Cardiac Arrest Management Techniques
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Questions and Answers

Which of the following is NOT a principle for optimising care in critically ill patients?

  • Maintaining normoxia while avoiding extremes of oxygen levels.
  • Maintaining systolic blood pressure above the 5th percentile for age.
  • Allowing mild hypercapnia to promote cerebral blood flow. (correct)
  • Aggressively treating fever and avoiding hyperthermia.

    • When considering the termination of resuscitation attempts, which factor would suggest prolonging efforts beyond 20 minutes of asystole?

  • Confirmation of asystole lasting more than 20 minutes.
  • Significant risk of infectious disease transmission from the patient
  • The presence of a known incurable underlying disease.
  • Recent ingestion of a medicine overdose or poison. (correct)

    • Which finding would be most indicative of a foreign body aspiration?

  • Sudden onset of choking, followed by persistent unilateral wheeze. (correct)
  • Acute onset of bilateral wheezing and a productive cough.
  • The gradual development of a lower respiratory tract infection with fever.
  • Symmetrical findings in relation to a viral respiratory infection.

    • A chest X-ray for a possible foreign body aspiration is optimally performed using:

    <p>Chest X-ray on both full inspiration and full expiration.</p> Signup and view all the answers

    Which electrolyte abnormality is specifically mentioned as requiring monitoring and correction in the provided context?

    <p>General electrolyte abnormalities</p> Signup and view all the answers

    Which of the following does the text explicitly suggest as needing specialist referral?

    <p>Hypertension requiring inotropic medication.</p> Signup and view all the answers

    What specific aspect of blood pressure is targeted for maintenance in critically ill patients?

    <p>Systolic blood pressure should be at or above the 5th percentile.</p> Signup and view all the answers

    A persistent unilateral wheeze, in the context of foreign body aspiration, should prompt clinicians to consider all EXCEPT:

    <p>Treating with bronchodilators first.</p> Signup and view all the answers

    During bag-valve-mask ventilation, inadequate chest movement is noted. After initial re-assessment, what is the next step to improve ventilation?

    <p>Re-position the airway and consider a naso or oropharyngeal tube/airway.</p> Signup and view all the answers

    For a child in cardiac arrest with no witnesses, what additional cause should be considered?

    <p>Foreign body obstruction</p> Signup and view all the answers

    After establishing effective breathing in a child, what is the correct rate of chest compressions?

    <p>100-120 per minute</p> Signup and view all the answers

    When performing CPR with two rescuers, what is the correct ratio of compressions to breaths?

    <p>15 compressions to 2 breaths</p> Signup and view all the answers

    What is the initial dose of adrenaline (epinephrine) for a child in asystole or pulseless electrical activity (PEA)?

    <p>0.1 mL/kg of 1:10 000 solution</p> Signup and view all the answers

    How often should adrenaline be repeated in a child with persistent asystole or PEA?

    <p>Every 4 minutes</p> Signup and view all the answers

    If a child's arrest is preceded by circulatory shock, what initial fluid bolus is recommended?

    <p>20 mL/kg of 0.9% Sodium Chloride or Modified Ringers Lactate</p> Signup and view all the answers

    Besides hypoxia and hypovolaemia, which of the following conditions should also be considered during resuscitation?

    <p>Hypokalaemia</p> Signup and view all the answers

    Which of the following is NOT explicitly listed as a reversible cause to consider and correct during cardiac arrest?

    <p>Hypoglycemia</p> Signup and view all the answers

    According to the guidelines provided, what is the recommended initial defibrillation energy for a child experiencing pulseless ventricular tachycardia?

    <p>4 J/kg</p> Signup and view all the answers

    What is the recommended concentration of adrenaline (epinephrine) for intravenous administration during cardiac arrest?

    <p>1:10,000</p> Signup and view all the answers

    After administering the third defibrillation shock in a persistent ventricular tachycardia/fibrillation case, what is the recommended next step?

    <p>Administer adrenaline (epinephrine) 0.1 mL/kg of 1:10,000 solution</p> Signup and view all the answers

    Following successful resuscitation, which of the following is NOT an action explicitly mentioned?

    <p>Immediate referral to specialist</p> Signup and view all the answers

    What is the amount of adrenaline (epinephrine) in micrograms, administered per kilogram, during cardiac arrest after the third defibrillation?

    <p>10 mcg/kg</p> Signup and view all the answers

    What is the duration of continuous CPR recommended between each defibrillation shock for ventricular fibrillation or pulseless ventricular tachycardia?

    <p>2 minutes</p> Signup and view all the answers

    What is the recommended next step after the second adrenaline (epinephrine) dose during a continued ventricular fibrillation/tachycardia arrest scenario?

