Topic 1 - Cardiac Arrest

Question 1

ROLE criteria for non-obvious death

Answer 1

• No palpable carotid pulse
• No heart sounds (30 seconds)
• No breath sounds (30 seconds)
• No response to centralised stimuli
• Fixed and dilated pupils

Question 2

Reportable deaths under S8 of the Coroners Act 2003

Answer 2

• 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

Question 3

Reasons for withholding CPR

Answer 3

• 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.

Question 4

General CPR discontinuation criteria

Answer 4

• 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)

Question 5

Rapid CPR discontinuation criteria

Answer 5

• 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

Question 6

Health attorney decisions in withholding CPR

Answer 6

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

Question 7

Patient decision (Advance Health Directive) - withholding CPR - appropriate conditions

Answer 7

• The patient has impaired decision making capacity
• There is no reasonable prospect that the patient will regain capacity

Question 8

CPR adult compression rate

Answer 8

100-120/minute

Question 9

LMA, ETT and IV access urgency and timing in cardiac arrest

Answer 9

• 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

Question 10

Cardiac Arrest - Reversible Causes

Answer 10

• Hypoxia
• Hypothermia
• Hypovolemia
• Hypo/hyperkalemia
• Hydrogen ion (acidosis)
• Tension pneumothorax
• Tamponade
• Toxins
• Thrombosis

Question 11

Newly born resuscitation - target heart rate

Answer 11

>100bpm

Question 12

Newly born - assisted ventilation rate

Answer 12

40-60 bpm

Question 13

Resuscitation of a Newly born - guideline

Answer 13

Question 14

Traumatic cardiac arrest causes

Answer 14

• Airway obstruction and poor ventilation
• Tension pneumothorax
• Hypovolemia secondary to hemorrhage

Question 15

Adult versus pediatric transport priority in traumatic cardiac arrest

Answer 15

• 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

Question 16

Traumatic cardiac arrest guidlines

Answer 16

Question 17

Hypothermia and cardiac arrest

Answer 17

• 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

Question 18

Defib paddle placement where ICD is insitu

Answer 18

Paddles should be positioned around 8 cm from the generator position

Question 19

Paramedic witnessed cardiac arrest and early defibrillation

Answer 19

Unless a delay of greater than 30 seconds is suspected, shock should be given before initiation of compressions

Question 20

Primary aims in ROSC

Answer 20

• Support ABC’s
• Maintain cerebral perfusion
• Manage cardiac dysrhythmias (all patients should receive a 12-lead ECG)

Question 21

ROSC vital sign goals

Answer 21

• 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)

Question 22

Adrenaline (Precautions)

Answer 22

• Hypertension
• Hypovolemic shock
• Concurrent MAOI therapy
• MS

Question 23

Adrenaline (Side Effects)

Answer 23

• Anxiety
• Hypertension
• Palpitations
• Pupil dilation
• Tremor

Question 24

Adrenaline (Contraindications)

Answer 24

Nil

Question 25

Adrenaline (Indications)

Answer 25

• 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)

Question 26

Adrenaline cutt-off for IM half dose

Answer 26

6 years of age

Question 27

Waveform capnography indications

Answer 27

• CPR
• Sedation and procedural sedation
• Endotracheal intubation
• Ongoing monitoring of ventilation

Question 28

Answer 28

Reduced EtCO2 levels - causes of this waveform include shock, PE and effective CPR

Question 29

Answer 29

Endotracheal tube in oesophagus

Question 30

Answer 30

Inadequate seal around ETT

Question 31

Answer 31

Increased EtCO2 levels - causes of this waveform include shock, PE and effective CPR

Question 32

Answer 32

Decreased EtCO2 levels from normal - ROSC

Question 33

Answer 33

Obstruction in breathing circuit or airway

Question 34

Answer 34

Increased EtCO2 values towards normal - causes of this waveform include restoration of normal respiratory activity, improved cardiac output or improved integrity of airway seal.