Flashcards in Chapter 1 Deck (74)
Disease of the coronary arteries and their resulting complications such as angina pectoris and acute MI
Coronary heart disease
Disease of the arteries that supply the heart muscle with blood
Coronary artery disease
A sudden loss of effective blood flow that's caused by cardiac and/or peripheral vascular factors that may reverse spontaneously (like syncope) or only with intervention (like cardiac arrest)
The absence of cardiac mechanical activity, which is confirmed by the absence of a detectable pulse, unresponsiveness and apnea or agonal gasping breathing
Cardiopulmonary (cardiac) arrest
A natural death of cardiac cause that's preceded by an abrupt loss of consciousness within one hour of the onset of an acute change in cardiovascular status
Sudden cardiac death
What are the heart rhythms that may be observed in a cardiac arrest?
1. Pulseless VT (wide regular QRS faster than 120 bpm)
2. VFib (irregular chaotic deflections that vary in shape and height are observed but there's no coordinated ventricular contraction)
3. Asystole (no cardiac electrical activity is present
4. Pulseless electrical activity (Electrical activity is visible on EKG but central pulses are absent)
What are the shockable rhythms? the nonshockable?
Shockable - VT and VF
nonshockable - Asystole and PEA
What are the links in the chain of survival?
1. early recognition and activation
2. early CPR
3. Early defibrillation
4. Effective advanced life support
5. Integration of post-cardiac arrest care
Who makes up a medical emergency team or a rapid response team?
A physician and a nurse with critical care training who are available at all times
What are the components of basic life support?
1. recognition of signs of cardiac arrest, heart attack, stroke and foreign body airway obstruction.
2. relief of foreign body airway obstruction
3. cardiopulmonary resuscitation (CPR)
4. defibrillation with an automated external defibrillator (AED
When performing chest compressions, when is systole and when is diastole?
Systole is in the chest compression phase and diastole is in the release phase
Whats the key detereminant of the success of resuscitation ?
Coronary perfusion pressure, generated when performing external chest compressions
note that adequate cerebral and coronary perfusion pressures are critical to neurologically normal survival
when you determine that CPR is needed what is the initial action performed?
Chest compression - this enables better delivery of the oxygen that's already present in the lungs and arterial circulation to the heart and brain
What's the Cardiac output during CPR?
25-33% of normal
What makes high quality chest compressions?
- Pushing had on a victims chest
- Ccompressing at a rate of at least 100 compressions/minute allowsing full chest recoil after each compression (so the heart can refill)
- Minimizing the interruptions in chest compressions
How hard should you push on an adults chest?
at least 2 inches (5cm) in adults
How hard should you push on an infants chest?
A depth of at least one third the AP diameter of the chest or about 1.5 inches (4cm)
how hard should you push on a childs chest?
about 2 inches (5cm)
What is the post-cardiac arrest syndrome?
Pathophysiology due to the ischemia-reperfusion response that occurs during cardiac arrest and subsequent return of spontaneous circulation
What are the components of the post cardiac arrest syndrome?
- post-cardiac arrest brain injury
- post-cardiac arrest myocardial dysfunction
- systemic ischemia/reperfusion response
- persistent precipitating pathology that caused or contributed to the cardiac arrest
What are the PATCH-4-MD possible treatable causes of cardiac emergencies?
Pulmonary embolism - anticoagulant, surgery
Acidosis - ventilation, correct acid-base disturbance
Tension pneumothorax - needle decompress
Cardiac tamponade - pericardiocentesis
Hypovolemia - replace volume
Hypoxia - ensure adequate oxygenation and ventilation
Hypo/Hyperkalemia (and other electrolytes) - monitor glucose carefully wile correcting electrolytes
Myocardial infarction - reperfusion therapy
What are the 5 H's for possible treatable causes of cardiac emergencies?
Hydrogen ion (acidosis)
What are the 5 T's for possible treatable causes of cardiac emergencies?
Thrombosis: lungs (massive PE)
Thrombosis: heart (ACS)
What are the three phase of cardiopulmonary resuscitation due to VF?
1. Electrical phase
2. Circulatory (hemodynamic) phase
3. Metabolic phase
What is the time frame and intervention of phase 1 of cardiopulmonary resuscitation?
Occurs from the time of VF arrest to about the first 5 min after the arrest
Intervention is electrical therapy (defibrillation)
What is the time frame and intervention of phase 2 of cardiopulmonary resuscitation?
Circulatory (hemodynamic) phase
Occurs from 5 min to 15 min after VF arrest
Intervention is CPR before electrical therapy
What is the time frame and intervention of phase 3 of cardiopulmonary resuscitation?
Occurs after about 15 minutes
Intervention is therapeutic hypothermia
What type of drug may improve perfusion pressures during cardiac arrest?
What is a common cause of intrathoracic pressure during CPR?
Increased pressure can decrease venous return during the release (diastolic) phase of chest compression