Topic 1 - Cardiac Arrest Flashcards
ROLE criteria for non-obvious death
- No palpable carotid pulse
- No heart sounds (30 seconds)
- No breath sounds (30 seconds)
- No response to centralised stimuli
- Fixed and dilated pupils
Reportable deaths under S8 of the Coroners Act 2003
- The identity of the person is unknown
- The death was violent or unnatural
- The death happened under suspicious circumstances
- The death was healthcare related
- It is unlikely that a death certificate will be issued
- The death was in care
- The death was in custody
- The death occurred during police operations
Reasons for withholding CPR
- Where the patient is exhibiting obvious signs of death such as decomposition, hypostasis or rigor mortis
- Where the patient has sustained injuries that are totally incompatible with life such as decapitation, cerebral destruction, hemicorporectomy, incineration or foetal maceration.
General CPR discontinuation criteria
- CPR for 20 minutes
- General ROLE criteria are fulfilled
- The patient’s rhythm is asystole or PEA at a rate of less than 10 bpm (If in shockable rhythm after 30 minutes - consult)
Rapid CPR discontinuation criteria
- Patient was unresponsive and pulseless for at least ten minutes prior to paramedic arrival
- No CPR was provided during this time
- Genera ROLE criteria are fulfilled
- Asystole rhythm
Health attorney decisions in withholding CPR
Consent from a health attorney or guardian cannot operate unless the health provider reasonably consider that the commencement or continuation of life-sustaining measures for the patient would, having regard for all the circumstances, be inconsistent with good medical practice
Patient decision (Advance Health Directive) - withholding CPR - appropriate conditions
- The patient has impaired decision making capacity
- There is no reasonable prospect that the patient will regain capacity
CPR adult compression rate
100-120/minute
LMA, ETT and IV access urgency and timing in cardiac arrest
- No LMA or IV access in first 6 minutes of CPR unless a glottic foreign body is suspected
- No ETT in first 10 minutes of CPR unless there is LMA failure
Cardiac Arrest - Reversible Causes
- Hypoxia
- Hypothermia
- Hypovolemia
- Hypo/hyperkalemia
- Hydrogen ion (acidosis)
- Tension pneumothorax
- Tamponade
- Toxins
- Thrombosis
Newly born resuscitation - target heart rate
>100bpm
Newly born - assisted ventilation rate
40-60 bpm
Resuscitation of a Newly born - guideline
Traumatic cardiac arrest causes
- Airway obstruction and poor ventilation
- Tension pneumothorax
- Hypovolemia secondary to hemorrhage
Adult versus pediatric transport priority in traumatic cardiac arrest
- Adult patients should not be transported until airway management, chest decompression and IV access are established on scene
- Pediatric patients will be transported on all occasions if resus has been initiated unless in special circumstances
Traumatic cardiac arrest guidlines
Hypothermia and cardiac arrest
- Lack of signs of life cannot be reliably used
- As temperature decreases - sinus bradycardia - AF - asystole
- Withhold adrenaline and other pharmacological resuscitation measures until the patient has been warmed to a temperature higher than approximately 30 degrees
- Above 30 degrees, the interval between adrenaline doses should be doubled
- Normal drug administration above 35 degrees
- If under 30 degrees and the patient is in VF/VT - maximum shock charge should be used
- After 3 shocks at maximum joules, withhold until patient is over 30 degrees
Defib paddle placement where ICD is insitu
Paddles should be positioned around 8 cm from the generator position
Paramedic witnessed cardiac arrest and early defibrillation
Unless a delay of greater than 30 seconds is suspected, shock should be given before initiation of compressions
Primary aims in ROSC
- Support ABC’s
- Maintain cerebral perfusion
- Manage cardiac dysrhythmias (all patients should receive a 12-lead ECG)
ROSC vital sign goals
- Maintain SpO2 over or equal to 94%
- Consider advanced airway
- Maintain EtCO@ of 24-40 mmHg or 8-12 breaths/minute
- SBP of over or equal to 100 (adults) or 80 (children)
Adrenaline (Precautions)
- Hypertension
- Hypovolemic shock
- Concurrent MAOI therapy
- MS
Adrenaline (Side Effects)
- Anxiety
- Hypertension
- Palpitations
- Pupil dilation
- Tremor
Adrenaline (Contraindications)
Nil
Adrenaline (Indications)
- Anaphylaxis or severe allergic reaction
- Severe life-threatening bronchospasm OR silent chest (patients must only be able to speak in single words or have hemodynamic compromise or ALOC)
- Cardiac arrest
- Croup (with stridor at rest)
Adrenaline cutt-off for IM half dose
6 years of age
Waveform capnography indications
- CPR
- Sedation and procedural sedation
- Endotracheal intubation
- Ongoing monitoring of ventilation
Reduced EtCO2 levels - causes of this waveform include shock, PE and effective CPR
Endotracheal tube in oesophagus
Inadequate seal around ETT
Increased EtCO2 levels - causes of this waveform include shock, PE and effective CPR
Decreased EtCO2 levels from normal - ROSC
Obstruction in breathing circuit or airway
Increased EtCO2 values towards normal - causes of this waveform include restoration of normal respiratory activity, improved cardiac output or improved integrity of airway seal.
