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TERM 3 STUDY > Complex CAM and POST-ROSC care > Flashcards

Complex CAM and POST-ROSC care Flashcards

1
Q

How is “sustained ROSC” defined?

A

Sustained ROSC is deemed to have occurred when chest compressions are not required for 20 consecutive minutes and signs of circulation persist

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2
Q

What is the most common cause of Traumatic cardiac arrest?

A

Hemmorrhage

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3
Q

What are the top priorities in TCA management?

A

Prioritizing the underlying cause of arrest over CPR.

  • Hypovolemia
  • Hypoxemia
  • Tension pnx
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4
Q

When should early discontinuation be. considered in TCA?

A
  • Blunt traumatic arrest.
  • Transport times exceeding 15minutes.
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5
Q

When should rapid transport be considered in traumatic cardiac arrest?

A

Less than 15 min transport time and penetrating traumatic arrest.

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6
Q

Describe the HOTTT Drill

A

Systematic approach to identifying and treating the most common and easily correctable causes of arrest in trauma patients.

  • Hemorrhage
    • Control deadly bleading
  • Oxygenate
    • Ensure intact airway, ventilation, oxygenation
  • Tension
    • Decompress
  • Tourniquet (Pelvis binder)
  • Transfuse
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7
Q

What are reasonable goals for ACP-led pre-hospital traumatic cardiac arrest care?

A
  • Stop massive hemorrhage
  • Solo intubation
  • Immediate bilateral needle decompression (4)
  • Apply pelvic binder
  • 2L infused–>bilateral humeral IO.
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8
Q

Special considerations in crush injury patients

A
  • calcium, sodium bicarb,
  • N/S loading
  • Tourniquets.
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9
Q

What does the dicrotic notch on an arterial pressure waveform represent?

A
  • Closure of the aortic valve
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10
Q

What is the significance of the total area under the curve of an arterial pressure waveform?

A

represents MAP

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11
Q

What is represented by the difference between the top and bottom of an arterial pressure waveform?

A

pulse pressure

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12
Q

What does a widening vs. narrowing arterial pressure waveform represent?

A
  • Widening = greater SVR, indicates vasoconstriction
  • Narrowing = lower SVR, indicates fluid depletion or vasodialtion
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13
Q

Which takes precedence in treatment of traumatic Cardiac arrest? Treatment of reversible causes or chest compressions?

A

treatment of reversible causes!

Use the HOTTT drill

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14
Q

What are the three leading field-treatable (by ACP)causes of traumatic cardiac arrest

A
  • Hypovolemia
    • stop the bleeding
  • Hypoxia
    • oxygenate/ventilate
  • Tension pneumothorax
    • Decompress the chest
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15
Q

Which two cadiac rhythms in traumatic cardiac arrest are most associated with poor outcomes?

A
  • Asystole (duh)
  • BRADYCARDIC PEA (HR<40bpm)
    • non-bradycardic PEA does not carry as poor of a prognosis and the patient should be agressively resuscitated
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16
Q

Compare/contrast the terms “ROC”, “sustained ROSC”, and “survived event”

A
  • ROSC
    • A brief (approximately 30 seconds or greater) restoration of spontaneous circulation that provides evidence of more than an occasional gasp, occasional fleeting palpable pulse, or arterial waveform
  • Sustained ROSC
    • ROSC with no need for re-initation of compressions >20 consecutive minutes
  • Survived event
    • Sustained ROSC to transfer of care at receiving facility
17
Q

Define Ischemia-reperfusion Injury (IRI) or reperfusion syndrome

A

paradoxical exacerbation of cellular dysfunction and death, following restoration of blood flow to previously ischaemic tissues.

18
Q

What are CPG-supported priorities in post-ROSC mangement

A

ABC!

  • Manage airway
    • include waveform etCO2 to confirm ETT/SGA integrity
  • Manage respiratory parameters
    • Target SpO2 92-98%
    • Initial RR=10bpm, titrate to EtCO2 of 35-45mmHg
  • Manage hemodynamic parameters
    • SBP >90mmHG or MAP>65mmHg
    • Consider fluids/vasopressors/inotropes
19
Q

Hs and Ts in Cardiac Arrest

A

Hypovolemia

Hypoxia

Hydrogen ion or acidosis (respiratory or metabolic)

Hypo or hyperkalemia

Hypothermia

Tension pneumothorax

Cardiac tamponade

Toxins

Pulmonary thrombosis

Coronary thrombosis

20
Q

Describe effects of hyper/hypocapnia and hypoxemia in the Cerebral, Systemic, and Pulmonary Circulation

A
  • Cerebral
    • Hypercapnia = vasodilation = increased CBF
    • Hypocapnia = vasoconstriction = decreased CBF
    • Hypoxemia = vasodilation = increased CBF
  • Systemic (same as in brain)
    • Hypercapnia = vasodilation
    • Hypocapnia = vasoconstriction
    • Hypoxemia = vasodilation
  • Pulmonary (opposite!)
    • Hypercapnia = vasoconstriction
    • Hypocapnia = vasodilation
    • Hypoxemia = vasoconstriction++++
21
Q

Describe situations where permissive hypercapnia or hypocapnia may be acceptable in the post-ROSC setting

A
  • Hypercapnia: patients with acute lung injury or high airway pressures
  • Hypocapnia: temporizing of patients with suspected cerebral edema
22
Q

Describe neuro-protective

A

TERM 3 STUDY (11 decks)

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