Chapter 9 Flashcards

(13 cards)

1
Q

How is time to defibrillation and mortality related?

A

Without bystander CPR - every minute that passes between collapse and attempted defibrillation increased mortality by 7-10%
With bystander CPR - every minute that passes between collapse and attempted defibrillation increases mortality by 3-4%

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2
Q

Alternative defib pad positions

A

Antero-posterior - one anteriorly over left precordium, other on the back behind the heart just inferior to the left scapula
Postero-lateral - one in mid-axillary line, level with V6 electrode and other on the back, inferior to the right scapula
Bi-axillary - each electrode on the lateral chest wall, one on the right and one on the left

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3
Q

How to place the defib pads in patients with implantable medical devices

A

Away from device (at least 10-15cm) or use alternative electrode position (antero-lateral or antero-posterior)

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4
Q

Considerations for safe defibrillation

A

Avoid water - dry patients chest
Make sure everyone is clear of the patient/their surroundings - don’t hold IV access or trolley
Take of oxygen mask/nasal cannulae and place them 1m away from the patient’s chest
Leave the ventilation bag connected to the tracheal tube or supraglottic airway - no increase in oxygen concentration occurs with these
Can detach and move 1m away

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5
Q

Are automated external defibrillators accurately able to analyse rhythms?

A

Yes

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6
Q

What are the advantages of manual defibrillators over AEDs?

A

Allow operator to diagnose rhythm and deliver a shock rapidly without having to wait for rhythm analysis, which minimises interruptions to chest compressions.
Manual defibrillators also allow for synchronised shocks and external pacing

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7
Q

Appropriate energy level for delivering shocks

A

Initial shock 120-150J
Same or higher for subsequent shocks

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8
Q

When is synchronised cardioversion appropriate? How is it performed?

A

For atrial or ventricular tachyarrhythmias (not required for VT/VF), shock must be synchronised with the R wave of the QRS complex.
Conscious patients should be sedated before cardioversion.
Manual defibrillators allow for synchronisation
Need to account for delay between pressing button and delivering shock as next R wave comes
If peri-arrest with VT and synchronised shock fails - give unsynchronised shock

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9
Q

How should defibrillation be approached in patients with implantable electronic devices?

A

Follow resuscitation guidelines, awareness of the presence of device allows for additional measures to optimise outcome.
Put defib pads away from device - >10cm. Use alternative position (antero-posterior).
If ICD senses shockable rhythm will deliver shocks - can disable this with ring magnet placed over ICD
Can use ICD after resuscitation to analyse rhythm which led to cardiac arrest

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10
Q

How should loop recorders be managed during cardiac arrest?

A

Not relevant during resuscitation
Small chance of damage to device
Can be interrogated after event to analyse rhythm

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11
Q

How should implantable neurostimulators be managed during resuscitation?

A

Place defib pads 10-15cm away from device

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12
Q

How much energy is applied during internal defibrillation?

A

10-20J

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13
Q

How much energy do ICDs deliver?

A

40J via pacing wire to R ventricle, 80J for subcutaneous devices

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