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Cardiac arrest in special circumstances > Cardiac arrest in special circumstances > Flashcards

Cardiac arrest in special circumstances Flashcards

1
Q

What is the most likely rhythm in asphyxia cardiac arrests

A

PEA or asystole

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2
Q

Three causes of asphyxia cardiac arrest

A

Hanging
Drowning
Asthma

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3
Q

Normal range for serum potassium

A

3.5-5.0mmol/L

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4
Q

Serum range for severe hyperkalaemia?

A

> 6.5 mmol/L

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5
Q

What happens to serum potassium levels in acidaemia?

A

Increase in serum potassium

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6
Q

Three causes of hyperkalaemia ?

A 
Renal failure (C/A)
Drugs
Tissue breakdown
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7
Q

Three drugs ass. w/ hyperkalaemia?

A

ACEI, beta blockers, NSAIDS

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8
Q

ECG abnormalities associated with hyperkalaemia

A

Tall tented T waves (T>R in >1 lead)
Flat/absent P waves
S&T wave merging

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9
Q

What is used to shift potassium into cells? What should be monitored?

A 
Glucose (25g) + insulin (10 units) solution. 
 or nebulised (10-20mg) of salbutamol (severe). Monitor glucose and K
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10
Q

What is used for cardiac protection in hyperK

A

IV Calcium chloride or calcium gluconate

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11
Q

What can be used to remove potassium in

a) mild hyperK
b) sever hyperk

A

a) calcium resonium

b) dialysis

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12
Q

How is hypokalaemia defined?

A

<3.5mmol/L

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13
Q

Three causes of hypokalaemia

A

GI losses, endocrine disorders, dialysis

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14
Q

Symptoms and signs of hypoK?

A

Mild- weakness, fatigue, cramps

Severe- rhabdomyolysis, ascending paralysis

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15
Q

2 ECG changes ass. w/hypoK?

A

U waves & flat T waves

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16
Q

What other electrolyte might be important to give in hypoK?

A

Magnesium

17
Q

What temperature is classified as severe hypothermia?

A

28-24 C

18
Q

What should be used to diagnose hypothermia?

A

Low reading thermometer placed in the lower third of the oesophagus

19
Q

What is the rationale behind therapeutic hypothermia?

A

Cellular demand for oxygen reduces by 6% for every 1 C drop in temperature. Inducing hypothermia-> better neurological outcomes

20
Q

What CPR sequence should be used in patients:

a) temp <28 C
b) temp <20 C

A

a) Continuous CPR (or CPR 5 mins/ 5 min break repeat)

b) CPR 5 mins/break 10 mins repeat

21
Q

When would you hesitate to resuscitate a hypothermic patient?

A

Asystole, snow obstructing airway, signs of irreversible death, if hypothermia unlikely to be primary cause of CA

22
Q

When should the rescuer give a hypothermic patients drugs? How should these drugs be given?

A

Drugs (and shocks) withheld until temp >30 C. When temp >30 C, interval between doses should be doubled. Revert to standard when >35 C

23
Q

Which is the only rhythm that should be shocked in hypothermic patients?

A

VF- shock 3x and if failed, wait until temp >30 C before starting.

24
Q

In PHM- how are hypothermic patients rewarmed?

A

Remove p from cold environment. Passive rewarming e.g. blankets and aluminium foil. Active external e.g. heats pads.

25
Q

In hospital, how are hypothermic patients rewarmed?

A

If not severe- warm IV fluids & humidified air.

If severe can consider VA-ACMO with warm fluids.

26
Q

Why do hypothermic patients required so much fluid during rewarming?

A

Vasodilation during hypothermic increases intravascular space.

27
Q

How is heat stroke differentiated from heat exhaustion?

A

Heat stoke - change in mental status, temperature >40 C, SIRS and varied organ dysfunction

28
Q

What are some risk factors for heat stroke?

A

Elderly age, specific drugs e.g. anticholinergics, hyperthyroidism, skin conditions

29
Q

What is the treatment for hyperthermia?

A

Fluid & electrolyte correction & rapid cooling e.g. cold IV fluids, cold packs, drinking cold fluids

30
Q

What is malignant hyperthermia?

A

Genetic condition. Calcium homeostasis of skeletal muscle. Hypermetabolism & muscle contracture caused by specific anaesthetics and muscle relaxants

31
Q

Treatment of malignant hyperthermia?

A

Dantrolene, stop trigger, active cooling, oxygen, correct acidosis & electrolytes

Cardiac arrest in special circumstances (1 decks)

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