    <p>Administer a third dose of adrenaline (epinephrine) in 4 minutes</p> Signup and view all the answers

    What is the primary goal of epilepsy treatment?

    <p>To reduce or eliminate seizure frequency and enhance quality of life</p> Signup and view all the answers

    Which of the following is typically the first-line treatment for epilepsy?

    <p>Antiepileptic medications to manage the electrical activity in the brain</p> Signup and view all the answers

    When is surgical intervention considered for epilepsy?

    <p>When the seizures are resistant to medication and a specific area is found to be the cause</p> Signup and view all the answers

    Which of these is NOT a common diagnostic test used in the evaluation of epilepsy?

    <p>Blood glucose level measurement</p> Signup and view all the answers

    What factors contribute to the variation in seizure frequency and severity among individuals with epilepsy?

    <p>Variations can be caused by differences in the nature and location in the brain, and individual susceptibility to triggering factors</p> Signup and view all the answers

    What is the primary characteristic that defines epilepsy?

    <p>Recurrent, unprovoked seizures over a period of time.</p> Signup and view all the answers

    Which of the following best describes the nature of a seizure?

    <p>Abnormal, excessive, and hypersynchronous neuronal firing.</p> Signup and view all the answers

    A patient experiences a sudden lapse in consciousness without significant motor activity. Which type of seizure is this most likely to be?

    <p>Absence seizure</p> Signup and view all the answers

    What is the term for a sensation that indicates an impending seizure?

    <p>Aura</p> Signup and view all the answers

    Which of the following is a characteristic of a generalized seizure?

    <p>It involves both hemispheres of the brain.</p> Signup and view all the answers

    Which of the following is a key difference between a provoked and unprovoked seizure?

    <p>Provoked seizures have a known temporary cause, unprovoked seizures may have no clear cause.</p> Signup and view all the answers

    A seizure characterized by a loss of consciousness, followed by muscle stiffening and then rhythmic jerking movements is known as:

    <p>Tonic-clonic seizure</p> Signup and view all the answers

    Which condition involves recurrent seizures due to underlying brain dysfunction?

    <p>Epilepsy</p> Signup and view all the answers

    Study Notes

    Cardiac Arrest Management

    • Initial Actions: Defibrillation (asynchronous mode, 4 J/kg shocks) should be performed immediately. CPR (compressions and ventilation) must continue throughout the process (except during the shock itself) until adequate circulation is established.

    • Shock Cycles: If ventricular fibrillation or pulseless ventricular tachycardia persists, administer shock cycles every 4 minutes for a total of 3 cycles (2-minute shock intervals).

    • Adrenaline (Epinephrine) Administration: After the third shock cycle, administer adrenaline 1:10 000 (diluted) IV at 0.1 mL/kg. Administer subsequent doses every 4 minutes (after every second shock). Each administration should be followed by a small bolus of 0.9% sodium chloride.

    • Dilution: Dilute 1 mL of 1:1000 adrenaline (epinephrine) with 9 mL of 0.9% sodium chloride or sterile water to create a 1:10 000 solution.

    • Dose Equivalents: 0.1 mL of a 1:10 000 solution equalling 10 mcg of adrenaline.

    • CPR and Rhythm Check: Allow one minute of CPR between any medication administration and the next shock cycle.

    • IO Adrenaline: Intrathoracic adrenaline is no longer preferred; intraosseous (IO) access and injection are recommended for faster and more consistent absorption.

    • Asystole/PEA Treatment: If the rhythm is asystole or pulseless electrical activity, administer adrenaline 1:10 000 at 0.1 mL/kg, IV/IO, repeated every 4 minutes during CPR.

    • Circulatory Shock Preceding Arrest: If the arrest was preceded by circulatory shock, administer 0.9% sodium chloride or Modified Ringer’s Lactate at 20 mL/kg as an IV bolus.

    Post-Resuscitation Care

    • Admission/Referral: Admit to a monitoring facility (high-care or intensive care unit) as soon as possible.

    • Underlying Pathology: Identify and manage any underlying medical conditions.

    • Normoxia Maintenance: Maintain appropriate oxygen levels (avoid both hyperoxia and hypoxia).

    • Acid-Base Balance: Control blood pH by avoiding hypo- and hypercapnia.

    • Blood Pressure: Maintain systolic blood pressure above the 5th percentile for the patient's age; monitor and manage by fluids and inotropes.

    • Fever Management: Control and reduce fever.

    • Nutrition: Provide adequate nutrition.

    • Glucose and Electrolytes: Monitor and correct glucose and electrolyte imbalances.

    • Pain Management: Provide appropriate analgesia.

    • Rehabilitation: Consider and plan for rehabilitation requirements.

