Week 6- Management of Cardiac Arrest Flashcards
1
Q
What is a cardiac arrest?
A
- Occurs when the heart suddenly and unexpectedly stops pumping
- Often from an irregular heart rhythm
- Blood stops flowing to the brain and other vital organs
2
Q
What are the causes of cardiac arrest?
A
- Atherosclerosis or other underlying cardiac diseases
- Genetic disorders
- Cardiomyopathies
- Can occur after electrocution, drowning, trauma, drug overdoses
3
Q
Pt. Location during a Cardiac Arrest
A
- Ensure they are on a hard flat surface- floor vs. bed
- Ensure there is enough space
- Planning ahead- extrication
- Move pt. ONLY if necessary
DON’T MOVE PT. BACK
4
Q
What should you do to confirm a cardiac arrest?
A
- Rapid assessment of C-A-B to determine if pt. is in cardiac arrest
- Many different presentations can initially appear as cardiac arrest
- Check carotid & radial pulses as well as breathing in <10 secs
5
Q
Once a cardiac arrest is confirmed, what should you do next?
A
Apply the monitor
- Apply pads immediately
6
Q
Do we count pre-arrival interventions when dealing with a cardiac arrest?
A
- Paramedics DO NOT count pre-arrival interventions into their pt care.
- Care delivered prior to arrival can be “considered”and documented
7
Q
What do we follow when doing CPR?
A
- High-quality CPR
- Do not interrupt compressions except for rhythm checks and defib
- Remember that once an advanced airway is placed- compressions become continuous
- Don’t interrupt CPR for an advanced airway
- Swap compressors every 2 mins
30:2 without advanced airway- 1:6 when advanced airway, CPR becomes continuous
8
Q
What is the airway management?
A
- Begin with OPA and BVM ventilations
- Ensure ETCO2 is applied
- Suction as needed
- Introduce advanced airway when possible
9
Q
What do you want to aim to have SPO2 & ETCO2?
A
SPO2= 94-96%
ETCO2= 35-45 mmHg
10
Q
What happens once an advanced airway is placed in your pt?
A
- Compressions become asynchronous at a rate of 10bpm, 1:6
11
Q
What are the advanced airways for PCP?
A
- Supraglottic airways (king LT’s & I-gel)
12
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
13
Q
When should you do pulse checks?
A
- Routinely every 2 mins
- Done last 15 secs of the 2 min CPR cycle
- Use carotid or femoral
14
Q
What does defibrillation do to the heart?
A
- Defib stuns the heart muscle momentarily and allows the normal conduction to resume control
15
Q
How old must a pt be to get defibed?
A
- Pt. must >24 hrs old
16
Q
How do you prep the chest?
A
- Shave excessive hair if needed
- Dry the skin if moist/ wet
- Remove medication patches only if they are directly where pads will go
17
Q
What is the defib pad placement?
A
- Generally sternum/ apex
- Can be anterior and posterior
- Sternum pad to the right of the sternum, with the top edge just touching the bottom of the right clavicle
- Apex pad to the left lower ribs at the anterior axillary line
18
Q
What are the joule settings for >24 hrs to <8 yrs?
A
- Initial dose: 2J/ kg
- Subsequent dose: 4J/ kg
- Interval= 2 mins
19
Q
What are the zoll joule settings?
A
- 120J, 150J, 200J
20
Q
What are the lifepak joule settings?
A
- 200J, 300J, 360J
21
Q
What are the 2 shockable rhythms?
A
- V tach and V Fib
22
Q
What are the steps to safely defibrillate?
A
- Stop CPR at the 2 min interval and check rhythm and confirm the absence of pulse
- Once shockable rhythm is confirmed, have the compressor resume compressions
- Select the “energy select” arrow on the monitor until you select your desired joule settings
- Press “charge”
- Monitor will alert and the “shock” button will flash when the monitor is ready to defibrillate
- Clear the pt- “I’m clear, you’re clear, all clear”
- Once clear- press the flashing shock button
- Immediately resumeCPR
23
Q
What are the 5 main uses for ETCO2 in cardiac arrest?
A
- Verify tracheal tube placement
- Identify tracheal tube displacement
- Evaluate CPR quality
- Identify ROSC
- Determine when ROSC is unlikely
24
Q
During cardiac arrest, what does higher ETCO2 indicate?
A
- Higher cardiac output (good CPR)
25
During cardiac arrest, what does lower ETCO2 indicate?
- Change compressors or improve CPR quality
26
During cardiac arrest, what does ETCO2 decreasing indicate?
- Observe for chest compressor fatigue, hyperventilation, airway obstruction, or tracheal tube displacement
27
During cardiac arrest, what does ETCO2 increasing indicate?
- CPR is likely effective and ventilation appropriate; substantial rise can indicate ROSC
28
What does ETCO2 <10 mmHg at 20 mins indicate?
- Futility (exceptions include hypothermia)
29
What does ETCO2 >25 mmHg at 20 mins indicate?
- survival
30
What are the 5 signs of a ROSC?
1. sudden increase in ETCO2
2. Spontaneous resps
3. Palpable pulses
4. Change in colour
5. Spontaneous movement
31
What should you do if you obtain a ROSC?
- Do a complete assessment of CAB
- 12 lead ECG
- Full set of vitals
- Continually reassess & treat findings
32
When should you establish the presence of a DNR?
- ASAP
- If one present- confirm it is valid
33
What should you do if DNR is incomplete/ not present?
- Phone BHP to discuss it
34
What will a valid MOH DNR include on it?
1. The name of pt (surname & first name)
2. A checkbox that has been checked to identify one of the following conditions has been met
a. A current plan of tx exists that reflects the pt's expressed wish when capable, or consent of SDM when pt is incapable, that CPR not included in pt's tx plan
b. The physician's current opinion is that CPR will almost certainly not benefit the pt & is not part of the tx plan, and the physician has discussed this with the capable pt or SDM when pt is incapable
3. A checked box that identify the professional designation of the MD, RPN, RN, RN (EC), who has signed the form
4. Printed name of the MD, RPN, RN or RN (EC) signing the form
5. A signature by the appropriate MD, RPN, RN or RN (EC)
6. The date that the form was signed, which must be the same as or precede the date of request for ambulance service
35
Can the DNR be a copy of the fully completed original?
- Yes, as long as it is fully completed
36
What happens when we are presented a valid MOH DNR?
- We shall not initiate CPR on the pt in the event that the pt experiences resp or cardiac arrest (resp & pulse are absent for at least 3 mins from the time that was noted by the paramedic)
37
When can a paramedic initiate CPR on a pt who has experienced resp or cardiac arrest?
- The pt with a valid MOH DNR Form appears to the paramedic to be capable and expresses clearly a wish to be resuscitated in the event they need to be OR
- The pt with a valid MOH DNR form appears to the paramedic capable and expresses a wish to be resuscitated in the event they need to be, but the request is vague, incomplete or ambiguous such that it is no longer clear what the wishes of the pt are
38
If a DNR is presented to the paramedics, in the event the pt is dying, then they should...
- The paramedic shall provide pt management as necessary to provide comfort or alleviate pain, as required by the pt's clinical condition
- Once it has been determined that death has occured, the paramedic shall:
a. Advise the CACC/ ACS; and
b. follow the deceased pt standard
- In conjunctions with the Documentation of Pt Care Standard, the paramedic shall not and document the time at which the paramedic confirms the pt was deceased
39
What should you be doing with the family of the pt in cardiac arrest?
- Update as much as possible
- Use definitive wording
- Explain what you have done & what the response has been
- Update family on transport decision
- Family watching resus- generally positive
