cardiac arrest management

Question 1

how do you recognise a cardiac arrest?

Answer 1

• unresponsive patient
• not breathing properly
• no pulse

Question 2

what is the in-hospital management of collapsed/sick patient?

Answer 2

collapsed/sick patient
shout for help and assess patient
signs of life
NO = call resuss team, CPR 30:2, defib if appropriate, adv life support from team
YES = asses ABCDE, oxygen, monitoring, IV access, call ressus team if app, hand over to team

Question 3

what are shockable rhythms?

Answer 3

• VF

- pulseless VT

Question 4

what is the immediate post cardiac arrest treatment?

Answer 4

• ABCDE
• aim for O2 of 94-98
• aim for normal CO2
• 12 lead ECG
• treat cause
• targeted temperature

Question 5

what drug is given for bradycardia?

Answer 5

• atropine or B-stimulant eg ephedrine

Question 6

what drug do you use for excess afterload?

Answer 6

• vasodilators

eg HBP

Question 7

what drug do you use to reduce afterload?

Answer 7

• vasoconstrictor

eg septic shock

Question 8

how is airway obstruction treated?

Answer 8

• airway opening eg head tilt chin lift
• simple adjuncts
• advanced techniques eg LMA, tracheal tube
• oxygen (increase FiO2)

Question 9

what are the 4 categories that patients can be in?

Answer 9

1. responsive/unresponsive = conscious/uncoscious
2. breathing = unconscious = recovery position/help
3. not breathing = respiratory arrest = help/ventilation
4. no pulse = cardiac arrest = help/CPR

Question 10

what is the diagnosis of a cardiac arrest?

Answer 10

• unresponsive

- not breathing normally

Question 11

how to carry out adult basic life support?

Answer 11

• shake and shout
• head tilt chin lift
• assess breathing eg look for movement
• 30 chest compressions - 5-6cm, 100-120 per minute
• 2x rescue breath - hold nose

Question 12

what do you do if someone is chocking?

Answer 12

• severe?
  unconscious = start CPR
  conscious = 5 back blows, 5 abdominal thrusts

Question 13

what is ventricular fibrillation?

Answer 13

• a shockable rhythm
• no recognisable QRS complexes
• random frequency and amplitude
• unco-ordinated electrical activity

Question 14

what is ventricular tachycardia? VT

Answer 14

• monomorphic VT
• broad complex rhythm
• rapid rate
• constant QRS morphology
• polymorphic VT
• torsade de pointes

Question 15

what is defibrillation?

Answer 15

• use of electrical current to reset heart electrical rhythm with hope that regular rhythm will recur

Question 16

after delivery of shock, what should you do?

Answer 16

• CPR for 2 mins
• deliver second shock
• CPR for 2 mins
• deliver 3rd shock
• given amiodarone
• CPR, if VF/VT persists give 1mg adrenaline IV

Question 17

what is an example of a non shockable rhythm?

Answer 17

• asystole

- PEA

Question 18

what is asystole?

Answer 18

• absent ventricular (QRS) activity (check electrodes)
• P waves may persist
• rarely a straight line trace
• adrenaline 1mg IV as soon as possible
• every 3-5 mins thereafter

Question 19

what is pulseless electrical activity?

Answer 19

• clinical features of cardiac arrest
• ECG normally associated with an output
• exclude / treat reversible causes
• adrenlaine 1mg IV asap
• every 3-5 mine thereafter

Question 20

what are the potentially reversible causes of MI?

Answer 20

• hypoxia
• hypovolaemia
• hypo/hyperkalaemia/metabolic
• hypothermia
• thrombosis - coronary pulmonary
• tension pneumothroax
• tamponade - cardiac
• toxins