Chapter 6 Flashcards

Question

VASCULAR acess in resus

Answer 1

always go for peripheral lines rather than any central as this requires to stop the CPR drugs injected peripherally needs to be FOLLOWED by a flush 20ml fluid and elevation of that extremity for 10-20s to facilitate drug delivery ======== if rapid IV access if impossible consider Inter osseous route - it achieves adequate plasma concentration in a time comparable with injection through vein. once inserted confirm correct placemnet - attempt to aspirate fom needle - presence of IO blood indicates this , but void aspiration does not imply failed attempt. -always flush the needle Ensure latency and observe for leakage and extravasation Fluids and blood products can also be given IO however pressure will be needed to achieve reasonable flow rates using either a pressure bag or a syringe

Answer 2

proximal humerus proximal tibia distal tibia contra - trauma , infection , prosthesis recent IO access in the past 48 hr , including FAILED attempts failure to identify anatomical landmarks Complications - extravasation and that leading to compartment syndrome Fracture or chipping of bone during insertion

Answer 3

The H and T Hypoxia , hypovolemia, hyperkalemia/hypokalemia Hypocalcemia Hypoglycemia Hypo/hyperthermia Hydrogen ion - acidosis Thrombosis Tension pneumothorax Tamponade Toxins Trauma

Answer 4

Always ensure patient receives 100 percent oxygen during CPR to stop HYPOXIA - adequate chest rise and bilateral breath sounds PEA can be caused by severe haemorrhage which can lead to hypovolemia - rapid fluid or blood needs to be given. Hyperkalemia/hypokalemia /hypoglycaemia /hypocalcemia and other metabolic disorders can be suggested by last medical history - renal failure)

Answer 5

Intravenous calcium chloride

Answer 6

Coronary thrombosis common cause. If acute coronary syndrome is expected to be the cause of refractory cardiac arrest - can perform percutaneous coronary angiography and Conor any intervention whilst ongoing CPR =it would require automated chest compression device Decision to transport patient need to be assessed - realistic chance of survival are those with witnessed cardiac arrest with initial shockable rhythm (VF /pVT) and bystander CPR ===== Most common cause is massive PE Then consider fibrinolytics immediately =survival and good neurological outcome reported If fibrinolytic drug is given CONSIDER PERFORMING CPR for ATLEAST 60-90min before termination When and if available - extracorporeal CPR or surgical and mechanical thrombectomy should be considered. ==== Tension pneumothorax = PEA Diagnosis - clinically of focussed US of chest Decompress rapidly with thoracostomy of needle thoracocentesis nsertion of a large-bore needle with a syringe, partially filled with 0.9% saline adults : 2nd intercostal space at the midclavicular line or the 4th–5th intercostal space between the anterior and midaxillary line and insert chest drainage ====== Cardiac tamponade - difficult to diagnose Typical distended neck veins and hypotension cannot be assessed Focussed cardiac US during cpr can be used to diagnose pericardial effusion. Cardiac arrest after penetrating chest trauma or after cardiac surgery should strongly raise suspicion. Resuscitative thoracotomy ===== toxins and drugs

Answer 7

Detect cardiac tamponade , pulmonary embolism , ischemia (motion wall abnormality) , aortic dissection ,pneumothorax Requires training if we are trying to minimise interruption to CPR Sub-xiphoid probe position is recommended Placement of probe just before chest compression is stopped for rythm assessment and to obtain views in 10s needs a very skilled individual

Answer 8

Requires vascular access and a circuit with a pump and oxygen stir This can provide a circulation of oxygenated blood to restore tissue perfusion - buy time for restoration of an adequate spontaneous circulation and treatment of reversible underlying conditions. Evidence suggest ECPR can improove chance of survival in selected patients in where there is reversible cause for cardiac arrest( - myocardial infarction , PE, hypothermia , poisoning) ,little Co morbidity , the cardiac arrest is witnessed , individual receives high quality CPR , early implementation of ECPR and certainly within 1hr of collapse. Individual receives high quality COR and ECPR is initiated as soon as possible

Answer 9

Team leader should discuss stopping CPR with the team. Requires clinical judgment and careful consideration into ROSC likelihood , and LONG TERM SURVIVAL Duration is based on the INDIVIDUAL If it was considered appropriate to START RESUS then worthwhile to continue as long as patient in VF/pVT, or potential reversible cause Use of mechanical compression and ECPR makes it easier for prolonged attempts at resuscitation Generally accepted : Asystole of more than 20 mins with no reversible cause can stop being resuscitated

Answer 10

If decision made to stop CPR Observe patient for min 5 mins before confirming death Absence of mechanical cardiac function - no central pulse -no heart sounds Supplemented by Continuous asystole No pulsatile flow in intra-arterial pressure monitoring Absence of contractile activity in echocardiography If any return is cardiac or respiratory activity should prompt a further five min observation from the next arrest After five min waiting the absence of pupil reflex, corneal reflex, motor response to supraorbital pressure is confirmed then death has been certified

Answer 11

Allocation of further team roles , including handover to other team Documentation of resuscitation attempts Communication with relatives Post event debriefing- lead by resuscitation team leader-focuses on immediate issues and concerns Equipment and drug trolley replenished Audit form completed