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MEDiscuss • Cardiovascular diseases • Cardiac arrest and its management

  1. #1
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    Lightbulb Cardiac arrest and its management

    Cardiac arrest is a medical emergency where identification of the condition and immediate action is critical for the patient's survival. There are many causes and types of cardiac arrest.

    Let us discuss these and their management in brief. Please follow these simple rules:
    1. Do not use non-standard abbreviations
    2. Be brief, but fairly complete. Write about 3-4 paragraphs and use lists where necessary.
    3. Do not copy-paste directly from another resource/ website. Respect copyright.
    4. Include your own personal views and experiences too
    Points will be awarded for each response.
    What to do with these points? You will learn later

  2. #2
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    First response reserved for later use if necessary.

  3. #3
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    Management of cardiac arrest

    Cardiac arrest is define as sudden and complete loss of cardiac function.
    Causes of unexpected cardiac arrest:
    1) cardiac arrhythmias (eg. ventricular fibrillation)
    2) sudden pump failure (eg. acute myocardial infarction)
    3) acute circulation obstruction (eg. pulmonary embolism)
    4) cardiovascular rupture (eg. aortic dissection, myocardial rupture)
    5) vasomotor collapse (eg. pulmonary hypertension)
    Attached Files Attached Files
    Last edited by booih; July 20th, 2007 at 07:59 AM.

  4. #4
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    Cardiac Arrest and its management

    Cardiac Arrest
    - sudden and complete loss of cardiac function.
    - Patient will loss consciousness and respiration ceases immediately, pulse will be absent as well.
    - death is inevitable unless effective treatment is given.
    - accounts for 25% - 30% of people who die for cardiovascular disease.

    Common causes:
    - coronary artery disease (85%)
    • myocardial ischaemia
    • myocardial infarction
    - structural heart disease (10%)
    • aortic stenosis
    • hypertrophic cardiomyopathy
    • congenital heart disease
    - no structural heart disease (5%)
    • Long QT syndrome
    • Woff-Parkinson-White syndrome
    • adverse drug reactions
    • severe electrolyte abnormalities
    4 cardiac arrest rhythms
    -Ventricular asystole
    -Pulseless electrical activity
    -Ventricular fibrillation
    -Pulseless ventricular tachycardia

    Management of cardiac arrest:
    Basic life support(BSL)
    1. Check responsiveness
    2. open airway
    3. check breathing
    4. 2 effective breaths
    5. assess signs of circulation
    6. CPR - 100 per minute, ratio of 15 compressions to 2 breaths
    Advance life support(ALS)
    1. attach defibrillator/monitor
    2. assess rhythm, check pulse
    • If ventricular fibrillation or pulseless ventricular tachycardia - defibrillate 3 times as necessary, then do CPR 1 min.
    • If ventricular asystole or pulseless electrical activity - ventilate with high oxygen concentration, then do CPR for 3 minutes.
    -during CPR, administer adrenaline every 3 minutes. Consider anti-arrhythmics, atropine/pacing, buffers. Check monitor as well.
    - during CPR, correct reversible causes e.g hypoxia, hyper/hypo-kalemia.

  5. #5
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    Jul 2007

    management of cardiac arrest

    1) Check responsiveness (shake and shout)
    2) Open airway by head tilt and chin lift.
    3) Check breathing – Look listen and feel. If there is any breathing, then put in recovery position.
    4) Breathe – Two effective breaths
    5) Assesss – Sign of circulation (10 seconds only)
    If circulation present continue rescue breathing . Check circulation every minute.
    6) If NO CIRCULATION, compress chest 100 per minute, ratio of 15 com pressions to 2 breaths. ( send or go for help as soon as possible)

    Fig 1.1 Algorithm for adult life support
    Cardiac arrest
    Praecordial thump if appropriate
    BLS algorithm if appropriate
    Attach defibrillator / monitor
    Assess rhythm
    +/- Check pulse
    VF / VT
    non VF/VT

    CPR 3 mins
    Defibrillate (three times) 1min if immediately
    after defibrillation as necessary

    CPR 1 min
    During CPR
    Correct reversible causes
    If not ready:
    · Check reversible causes
    If not ready:
    · Check electrode/paddle
    Positions and contact
    · Give adrenaline (epinephrine)
    Every 3 mins
    Consider: anti arrthmics

    Potentially reversible causes:

    Tension pneumothorax
    Toxic/therapeutic disturbances
    Thromboembolic/ mechanical obstruction
    Last edited by Shashikiran; July 20th, 2007 at 08:48 AM.

