Test2: week 5 Flashcards
what are the 6 parts to the chain of survival?
- early recognition and 911 initiation
- early bystander CPR
- early defibrillations in 3-5 mins
- Early ALS
- Post ROSC care
- recovery
the effects of EMS response Increase after 5-6 mins of SCA (T/F)?
False, they effects decrease
compression depth for Adult
2” or 5 cm
pediatric compression depth is
1 1/2” or 1/3 the chest depth
physiology of compressions
compressing the chest cause s an increase in intrathroacic pressure which in turn pumps blood out of the heart and into circulation then allowing the heart to refill again.
what is the rate for adult compressions?
100-120bpm
what is the preffered technique for given peds chest compressions?
circumferential grip with the thumbs at the nipple line.
what is the SBP that compressions maintains?
60-80mmHG
for every min without BCPR for a witnessed sudden VF survival decreases by 7-10% (t/f)
true
how do defib work?
depolarize the whole heat & stops signal transduction in the hopes of the SA node taking over pacing.
what a/w position should we be maintaining for the patient and how do we achieve this?
Sniff position can be achieved by head-tilt-chin-lift or modified jaw thrust. we can also maintain patentcy with the use of OPA/NPA and SGA’s
when should PPV be initiated?
when the patient is apneic or has gasping (aogonal respirations)
during CPR a patients metabolic demand is increased ( true or false?)
false, during CPR a pt metabolic demand is decreased because their is decreased cellular uptake of O2 and O2 delivery.
during CPR CO is 25-33% of what it normally is ( true or false)
true
how much should we be ventilating adult lungs?
500-600ml or till we see chest rise and fall
when checking a pulse it should take less than____ sec
10
what are the landmarks for CPR on an adult?
lower half of the sternum or center of the chest between the nipples at the xiphoid process.
ratio for adult 2 rescuer cpr
30:2
ratio for 2 rescuer peds cpr
15:2
rtio for 2 rescuer neonatal resus
3:1
once an SGA has been put into place breaths should be asynchronous at what rate?
10-12 breaths per min so 1 breath every 5-6 seconds.
how long after a ROSC should you do a 12 lead?
10 mins
after a ROSC why should you tritrate the pt O2 to 94-98%?
because excessive O2 free radicals (100% sat) can have adverse effects like cellular disturbances & oxidative stress.
what are the 5 aspects of adult cpr
- rate, 2 depth, 3. release, 4. uninterrupted, 5. ventilation
what are the 3 phase of the arrest model
- electrical: 0-4 mins since sca, priority is defibs
- hemodynamic phase: 4-10 mins since SCA priority is compressions
- metabolic: after 10 mins of SCA, need ACP drugs
Once an SGA is inserted how should ventilation be done?
asynchronous with one breath every 5 seconds
how long should pulse checks be and when should they be done?
<10 sec every 2 mins or once organized rhythm is present on the monitor
what are the joule settings for a ZOLL monitor?
120j, 150J, 200J
what are the indications for medical cardiac arrest medical directive?
non-traumatic cardiac arrest
what are the primary considerations for a medical cardiac arrest?
Pregnancy >/= 20 weeks gestation, non-opioid OD, hypothermia, FBAO, other known reversible causes untreated * pt in refractory vf or no change after the 3rd analysis
what are the known reversible causes for medical cardiac arrest?
Hypothermia
hypoglycemia
hypoxia
H+ (acidosis)
hyperkalemia/hypokalemia
toxins ( opioidOD)
Tamponade
thrombosis ( coronary or pulmonary)
Tension pneumothorax
what are the conditions for medical cardiac arrest?
CPR: loa= altered, other=performed in 2min intervals.
Defibs: age= >/= 24hrs, LOA= altered, other: pulseless VT or VF
aed/saed: Age=>/= 24hrs, LOA= altered, Other: shock advised
Epi: age>/= 24hrs, LOA= altered, Other: anaphylaxis is the suspected
medical TOR:
age:>/= 16 years
loa= altered
Other: arrest not witnessed by EMS and no shocks delivered
contraindications for medical cardiac arrest?
