Chapter 14: Pre-hospital Cardiac Arrest

Question 1

What interventions offer the best chance of survival after OHCA?

Answer 1

1. Bystander CPR
2. AED before ambulance arrives

Question 2

Positions of team during OHCA:

Answer 2

Position 1: Head of patient - Airway

Position 2: Pt’s left side - Compressions, defib, drugs

Position 3: Pt’s right side - Compressions, drugs

Position 4: Stand back & oversee - Team Leader

Question 3

What is the aim of pre-hospital airway Mx?

Answer 3

1. Maintain patent airway
2. Adequate oxygenation
3. Adeqaute ventilation

Question 4

Stepwise approach to airway Mx:

Answer 4

1. No interventions
2. Mouth-to-mouth
3. BMV
4. SGA
5. ETT

Question 5

What are the practical considerations in pre-hospital intubation?

Answer 5

1. 360° access
2. All equipment available in “kit dump”
3. Check all equipment
4. Pateint positioning - trolley at knee level of airway person
5. Don’t use cricoid pressure routinely
6. Use bougie
7. Use correct size blade - Size 4 in adults
8. Secure tube immediately after insertion: 22-23 cm males; 21-22 cm females
9. Minimise interruptions to compressions

Question 6

Cx of pre-hospital intubation:

Answer 6

1. Hypoxaemia
2. Unrecognised oesophageal intubation
3. Endobronchial intubation

Question 7

When not to start resus in pre-hospital arrest?

Answer 7

1. DNACPR
2. Refusal of CPR in ADRT
3. Decapitation
4. Hemicorporectomy
5. Massive cranial & cerebral destruction
6. Incineration - > 95% full thickness burns
7. Decomposition / putrefaction
8. Rigor mortis & hypostasis

Question 8

What is safest option when unsure of facts of when not to start resuscitation?

Answer 8

1. Start resus
2. Continue until facts known

Question 9

When to stop CPR in asystolic patient in pre-hospital setting?

Answer 9

1. Persistent & continuous asystole
2. > 20 min
3. All reversible causes have been identified & corrected

Question 10

Which patients with asystole should be transported to nearest facility with ongoing resus as “priority” cases regardless of time?

Answer 10

1. < 18 years
2. Drowning
3. Hypothermia
4. Poisoning
5. Pregnant

Question 11

When to stop CPR in PEA patient in pre-hospital setting?

Answer 11

1. More difficult to determine
2. Recommend involving senior clinician to support decision
3. When PEA > 20 min
4. All reversible causes have been identified & corrected

Question 12

General priniciples of pre-hospital post-resus care:

Answer 12

1. Sats: 94-98%
2. Capnography: 4.6-6.0
3. BP
4. ECG
5. Blood glucose
6. Temp: Prevent fever < 37.7

Question 13

How to give fluids in pre-hospital setting post ROSC?

Answer 13

1. 250 ml IV bolus of 0.9% NaCl

Question 14

How to give adrenaline in pre-hospital setting post ROSC?

Answer 14

1. Boluses of ADR 0.05-0.1 mg IV
2. Titrated against BP
3. Keep SBP > 100

Question 15

Position to transport patient in to optimise cerebral perfusion:

Answer 15

1. Supine
2. Feet-first if coming down stairs
3. Head up slightly - 30° position

Question 16

How to pre-alert hospital for medical case?

ATMIST

Answer 16

1. Age
2. Time of onset
3. Medical complaint / Hx
4. Investigations (exam findings)
5. Signs (vital)
6. Treatment + ETA + resources needed on arrival

Question 17

How to pre-alert hospital for trauma case?

ATMIST

Answer 17

1. Age
2. Time of incident
3. Mechanism of injury
4. Injuries (head-toe)
5. Signs (vital)
6. Treatment + ETA + resources needed on arrival