Flashcards
Cardiac arrest
Cards in this deck (9)
- 1Outline the approach to a patient in cardiac arrest (unresponsive and not breathing normally)1) Call resus team
2) CPR 30:2, attach defib, IV access
*3) Assess rhythm
a) Shockable (VF/pulseless VF): 1 shock then immediately resume CPR for 2 mins *
b) Non-shockable (PEA/asystole): immediately resume CPR for 2 mins *
c) Return of spontaenous circulation: immediate post-cardiac arrest Tx - 2Outline what should be done during CPR- High quality chest compressions
- Minimise interruptions
- Give oxygen
- Use waveform capnography
- Give adrenaline after 3 shocks, every 3-5 mins
- Give amiodarone after 3 shocks - 3What reversible causes need to be considered in cardiac arrest?- Hypoxia
- Hypovolaemia
- Hypo-/hyperkalaemia/metabolic
- Hypothermia
- Thrombosis
- Tension pneumothorax
- Tamponade
- Toxins - 4What is included in post-cardiac arrest sydrome?- Post-arrest brain injury
- Post-arrest myocardial dysfunction
- Systemic ischaemia / reperfusion response
- Persistent precipitant pathology
* Severity depends on duration of arrest and may not happen at all - 5Outline the general approach to post-cardiac arrest treatment- ABCDE
- Aim for SpO2 of 94-98%
- Aim for normal PaCO2
- 12 lead ECG
- Treat precipitating cause
- Targeted temperature management - 6Outline the A and B components of A-E post-cardiac arrest care- If arrest was brief, pt will not require tracheal intubation/ventilation
> Give O2 via facemask if SpO2 <94%
> Avoid aggresive O2 therapy if not necessary (can ↑ oxidative stress)
- And pt with obtunded cerebral function should be sedated and ventilated + admitted to ICU - 7Outline the C component of A-E post-cardiac arrest care- If ST elevation/LBBB on ECG: PCI indicated
- Perform echocardiography to assess myocardial function
- Pts often require ionotropic support: titrate + fluids to maintain adequate urine output
- There is often transient hypokalaemia: give IV potassium - 8Outline the D component of A-E post-cardiac arrest care- Maintain blood pressure near to MAP (loss of cerebral auto-regulation)
- If targeted temperature management is used, sedation is necessary
- May need EEG to detect seizures if sedated - 9Outline the E component of A-E post-cardiac arrest care- A period of hyperthermia is common in the first 48hrs after arrest (associated with poor outcomes)
- Targeted temperature management:
> Cooling to 36 degrees is neuro-protective, indicated in those who remain unresponsive after return of circulation
> Cooling blankets, pads etc
> Require sedation to prevent shivering
> Cool for >24hrs
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- Critical Care Flashcards on Cardiac arrest, created by Liam Musselbrook on 24/11/2017.
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- Liam Musselbrook
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