis for 12 hours post arrest

Question 18

lidocaine CPR

Answer 18

antiarrhythmic

used for refractory VF, pulseless VT (non responsive to defibrillation)

Increases the fibrillation threshold But increases defibrillation threshold (harder to defibrillate pt on lidocaine)

do not give with slow ventricular escape rhythm could be fatal

Question 19

you should not use lidocaine for — rate

Answer 19

slow ventricular escape rhythm

could be fatal

Question 20

vasopressin should be used for

Answer 20

asystole, PEA, VF
can be used instead of epi

needs to be cold and $$

vasopressin is a vasoconstrictor, lasts 30 mins- only need to give once

Question 21

when to use calcium gluconate

Answer 21

Hyperkalemia, Hypocalcemia, Hypermagnesimia

Question 22

when to use amiodarone

Answer 22

Refractory VF, pulseless VT (non responsive to defib)

less frequently used anti-arrhythmic

Question 23

what to do if arrest

Answer 23

Turn OFF vaporizer & flush system

Administer relevant reversal agents
* Naloxone (opioids)
* Flumazenil (benzodiazepines)
* Atipamezole (alpha 2 agonists)

ABC , Start compressions

Treat according to rhythm

Question 24

how often to give epi

Answer 24

every 2 cycles

Epinephrine low dose ONCE (ONLY AFTER 2 CYCLES OF DEFIBRILLATION FAILED)

Question 25

what to do with pt in Vfib or pulseless Vtach

Answer 25

ABC
defibrillate
resume chest compressions 90-120 sec
repeat shock
give low dose epi once (only after 2 cycles of failed defibrillation

Question 26

what to do for asystole or PEA

Answer 26

ABC
start compressions
epi low dose ONCE
atropine
lidocaine once

repeat atropine and epi every other cycle