  6. #6
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    Jul 2007

    Management of Cardiac arrest


    A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.

    It is a medical emergency.

    [FONT=&quot]When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD)
    [/FONT][FONT=&quot]The out-of-hospital cardiac arrest (OHCA) has a worse survival rate (2-8% at discharge and 8-22% on admission), than an in-hospital cardiac arrest (15% at discharge).

    2 main mechanisms of sudden unexpected cardiac arrest:
    -Ventricular fibrillation/ Ventricular tachycardia
    - Non-VF/VT (asystole and pulseless electrical activity ie electromechanical dissociation)

    Basic Life support
    [/FONT][FONT=&quot]-Shout for help
    -Assess resposiveness of victim by shouting or shaking
    -Check airway, breathing, circulation
    - Airway- Head tilt + Chin lift + clear mouth
    - Breathing- Look for chest movement, listen to breath sound, feel for expired air
    - Circulation- carotid pulse
    - Start cardiopulmonary resuscitaion
    - Give 2 effective breaths
    - Assess carotid pulse in 10sec
    - Circulation present- continue rescue breathing, check circulation every minute
    - No circulation- chest compression 100/min in 15:2 ratio

    Advanced cardiac life support
    - ECG monitoring, endotracheal intubation, IV infusion

    In VF/VT, defribillation without delay, defribillation x 3 then CPR 1 min then assess rhhythm
    In non- VF/VT, CPR upto 3min then reassess

    Correct REVERSIBLE causes during performing CPR such as hypoxia, hypovolemia, hyper/hypokalemia, hypothermia, tension pneumothorax, cardiac tampone etc

    Simultaneously, give epinephrine 1mg every 3min. Consider amiodarone, atropine/pacing buffer. antiarrthymics

    Maximize prognosis by:
    1. Early assess
    2. Early CPR
    3. Early defribillition
    4. Early hospital care

  7. #7
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    Jul 2007

    Management of cardiac arrest.

    Management of cardiac arrest.
    1) Confirm the diagnosis, check the time, start CPR and call for help.
    2) Maintain the airway, breathing, circulation.
    3) When the help arrives, give 100% oxygen via ambu-bag, set up IV line and infuse normal saline.
    4) Place ECG leads.
    5) Carry on CPR except during intubation and defibrillation.
    6) Subsequent management will depend on ECG rhythm. (specific cardiac sequences)
    7) Prepare the following drugs: 1ml 1:1,000 adrenaline, lignocaine 100mg IV, 50ml bicarbonate 8.4%, isoprenaline 2mg in 500ml 5% dextrose to be used when necessary.
    8) If cardiac arrest has persisted for > 30 minutes, resuscitation is unlikely to be successful, look for signs of brain death.
    9) If resuscitation successful, it is very important to maintain the vital signs. Fluid balance, ABG, CVP, urine output and electrolytes need to be monitored closely and treated appropriately.
    10) The further management depends on specific cardiac sequences.

  8. #8
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    • Early recognition - Recognition of illness before the patient develops a cardiac arrest will allow the rescuer to prevent its occurrence.
    • Early CPR- This buys time by keeping vital organs perfused with oxygen whilst waiting for equipment and trained personnel to reverse the arrest.
    • Early defibrillation - This is the only effective for Ventricular fibrillation, and also has benefit in Ventricular tachycardia.
    • Early post-resuscitation care - Treatment and rehabilitation in a hospital by specialist staff helps to prevent further complications.

