Cardiac Arrest Pathophysiology and Resuscitation
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1
what is defined as a medical cardiac arrest?
primary electrical OR pump problem- heart stops so CPR/defib are firstest answer
2
what are the H's and T's of cardiac arrest?
H's: hypovelimia, hypoxia, hydorgen ions (acidosis), hypo/hyper-kalemia, hypoglycemia, hypothermia
T's: tension penumo, tampenade, toxins, thrombosis (pulmonary), thrombosis (cardiac)
T's: tension penumo, tampenade, toxins, thrombosis (pulmonary), thrombosis (cardiac)
3
what is defined as a traumatic cardiac arrest?
plumbing/volume problem - hypovolemia from hemmorage or obstruction from tension pneumo stops heart from filling in first place
4
why can CPR on an "empty" or obstructed heart nevere genarate a pulse?
reversible cause must be adressed ( body cant fix if its there/not there)
5
what does a newborns first breath trigger?
dramatic shift in pulmonary /vascular resistance drops
ciruculation shifts from placenta to pulmonary oxygenation
ciruculation shifts from placenta to pulmonary oxygenation
6
what is the physicology being a ROSC?
reprofusion after global ischemia can stun mypcardium and drop pressume when brain needs reprofusion when brain needs it the most
7
what are the two pad placement options?
anterior-posterior (1st) and anterior lateral (2nd)
8
in DSED how many shocks should be done before transport and what is the sequence of it?
3 normal shocks -> vector change -> three more -> transport
9
if a shock is delivered at any point during a cardiac arrest does transport need to happen?
yes - unless ACP calls it
10
if a pt has been pulled from water what needs to be done before defibrilation?
dry them off
11
what can be qualified as futile in resus?
age (old), terrible ETCO2, comorbities
12
if a patient re-arrests or arrest for the first time on route to hosptial what is the procedure?
find safe place to stop
perform minimum of one analysis
use clinical judgement ( non-shockable go or shock then go)
perform minimum of one analysis
use clinical judgement ( non-shockable go or shock then go)
13
during DSED or VCD and a pateint re-arrest/arrest on route to hospital what is the procedure?
- find safe place to pull over
-preform three analysis in inital pad orientation
- one further shock in second orientation or with second set of pads
note: 4 shocks total before resuming transport
-preform three analysis in inital pad orientation
- one further shock in second orientation or with second set of pads
note: 4 shocks total before resuming transport
14
what happens if a shockable rhythm becomes unshockable at any time?
stop attempting further shocks and initate transpot immmediatly
15
what type of defebrilation requires the truck to be stopped for acurrate analysis?
SAED/AED
16
expectation remains that unless a patient arrest OR re-arrest for the first time _______?
do not pull over on the way to receiving facility
17
how long should CPR be preformed on scene + how many rhythm analysis during a medical cardiac arrest?
20 minutes with minimum of of four analysis
18
when can paramedics initiate early transport in a medical cardiac arrest?
younger age
arrest witnessed by medics
ACP availibility
non-agonal PEA
arrest witnessed by medics
ACP availibility
non-agonal PEA
19
if ROSC is achived and pt re-arrets while on route using a semi-automated defib_______?
pull over
preform one immediate rhythm interpretation
treat rhythm
continue transport with no further stops
preform one immediate rhythm interpretation
treat rhythm
continue transport with no further stops
20
what is EPI's MOA?
stimulates alpha 1, beta 1, causing peripheral vasoconstriction that raises coronary and cerebal profussion pressure, incresed HR + contractability
21
what is DSED and VCD MOA?
refractory VF/pulseless VT persites because inital defib doesent depolarize enought myocardial mass
- aim to capture more myocardium
- aim to capture more myocardium
22
what roles should be assigned during an arrest ?
compressor
airway
defib
timer
airway
defib
timer
23
when should transport threshold be decided?
10 minutes into the call
24
what is considered obviously dead per the BLS?
decapitation
brain matter
deeply charred body
brain matter
deeply charred body
25
where does blunt vs penetrating trauma go in traumatic cardiac arrest?
penetrating - lead trauma hospital only
blunt - closest facility ( do pitt stop) if needing ot go to lead truama
blunt - closest facility ( do pitt stop) if needing ot go to lead truama
26
if pt is in asystole during a traumatic cardiac arrest with penetrating trauma close to lead trauma hospital with is the protical with TOR?
may bypass it and be transported
27
while preforming CPR on a traumatic cardiac arret pt should be simultaneouly be being done?
control external hemmorhage
splint pelvis ( hypovolemia)
prioritze basic airwau/ventilation ( hypoximia)
splint pelvis ( hypovolemia)
prioritze basic airwau/ventilation ( hypoximia)
28
during newborn resusitation, when should you stay on scene and when should you transport?
stay: fixing the proble,
transpot: not getting better OR getting worse
transpot: not getting better OR getting worse
29
what is the breath and compression ration on a newborn?
