A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
Use of a phosphodiesterase inhibitor within the previous 24 hours.
Describe Agonal Gasps
Not normal breathing. Agonal gasps may be present in the first minutes after sudden cardiac arrest. A Pt who gasps usually looks like he is drawing air in very quickly. The mouth may be open and the jaw, head, or neck may move with gasps. Gasps may appear
Describe Quality Compressions
-Compress the chest at least 2 inches
-Compress the chest hard and fast at a rate of 100-120/min
-Allow complete chest recoil after each compression.
-Minimize interruptions in compressions (10 sec or less)
-Switch compressor about every 2 min or earlier
You are providing bag-mask ventilations to a patient in respiratory arrest. How often should you provide ventilations?
About every 5-6 seconds.
What actions is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation?
Ventilating too quickly or too hard
What is the recommended rate of CPR?
100-12m compressions per minute
The Primary Assessment Actions as appropriate for Airway
-Maintain Patent Airway in unconscious Its by using head tilt-chin lift, or advance airway management as needed
-Confirm proper CPR and ventilation
-Confirm proper placement of adv. airway devices
-Secure the device to prevent dislodgment
-Monitor airway
The Primary Assessment Actions as appropriate for Breathing
-Give supplemental 02 when indicated. For Cardiac arrest, give 100% oxygen, for others titrate oxygen 94% or greater. .
-Avoid excessive ventilation.
The Primary Assessment Actions as appropriate for Circulation
-Monitor CPR quality
-Attach monitor/defibrillator for arrhythmias or cardiac arrest rhythms
-Provide defibrillator/cardioversion
-Obtain IV/IO access
-Give appropriate drugs to manage rhythm and BP
-Check glucose and temp
-Check perfusion issues
List the Arrhythmias or Cardiac arrest rhythms
Ventricular Fibrillation (VF), Pulseless Ventricular Tachycardia (PVY), Asystole, Pulseless Electrical Activity (PEA)
The Secondary Assessment looks at what?
Focused medical history looking for underlying causeless. (H and Ts)
Use this memory aid
SAMPLE:
S-signs and symptoms
A-Allergies
M-Medications (including last doses)
P-Past medical Hx, relevant
L-Last meal consumed
E-Events
List The Most Common Causes of Cardiac Arrest
(H and Ts)
H's:
Hypovolemia, Hypoxia, Hydrogen Ion (Acidosis)
Hypo-/Hyperkalemia, Hypothermia
T's:
Tension Pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (Pulmonary/ Coronary)
Most common causes of PEA
Hypovolemia and hypoxia are the most common underlying and potentially reversible causes of PEA.
Describe the pathophysiology of Ventricular Fibrillation
Ventricles consist of areas of normal myocardium alternating with areas of ischemic, injured, or infarcted myocardium, leading to a chaotic asynchronous pattern of ventricular depolarization and repolarization. Without organized ventricular depolarization
Defining Criteria per ECG for Ventricular Fibrillation
Rate/QRS complex: Unable to determine; no recognizable P, QRS, or T waves; baseline undulations occur between 150 and 500 per minute
� Rhythm: Indeterminate; pattern of sharp up (peak) and down (trough) deflections
� Amplitude: Measured from peak to troug
common etiologies of Ventricular fibrillation
� ACS leading to ischemic areas of myocardium
� Stable to unstable VT, untreated
� Premature ventricular complexes (PVCs)
with R-on-T phenomenon
� Multiple drug, electrolyte, or acid-base abnormalities that prolong the relative refractory period
� Primary
Coarse Ventricular Fibrillation
VF with fibrillatory waves greater than 3 mm in height
Fine VF
Fine VF. Note the complete absence of QRS complexes.
The ECG criteria for VF are as follows:
� QRS complexes: No normal-looking QRS complexes are recognizable; a regular negative-positive-negative pattern (Q-R-S) cannot be seen.
� Rate: Uncountable; electrical deflections are very rapid and too disorganized to count.
� Rhythm: No regular rhythmic
Pulseless Electrical Activity
Cardiac conduction impulses occur in an organized pattern but do not produce myocardial contraction (this condition was formerly called electromechanical dissociation), insufficient ventricular filling during diastole, or ineffective contractions.