CPR: obviously dead or DNR
Defib/AED/SAED: nonshockable rhythm
EPI: allergy or sensitivity
MED TOR: known reversible cause no corrected, pregnancy <20wks, non-opioid Toxicity, FBOA, Hypothermia,
What is the treatment for med cardiac arrest according to the directive?
Defibs:
age: >/= 24hrs-8yrs
Dose= 2j/kg
subsequent dose= 4j/kg
dose interval= 2mins
Age: >= 8 years
dose= 120j (zoll)
subsequent dose= 150j ( Zoll)
dose int= 2mins
max= n/a
EPI:
route: IM
Dose 0.01mg/kg
max single= 0.5 mg
max #=1 dose
what is the mandatory patch point for the for the medical cardiac arrest directive?
must patch to consider MED TOR, if patch fails or the pt does not meet the MED TOR standard —> transport to the nearest ED after 20 mins of resus w/ no ROSC
- patch early after the 4th analysis to consider the MED TOR if there are extenuating circumstances surrounding egress, prolonged transport or significant clinical limitations with the ongoing resus and med determines it to be futile
what are some important clinical considerations regarding the MED cardiac arrest directive?
doctor may not approve TOR even if the pt meets it bc location of pt, ETCO2, age, bystanders witnessed, BCPR, transport time, unusual cause etc.
doctor may aprove TOR even if the pt does not meet it bc exenuating egress, limits, prolonged extrication, caregivers wishes, DNR confirmed, underlying terminal illness
trauma cardiac arrest indications?
cardia arrest secondary to severe blunt or penetrating trauma
conditions for trauma cardiac arrest?
CPR:
- loa= altered
other: 2 min intervals
Defib:
age:>= 24 hrs
LOA= alt
other: pulseless VT or VF
Trauma TOR:
age: >/=16 years
LOA= altered
other: no palpable pulses & no defibs & rhythm asystole Or No signs of life since fully extricated OR signs of life since extricated & ED >/=30mins transport OR rhythm PEA & ED >/= 30 mins
contraindications for the Trauma cardiac arrest?
CPR:
other: DNR found or obviously dead
Defib: non shockable rhythm
trauma TOR:
age: <16 years
other: defibs given, signs of life since being fully extricated
- PEA and the ED is <30mins away
- pt has penetrating trauma to the torso, head/neck & the LTH =<30mins away
Treatment for Trauma cardiac arrest directive?
Defibs:
Age= >/= 24hrs-8yrs
dose= 2j/kg
subsequent dose= 4j/kg
dose int= 2mins
age= >/= 8yrs
dose= 120j
subsequent dose= 150j
Dose int= 2mins
what is the mandatory patch for Trauma cardiac arrest directive?
must patch for trauma TOR, If the patch fails or the pt dose no meet the TOR–> transport to the closest most appropriate ED after 1 analysis/shock
what dose the attending medic do for the arrest if following the pit crew approach?
controls monitor, get defibs on, shock and analyze
what dose your partner do according to pitcrew pproach?
compressions right away
what does the 3rd team member do according to the pitcrew approach?
manage the a/w, pulse checks, hook up ETCO2
what does the 4th person do in the pitcrew approach?
ALS treatment ( IV)
What should extra team members be doing during arrest?
2 ppl to rotate compressions, someone can time and document times, obtain hx from family,
what is a DNR?
preagreement ofof the measures that should be taken if a pt is to die. Reflects the pt wishes and doctors opinion. signed by DOC/NP and has pt name on and confirmation code.
if a pt DNR was signed 2 hours before they died is can be honoured (t/f)
no, the date signed must preceed the date of death
how is death confirmed?
if pulse or breath is absent 3mins after they were last preset
what should be done if the pt dies in the ambulance?
doc time of death, update CACC and receiving facility, continue to receiving facility
What should be done if a tor is approved?
let the care team known, leave all equipment in place, let the family known, call coroner or local police,
what info should be given to the coroner or the police?
age/gender, Ix, time of death, withnessed/unwitnessed arrest, assesment findings, initial and final ecg, pmhx, sample, police badges, obtain permission to move the body if family wants.
what should the pt wrist ID say for the deceased include?
date, full name, DOB, coroners name, paramedic region, Oasis, #
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