Cardiac Arrest

Question 1

initial actions to take when patient brought in with cardiac arrest

Answer 1

assess responsiveness–shake and shout

call for help

position victim/rescuer

Question 2

how do you do a primary survey

Answer 2

ABDC

Airway
–open airway with head tilt, chin lift, jaw thrust, remove foreign body, oropharyngeal airway if available

Breathing

• -look, listen, feel
• -give two quick breaths to rule out airway obstruction

Circulation

• -start chest compressions if remains pulseless
• -cardiac monitor

Defibrillation
–shock ventricular fibrillation or pulseless ventricular tachycardia

Question 3

what rhythms do you defibrillate

Answer 3

ventricular fibrillation

pulseless ventricular tachycardia

Question 4

what are the “Hs and Ts”

Answer 4

reversible causes of cardiac arrest

Question 5

what are the “Hs” of H and Ts

Answer 5

hypovolemia
hypoxia
H ions (acidosis)
hypo or hyperkalemia
hypoglycemia
hypothermia

Question 6

what are the Ts of H and Ts

Answer 6

toxins
tamponade
tension pneumo
thrombosis--coronary or pulmonary 
trauma

Question 7

how do you do a secondary survey

Answer 7

ABCD

Airway
–advanced airway control as needed i.e intubation

Breathing
–continue PPV, assess adequacy of ventilation

Circulation

• -IV access
• -BP monitoring
• -rhythm appropriate cardiac drugs via IV followed by 20-30 cc NS bolus and arm elevation

Differential Diagnosis

Question 8

in pulseless arrest, what is a shockable rhythm? not shockable?

Answer 8

shockable: VF, VT

not shockable: asystole, PEA

Question 9

how do you manage pulseless arrest

Answer 9

do the BLS algorithm
call for help
give CPR

give O2 when available

attach monitor/defibrillator when available

Question 10

how do you treat pulseless VF/VT

Answer 10

give 1 shock and the resume CPR

after 5 cycles of CPR check rhythm

if shockable, give another shock

resume CPR

if have IV, give EPINEPHRINE 1 mg IV/IO during CPR
–repeat every 3-5 minutes

OR may give 1 dose of vasopressin 40 U IV/IO to replace first or second dose of epinephrine

after another 5 cycles of CPR, check rhythm again

if shockable, give another shock, then resume CPR

at this point consider antiarrhythmics like amiodarone 300 mg IV/IO once then 150 mg once more thereafter
-or-
lidocaine

consider magnesium for torsades (1-2 g IV/IO)

Question 11

what meds may be used in the algorithm for managing VF/VT in addition to shocks

Answer 11

epinephrine
vasopressin
amiodarone
lidocaine
magnesium

Question 12

dose of epinephrine in cardiac arrest

Answer 12

epinephrine 1 mg IV/IO, repeat q3-5 min

Question 13

dose of vasopressin in cardiac arrest

Answer 13

vasopressin 40 U IV/IO to replace first or second dose of epinephrine

Question 14

dose of amiodarone in cardiac arrest

Answer 14

consider after third shock and after trying epinephrine

300 mg IV/IO x 1 then another dose of 150 mg IV/IO after if needed

Question 15

dose of magnesium used to manage/prevent torsades in VF/VT arrest

Answer 15

1-2 g IV/IO for torsades

Question 16

a patient is pulseless. what rhythm is NOT shockable

Answer 16

asystole

PEA

Question 17

how do you manage PEA or asystole

Answer 17

CPR
give epinephrine
(can also consider vasopressin)

consider ATROPINE for asystole or slow PEA rate –> atropine 1 mg IV/IO repeat q3-5 min for up to 3 doses