Managing cardiac arrest Flashcards
(51 cards)
what is a cardiac arrest?
effective cessation of the heart
- no circulation & no oxygen delivered
how do you recognise somebody is having a cardiac arrest?
1) unresponsive
2) not breathing normally
3) no pulse
why is the majority of cardiac rhythm shockable (i.e. able to be defibrillated?
- as presenting rhythm in most cases is VF/VT
= majority is potentially reversible
what 2 things commonly precede cardiac arrest?
- hypotension
- hypoxia
when should defibrillation be given, if appropriate?
= within 3 minutes
what are most problems of cardiac arrest caused by?
1) airway
2) breathing
3) circulation
= oxygen delivery problems
how can you improve SaO2 oxygen delivery factors?
1) SaO2
= clear airway
how can you improve [Hb= for oxygen deliver?
= transfusion trigger, treat anaemia
how can you alter heart rate for oxygen delivery?
= atropine or B-stimulant (e.g. ephedrine) for bradycardia, pace
how can you alter stroke volume to improve oxygen delivery?
1) preload = IV fluids, raise legs
2) afterload
= excess afterload (HBP) use vasodilators
= reduce after load (e.g. septic shock) use vasoconstrictors
3) contractility = treat cause
what other factors affect oxygen delivery?
= BP
how would you manage a cardiac arrest patient?
ABCDE
how can you check for SaO2 and [Hb] levels?
SaO2
= pulse oximetry on finger
= arterial blood fas (GOLD STANDARD)
[Hb]
= part of full blood count
- bedside (e.g. hemocue)
how would you check heart rate?
- pulse
- pulse oximetry
- ECG monitor with sound
- arterial BP monitor
how would you calculate B{?
BP = CO x TPR
what are 4 causes of obstruction which causes AIRWAY problems?
1) CNS depression = tongue
2) lumen blocker = blood, vomit, foreign body
3) swelling = trauma, infection, inflammation
4) muscle = laryngospasm., bronchospasm
how would you recognise airway obstruction (SpO2)?
- talking
- difficult breathing, distressed, choking
- shortness of breath
- noisy breathing = stridor, wheeze, gurgling
- see saw respiratory pattern using accessory muscles
how would you treat airway obstruction (SpO2)?
- airway opening
e. g. head tilt, chin lift, jaw thrust, suction - simple adjuncts
- advanced techniques
e. g. LMA, tracheal tube - oxygen (increase FiO2)
what are causes of BREATHING problems (SpO2)?
1) airway problems
2) decreased respirator drive
- CNS depression
3) decreased respiratory effort
- muscle weakness, nerve damage, restrictive chest defect, pain from fractured ribs.
4) lung disorders
- pneumothorax, haemothorax, infection, acute exacerbation COPD, asthma, PE, ARDS
how would you recognise breathing problems (SpO2)?
1) look - respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, consciousness level
2) listen - noisy breathing, breath sounds
3) feel - expansion, percussion, tracheal position
how would you treat breathing problems (SpO2)?
- oxygen
- airway
- treat underlying cause to improve breathing
e. g. drain pneumothorax - support breathing
e. g. ventilate with bag mask
what are primary and secondary causes of circulatory problems ([Hb]/CO)?
Primary
- Acute coronary syndromes
- Dysrhythmias
- Hypertensive heart disease
- Valve disease
- Drugs
- Hereditary cardiac diseases
- Electrolyte / acid base
- abnormalities
- Electrocution
Secondary Asphyxia
- Hypoxaemia
- Blood loss
- Hypothermia
- Septic shock
how would you recognise circulatory problems?
[Hb], CO = HR x SV
- general exam = distres, palor
- indications of organ perfusion
= chest pain, mental state, urine output - blood pressure
- pulse, tachycardia, bradycardia
- peripheral perfusion = capillary refit time
- bleeding, fluid losses, JVP, CVP
how do you treat circulatory problems?
1) ensure airway, breathing O2
2) IV/IO access, take bloods
3) treat cause
- fluid challenge
- inotropes/vasopressors
- oxygen, aspiring, nitrates, morphine for ACS
4) haemodynamic monitoring
