Cardiopulmonary resusitation

Question 1

Compression: breath ratio 1) neonate 2) paediatric 3) adult

Answer 1

Neonate = 3:1
Paediatric = 15:1
Adult = 30: 1

Question 2

Shock in joules

Answer 2

Paediatric = 4 J/kg
Adult = 200 J

Question 3

Adjuncts during CPR

Answer 3

LMA/ETT
Oxygen
Waveform capnography
IV/IO access

Question 4

Shockable rhythm drugs

Answer 4

Adrenaline 1mg after 2nd shock. Then every 2nd loop (every 4 minutes)
Amiodarone 300mg after 3rd shock

Question 5

Non-shockable rhythm drugs

Answer 5

Adrenaline 1mg immediately. Then every 2nd loop.

Question 6

What are the 4 H’s

Answer 6

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hyper/hypothermia

Question 7

What are the 4 T’s ?

Answer 7

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary, coronary)

Question 8

Post resuscitation care

Answer 8

Re-evalauate ABCDE
12 lead ECG
Treat precipitating cause

Question 9

Ideal respiratory rate once ETT or LMA placed in CRP?

Answer 9

10

Question 10

When should you give 3 stacked shocks?

Answer 10

Monitored and witnessed arrest in a patient
Well perfused and oxygenated patient
When defibrillation can be provided within 20 seconds

Question 11

Defibrillation instructions

Answer 11

1) Compressions continue, everyone else stand clear. Oxygen away.
2) charge check everyone and oxygen away
3) “Hands off”
4) Deliver or dump charge

Question 12

How many shocks will have been delivered before giving 300mg amiodarone for VF/pVT

Answer 12

3

Question 13

How many shocks will have been given in VF/pVT before adrenaline is given?

Answer 13

2

Question 14

When do you check pad position?

Answer 14

Refractory VT/VF

Question 15

When would you consider giving a 150mg dose of amiodarone?

Answer 15

After the 5th shock

Question 16

If there is no amiodarone, what dose of lignocaine would you give for VF/pVT?

Answer 16

1mg/kg

Question 17

When do you feel for a pulse during CPR?

Answer 17

During the rhythm check only if electrical activity consistent with possible cardiac output is seen (not asystole, VF or VT –> presumed pulseless VT if patient tolernating CPR

Question 18

Indication for precordial thump?

Answer 18

Witness and monitored pVT if there is a delay in getting defibrillator
No evidence for VF

Question 19

What should you do with the ECG leads if you see asysole?

Answer 19

Check placement. Ensure gain is appropriate.

Question 20

What should you do if you see P waves only (ventricular standstill) in an unconscious person?

Answer 20

Try pacing

Question 21

Does using an ETT over a SGA improve survival in an arrest?

Answer 21

No

Question 22

When is it appropriate to pause chest compression during ETT placement?

Answer 22

Only when passing tube through vocal cords. Pause must be < 5 seconds.

Question 23

Can end tital CO2 monitoring be used with SGA and bag mask?

Answer 23

Yes, but less reliable than with ETT

Question 24

You suspect ROSC. That patient is due adrenaline. Do you give it?

Answer 24

No. 1mg adrenaline could be harmful if ROSC. Withold till rhythm check.

Question 25

What is the role of end tidal capnography in CRP?

Answer 25

1) Ensure ETT placement 2) Ensure good quality CPR 3) Identify ROSC 4) Prognostication and indication of cause of arrest (higher in asphyxial arrest and with good CPR, declines over time) Higher CO2 = better prognosis

Question 26

What type and how much calcium would you give in severe hyperkalaemia

Answer 26

10ml of 10% calcium chloride

Question 27

How much glucose and insulin would you give in severe hyperkalaemia?

Answer 27

50ml 50% glucose = 25g | 10 units short acting insulin (novorapid)

Question 28

When would sodium bicarbonate be useful in hyperkaelamia? How much would you give?

Answer 28

In setting of acidosis. 50 mmol IV

Question 29

What is the difference between calcium gluconate and calcium chloride? Why would calcium chlroide be preferable in an arrest?

Answer 29

Calcium gluconate = 8.9mg/ml elemental calcium Calcium chloride = 27.2mg/ml elemental calcium = 3 x more calcium Calcium gluconate needs to be hepatically metabolised to release its calcium. In setting of arrest and poor liver function this may be an issue.

Question 30

How much potassium and magnesium would you give in an arrest if the patient has hypokalaemia?

Answer 30

5 mmol potassium IV push | 2g magnesium sulfate IV push

Question 31

What is dantrolene used for ?

Answer 31

Malignant hypertherthermia due to anaesthetic agents. | Can be useuful in MDMA and amphetamine overdose with hyperthermia also.

Question 32

A patient had witnessed cardiac arrest, with good bystander CPR. They initially had a shockable rhythm and at one point had ROSC. Would you consider transport for PCI or thrombolysis?

Answer 32

Yes

Question 33

Is routine use of fibrinolytic therapy for an out of hospital cardiac arrest recommended in most cases?

Answer 33

No

Question 34

A patient has a cardiac arrest, you suspected massive PE and provided thrombolysis. How long should you continue CPR for?

Answer 34

At least 30 minutes. Up to 60 - 90 minutes (good outcomes still documented)

Question 35

What are the clues pointing towards a tension pneumothoroax during CPR?

Answer 35

1) High pressure felt on manual ventilation 2) Abnormal chest rise/fall on affected side 3) decreased breath sounds on affected side 4) hyper-expanded chest with increased percussion note on affected side 5) Tracheal deviation away from affect side - late sign

Question 36

You've used a 14 G long needed to decompression a tension pneumothorax but it hasn't seemed to help. Name 3 reasons why.

Answer 36

1) Obstruction (blood, tissue, cannula kinked/compressed 2) Missing a localised pneumothorax e.g cannula too short 3) Inability to drain large air leak 4) Moving, dislodging and falling out

Question 37

What is Beck's triad in regards to pericardial effussion?

Answer 37

1) JVP distension 2) Muffled/distant heart sounds 3) Narrow pulse pressure *signs may only be briefly present, at at all prior to arrest*

Question 38

In the case of arrest due to toxins. Is there any evidence for providing antidotes the antidotes naloxone, flumazenil, digoxin specific antibodies fragments, phentolamine, glucagon?

Answer 38

No

Question 39

Name two toxic cause of arrest where providing an antidote is effective

Answer 39

1) Cyanide poisoning. Provide IV 5mg hydroxycobalmin. Repeat dose up to max of 15mg 2) TCA overdose: provide sodium bicarbonate boluses

Question 40

What reversible cause of cardiac arrest can an USS be used for?

Answer 40

1) Cardiac tamponade 2) Tension pneumothorax 3) aortic dissection 4) Hypovolaemia