- 1 breath every 3-4 seconds
- 3:1 compression
- 3:1 compression
30
what are the target SPO2 (right hand) for a newborn at the 1, 2,3,4,5 and 10 min mark?
1- 60-65 %
2- 65-70%
3- 70-75%
4- 75-80%
5- 80-85%
10- 85-95%
2- 65-70%
3- 70-75%
4- 75-80%
5- 80-85%
10- 85-95%
31
if newborn is DOA should the still be worked?
YES- always work down the algorithym including HR ≤ 60 bpm
32
if yes to what three conditions directs you to supprotive care instead of newborn resus?
term gestation
good muscle tone
breathing/crying
good muscle tone
breathing/crying
33
when checking a newborns HR in the 30 second incravals during resus what is the primary and secondary ways it can be done?
primary- 3 lead ECG
secondary- auscultation, brachial pulse, SPO2 on right arm
secondary- auscultation, brachial pulse, SPO2 on right arm
34
if the gestational age is uncertain OR newborn is between 20-25 weeks _________?
initiate resus
+
transport
+
transport
35
what is the PPV MOA?
substitutes first newborn breath
- Inflating lungs recruits alveoli, triggers drop in pulmonary vascular resistance, and lets oxygenated blood begin reaching circulation
- Inflating lungs recruits alveoli, triggers drop in pulmonary vascular resistance, and lets oxygenated blood begin reaching circulation
36
what does MR SOPA stand for and why do we do ti?
mask seal
reposition
suction
open moiuthg
pressure increase
alternate airway
- if PPV "isnt" working
reposition
suction
open moiuthg
pressure increase
alternate airway
- if PPV "isnt" working
37
why do we only oxygenate to 94-98% post ROSC?
hyperoxima after ROSC has been linked ot worse outcomes
38
what is target ETCO2 post rosc?
30-40 mmhg
39
what is target blood pressure post ROSC with a fluid bolus?
90 mmhg systolic
40
what is 0.9 NaCL fluid bloluses MOA?
isotonic to plasma expants intravascualr volume directly, increasing preload, stoke volume, and blood pressure
41
what two factors can drop blood pressure post ROSC?
transient myocardial stuning
+
vasodilation from ischemic reperfusion
+
vasodilation from ischemic reperfusion
42
what is thre first thing you should be doing post ROSC?
12-lead ( serial)
43
what should be used as your ventilation guide post ROSC?
waveform capnography
44
are pre-arrival interventions counted in medical cardiac arrests?
no ( consider for paperwork)
45
should compression be done during the shock cycle of a medical cardiac arrest?
yes minimizes perishock pause
46
what occurs to the compression rate once an SGA is placed?
continoused at 10 breaths per mintes(1-6) -adults
continuouse at 20 breathers/min (1-3) - kids
continuouse at 20 breathers/min (1-3) - kids
47
what needs to be done between EPI and antiarryhtmics being given during medical cardiac arrest?
saline flush
48
when is electrocution treated as medical vs truamatic cardiac arrest?
simple - medical
shock with significant trauma - trauma
shock with significant trauma - trauma
49
should commotio cordis be treated as medical or traumatic cardiac arrest?
medical
50
what is the goal ventilation post ROSC for peds and adulrs
- 10 breaths per min
-20 breahts per min
-20 breahts per min
51
can a fluid bolus be given during traumatic cardiac arrest?
considered to assits with reversible causes if transport to ED will not be delayed
52
what is the onset of epi by IV, IM and NEB?
IV: rapid
im: 3-10 min
Neb: 3-5 min
im: 3-10 min
Neb: 3-5 min
53
what is the peak of epi by IV, IM ?
IV: < 5 min
IM: 20 min
IM: 20 min
54
what is the duration of epi by IV, IM and NEB?
iv: 5-10 min
IM; 20-30 min
Neb: 1-3 min
IM; 20-30 min
Neb: 1-3 min
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