Medical Cardiac Arrest CPG Notes

Question 1

What are the four key care objectives of medical cardiac arrest management?

Answer 1

High-quality compressions, rapid defibrillation, advanced care (e.g., adrenaline/antiarrhythmics), and addressing reversible causes.

Question 2

What patient group does CPG A0201-1 apply to?

Answer 2

Patients aged ≥16 years in cardiac arrest.

Question 3

If there is any doubt about the presence of a pulse, what must be done?

Answer 3

Commence chest compressions.

Question 4

When is a traumatic cardiac arrest CPG used instead?

Answer 4

If mechanism, history, or injury pattern strongly suggests trauma.

Question 5

What does a sudden rise in ETCO₂ suggest during CPR?

Answer 5

ROSC (Return of Spontaneous Circulation).

Question 6

What does a gradual fall in ETCO₂ indicate?

Answer 6

CPR fatigue.

Question 7

What is the preferred initial airway management in cardiac arrest?

Answer 7

SGA to enable continuous compressions.

Question 8

When should an ETT be attempted?

Answer 8

When it does not interrupt compressions.

Question 9

What is the ventilation ratio without SGA/ETT?

Answer 9

30 compressions: 2 ventilations.

Question 10

What is the ventilation ratio with SGA/ETT?

Answer 10

15 compressions: 1 ventilation (6–8 breaths/min, no pause).

Question 11

How should fluids be managed in shockable rhythms?

Answer 11

Limit to flushes and TKVO; avoid large volume administration.

Question 12

What is the ideal time to first defibrillation?

Answer 12

≤2 minutes.

Question 13

What are the compression quality targets in HP-CPR?

Answer 13

100–120/min, ≥5 cm depth, full recoil.

Question 14

How often should compressors rotate?

Answer 14

Every 2 minutes.

Question 15

What is the max pause duration for compressions?

Answer 15

≤3 seconds.

Question 16

What should not be used for rhythm decisions?

Answer 16

See-Thru CPR.

Question 17

What is not compatible with HP-CPR?

Answer 17

Shock advisory mode.

Question 18

Define refractory VF/VT.

Answer 18

Persistent shockable rhythm after 3 shocks (including pre-AV arrival).

Question 19

Where should the sternal pad be placed?

Answer 19

Right chest, under clavicle and above nipple.

Question 20

Where should the apex pad be placed?

Answer 20

Left mid-axillary, 6th intercostal space.

Question 21

What are stacked shocks and when are they used?

Answer 21

Up to 3 immediate shocks in monitored VF/VT with pads on; used before HP-CPR.

Question 22

When is adrenaline given for VF/VT?

Answer 22

After 2nd shock.

Question 23

When is adrenaline given for PEA/Asystole?

Answer 23

As soon as possible without interrupting HP-CPR.

Question 24

When are antiarrhythmics given?

Answer 24

After the 3rd, 5th, 7th, and 9th shocks.

Question 25

What is the scene goal for HP-CPR before transport?

Answer 25

20 minutes (approx. 10 cycles).

Question 26

List 4 ECMO eligibility criteria.

Answer 26

* Age 16–70 * VF/VT initial rhythm * Witnessed arrest * No major comorbidities.

Question 27

When should mCPR not be used?

Answer 27

Within first 16 minutes or to assist other procedures.

Question 28

What’s the preferred ECMO hospital?

Answer 28

Alfred Hospital (if time equal to other centres).

Question 29

What should be done for pregnant patients >20 weeks?

Answer 29

Manual uterine displacement or left lateral tilt.

Question 30

What is the ketamine dose for CPRIC (IV & IM)?

Answer 30

50–100 mg IV q1–2min (no max), 200 mg IM (single dose).

Question 31

What drug may follow ketamine for intubation?

Answer 31

Rocuronium 150 mg IV.

Question 32

In hypothermic arrest <30°C, what adjustment is made to meds?

Answer 32

Double the dosing intervals for adrenaline, amiodarone, lignocaine.

Question 33

What fluid is given in hypovolaemia, asthma, or anaphylaxis?

Answer 33

1000–2000 mL Normal Saline.

Question 34

When is calcium gluconate used?

Answer 34

Confirmed or strongly suspected hyperkalaemia.

Question 35

What drugs are given for hyperkalaemia?

Answer 35

* Calcium gluconate 10% 6.6 mmol IV * Sodium bicarb 100 mL IV.

Question 36

What is given for TCA or CCB overdose?

Answer 36

* Sodium bicarb 100 mL IV (TCA) * Calcium gluconate for CCB.

Question 37

When should thrombolysis be considered?

Answer 37

Witnessed arrest from suspected PE with available resources for 60 minutes of HP-CPR.

Question 38

What should be done with VAD patients?

Answer 38

Anterior-posterior pad placement; don’t check for pulse; contact Alfred Heart Failure team.

Question 39

What should be done if a permanent pacemaker is present?

Answer 39

Use ECG leads to distinguish pacing spikes from QRS.

Question 40

When is chest decompression indicated?

Answer 40

Suspected tension pneumothorax as cause of arrest.