Adult Med and traumatic Cardiac Arrest

Question 1

VF/Pulseless VT

Answer 1

Defibrilate 200 J
Amiodarone 300mg IV if VF/VT after 3rd shock
Lidocaine 100mg IV if VF/VT after 5rd shock
Amiodarone 150mg IV if VF/VT after 7rd shock
Amiodarone 150mg IV if VF/VT after 7rd shock
Adrenaline 1mg IV every 2nd cycle (4 minutes)
Adrenaline 1mg IV every 2nd cycle (4 minutes)

Question 2

Asystole/PEA
Reversible causes

Answer 2

Hypovolaemia
Hypoxia
Hyperkalaemia
Hypothermia
Anaphylaxis
Asthma
Upper airway obstruction
Tension pneumothorax
Pulmonary embolism
Toxins

Question 3

All cardiac arrest patients

Answer 3

SGA
IV access
Adrenaline 1mg IV repeat every 2nd cycle (4 minutes)
Shockable: after 2nd shock
Non-shockable: as soon as time permits
Flush all medications with 20-30mls N/Saline
ETCO2 and OG tube through SGA (where time permits

Question 4

Special circumstances

Answer 4

Hypovolaemia/anaphylaxis/asthma: N/Saline 1000ml- 2000ml IV
Witnesses arrest and known or strongly suspected PE: Thrombolysis (consult)
CPR interfering pt– Ketamine 50-100mg IV every 1-2 minutes or 200mg IM if no access (single dose)

Question 5

Amiodarone

Answer 5

• Class III antiarrhythmic with some action in other classes. Its chief action is prolonging the duration of the action potential and refractory period for cardiac tissue, potentially terminating an arrhythmia. It does this by blocking potassium channels.
• Also displays other antiarrhythmic properties including Class I (inhibiting sodium channels), Class II (non-competitive beta-receptor blocking), and Class IV (calcium channel blocking). This breadth of effect gives it great flexibility as an out-of-hospital antiarrhythmic agent.

Question 6

Lidocaine

Answer 6

• Class Ib antiarrhythmic agent which blocks fast sodium channels in non-nodal tissue of the heart. Depolarisation of cardiac tissue is caused by an influx of sodium, which is inhibited by lidocaine (lignocaine). This prolongs depolarisation and helps inhibit aberrant tachyarrhythmias.
• Also decreases the action potential duration, decreases irritability of the tissue, and can decrease automaticity. As lidocaine (lignocaine) is most effective on depolarised or inactivated tissue states, this is helpful in ischaemic ventricular tissue, which can occur during refractory pulseless VT (pVT) or VF.
• Minimal effect on nodal tissue and does not affect nodal tissue function.