    Termination of Resuscitation

    • Clinical Judgment: The decision to stop CPR relies on the specific patient’s condition and should be based on clinical judgment.

    • Stopping Criteria: Consider stopping resuscitation attempts in the presence of incurable conditions, or in cases of asystole lasting more than 20 minutes.

    • Exception to Termination criteria: Cases should be considered for continued resuscitation under certain circumstances: severe hypothermia, drowning, poisoning, medicine overdose, and neurotoxic envenomation.

    Foreign Body Inhalation

    • Diagnostic Criteria: Active choking, persistent unilateral or bilateral wheezing, chronic cough, stridor, segmental or lobar pneumonia unresponsive to typical treatment, mediastinal shift, or radiographic (chest X-ray) evidence of hyperinflation, collapse, or an opaque foreign body.

    • Airway Management: If chest movement is inadequate with bag-valve-mask ventilation, reassess airway patency and adjust position with a tube as necessary (naso or oropharyngeal tube/airway, endotracheal tubes).

    • Respiratory Rate: Post-stabilization, initiate chest compressions of 100-120/minute (excluding neonates). Ventilation ratio is 30:2 for single rescuers, and 15:2 for two rescuers.

    • Monitoring and Access: Attach a cardiac monitor and secure vascular access (or IO access if IV is inaccessible).

    Epilepsy

    • Definition: Epilepsy is a chronic neurological disorder characterized by recurrent seizures.

    • Seizures: Seizures are sudden, uncontrolled electrical disturbances in the brain. These disrupt normal brain function, leading to various symptoms depending on the affected brain region.

    • Types: Epilepsy is not a single disease but a group of different disorders, each with unique causes and characteristics.

    • Causes: Causes of epilepsy can include genetic predisposition, brain injuries (traumatic brain injury, stroke, infections), developmental disorders, tumors, and metabolic conditions.

    • Mechanisms: The exact mechanisms underlying seizure generation are still under investigation.

    Seizures

    • Neurological Activity: Seizures are defined by abnormal, excessive, and hypersynchronous neuronal activity in the brain.

    • Neural Firing: During a seizure, neurons fire rapidly and in an uncontrolled manner, leading to temporary disruptions in brain function.

    • Categorization: Different types of seizures are categorized based on their characteristics, location of origin in the brain, and duration.

    • Focal Seizures: Focal seizures originate in a specific area of the brain and can manifest with localized symptoms.

    • Generalized Seizures: Generalized seizures involve both hemispheres of the brain and often lead to immediate loss of consciousness.

    • Absence Seizures: Absence seizures are a type of generalized seizure characterized by brief, sudden lapses in consciousness without major motor activity.

    • Tonic-Clonic Seizures: Tonic-clonic seizures (grand mal) involve a loss of consciousness, muscle stiffening (tonic phase) followed by rhythmic jerking movements (clonic phase).

    • Symptoms: The symptoms of a seizure can vary greatly depending on the specific type of seizure and the location of the seizure focus in the brain. Possible symptoms include muscle stiffening or jerking, loss of consciousness or awareness, sensory disturbances, emotional or behavioral changes, unusual or involuntary movements, and auras (sensations indicating an impending seizure).

    Relationship between Epilepsy and Seizures

    • Recurrent Seizures: Epilepsy is the tendency to have recurrent seizures.

    • Single Seizure: A single seizure is not sufficient to diagnose epilepsy.

    • Diagnosis: Recurrent seizures (two or more unprovoked seizures over a set period) are crucial for epilepsy diagnosis.

    • Provoked Seizures: Some seizures are considered "provoked", meaning they are caused by known factors not related to epilepsy (fever, lack of sleep, medications).

    • Evaluation: Epilepsy diagnosis requires careful evaluation of the patient's medical history, neurological examination, and often relevant diagnostic tests like EEG and neuroimaging (CT or MRI scans).

    • Variability: The frequency and severity of seizures vary among individuals with epilepsy.

    Treatment for Epilepsy

    • Aims: Epilepsy treatment aims to reduce or eliminate seizure frequency and improve quality of life.

    • Medications: Medications (antiepileptic drugs) are the primary treatment for epilepsy, aiming to control abnormal electrical brain activity.

    • Surgery: Surgical intervention may be considered for drug-resistant epilepsy, particularly when the cause is localized to a specific brain area.

    • Interventions: Lifestyle modifications and other therapies can also play an important supportive role in epilepsy management.

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    Description

    This quiz focuses on the essential techniques for managing cardiac arrest, including the proper use of defibrillation and adrenaline administration. It covers step-by-step actions to take during an emergency situation and the critical importance of continuous CPR. Test your knowledge on shock cycles and medication dosages.

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