Flashcards in Cardiac Arrest and Resuscitation Deck (19)
How soon after "clinical" death does biological death usually occur?
How is cardiac arrest confirmed?
- patient response (shake and shout)
- open airway and check for normal breathing and pulse in 10s
- check for signs of life (movements etc)
What makes CPR high quality?
- chest compressions of 5-6cm
- full recoil
- 2 per second (100-120 bpm)
- switch CPR provider every 2 mins
What should be avoided in CPR?
- spending too much time off the chest
- leaning over the patient (Shoulders should be above patients sternum)
- Over ventilating (should mimic normal breaths - otherwise complications => gastric inflation)
- Delayed use of DeFib
What can Waveform Capnography be used to assess?
- patients CO2 output during CPR
- measured by anaesthetist
- should be around 2-2.5kPa in high quality CPR
- If patient is shocked back to life, this increases to 5-5.5kPa
What should you do to maximise the amount of energy transferred from the AED to the patient?
- correct pad placement
- make sure pads are stuck securely with no air trapping
- remove hair on chest if necessary
- more energy may be required in larger patients, patients with specific disease etc due to higher resistance
Describe the main differences between VF and pVT
VF - bizzare irregular waveform, no QRS complexes recognisable, random amplitudes
pVT - monomorphic = broad but consistent QRS complexes, rapid rate
polymorphic = torsades de pointes
What is the main difference between a manual DeFib and AED that can minimise time off the chest?
Manual DeFib allows CPR to continiue whilst the Defibrillator is charging
What drug should be given after the 3rd shock from the defibrillator?
Adrenaline IV (1mg)
(Amiodarone may also be given - only slightly better than controls in studies)
Describe the appearance of asystole
- absent ventricular activity (no QRS complexes)
- P waves (atrial activity) may still be present
How are asystole and PEA treated if patients cannot be shocked with the defib?
High quality CPR
adrenaline 1mg IV every 3-5 mins
If vascular access cannot be achieved intravenously, where can blood be taken from in an emergency?
HOw can metabolic disturbances (hypo/hyperkalaemia) be tested for at the bedside?
ABG (after arterial stab)
What treatment is given in hyperkalaemia?
calcium gluconate FIRST TO PROTECT HEART
insulin - to lower potassium
dextrose - to counteract insulin and prevent
What treatment/intervention is given if a patient has a tension pneumothorax compressing their heart and causing cardiac arrest?
Needle decompression or thoracotomy
How is cardiac tamponade treated?
Pericardiocentesis or thoracotomy
How is cardiac arrest due to toxins treated?
How are patients treated for a PE and why should CPR continue for up to 90 mins after treatment is given?
- fibrinolytic therapy can take 60-90 mins to work
=> mechanical CPR given for 90 mins