  9. #9
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    [FONT=Times New Roman][/FONT]
    [FONT=Times New Roman]Cardiac arrest means an abrupt loss of the heart’s ability to pump.[/FONT]
    [FONT=Times New Roman]Three main causes of cardiac arrest:-[/FONT]
    • [FONT=Times New Roman]Ventricular fibrillation[/FONT]
    • [FONT=Times New Roman]Pulseless ventricular tachycardia[/FONT]
    • [FONT=Times New Roman]Assystole – no electrical acivity [/FONT]
    • [FONT=Times New Roman]Electrical and mechanical disassociation – no/less output despite good conduction [/FONT]
    [FONT=Times New Roman]The management in cardiac arrest can be explained well based on these 4 steps:[/FONT]
    • [FONT=Times New Roman]Call for help[/FONT]
    • [FONT=Times New Roman]Early CPR[/FONT]
    • [FONT=Times New Roman]Defibrillation[/FONT]
    • [FONT=Times New Roman]Early Advance Life Support[/FONT]
    [FONT=Times New Roman]There are 2 stages in the management, first is the Basic life support, which is aimed at maintaining a minimal circulation and breathing by doing CPR till definitive help arrives. Next is the Advance life support by defibrillation and it can also include intubation and IV drugs.[/FONT]
    [FONT=Times New Roman]A summary of actions taken in the management:[/FONT]
    • [FONT=Times New Roman]Call for help and initiate CPR[/FONT]
    • [FONT=Times New Roman]When help arrives, give 100% oxygen and start IV line with normal saline infusion and continue CPR[/FONT]
    • [FONT=Times New Roman]Take ECG at the same time.[/FONT]
    • [FONT=Times New Roman]Stop CPR only when need to defibrillate or intubate.[/FONT]
    • [FONT=Times New Roman]In ventricular tachycardia(VT) or ventricular fibrillation(VF) defibrillator is done for three times then continue CPR for 1 minute. In non ventricular fibrillation or tachycardia CPR for 3 minutes or for 1 minute after defibrillation.[/FONT]
    • [FONT=Times New Roman]Emergency drugs, 1ml 1;1000 adrenaline, lignocaine 100mg, bicarbonate and isoprenaline. Given through IV[/FONT]
    • [FONT=Times New Roman]If arrest persists more than 30 minutes then must look for signs of brain death[/FONT]
    • [FONT=Times New Roman]If patient has been successfully resuscitated, then monitoring with intake output chart, ABG, CVP, urine analysis and antiarrhytmic drug and dopamine if required.[/FONT]
    [FONT=Times New Roman]VF/VT[/FONT]
    [FONT=Times New Roman]Precordial thump in witnessed arrest.[/FONT]
    [FONT=Times New Roman]Defibrillation is initiated. (values correspond for the monophasic type)[/FONT]
    • [FONT=Times New Roman]200J, check pulse, recharged, give 15 chest compressions and check rhythm on monitor.[/FONT]
    • [FONT=Times New Roman]200-300J followed by the same.[/FONT]
    • [FONT=Times New Roman]360J at the third attempt[/FONT]
    • [FONT=Times New Roman]If still unsuccessful, adrenaline injection is given and 1 minute of CPR is done before repeating the whole sequence again.[/FONT]
    [FONT=Times New Roman]Electrical Mechanical Disassociation [/FONT]
    [FONT=Times New Roman]It is treated with CPR, while identifying the cause and correcting it.[/FONT]
    [FONT=Times New Roman]Asystole[/FONT]
    [FONT=Times New Roman]Is treated with CPR and intravenous drug like atropine and adrenaline and if required transvenous pacemakers to produce the electrical current. [/FONT]

  10. #10
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    Jul 2007

    Management of Cardiac Arrest

    [FONT=Verdana]Basic cardiac life support[/FONT]
    [FONT=Verdana]Basic cardiac life support aims to restore a circulation of oxygenated blood before professional help arrives. It comprises the basic skills of cardiopulmonary resuscitation (CPR) and combines closed chest compression with artificial ventilation of the lungs. [/FONT]
    [FONT=Verdana]1. Diagnose cardiac arrest by checking the patient's response to sound and touch, absent respirations and impalpable carotid or femoral pulses. [/FONT]
    [FONT=Verdana]2. If the arrest is witnessed, consider giving one or two precordial thumps. [/FONT]
    [FONT=Verdana]3. Assess and clear the airway with the patient on their side. Then position the patient on their back. To prevent obstruction of the upper airway by the tongue, lift the jaw forwards and tilt the head backwards. [/FONT]
    [FONT=Verdana]4. Occlude the patient's nose and give two breaths into the mouth, or, in small children, into the mouth and nose together. Each breath should last about 1.5 seconds. Do not exhale too vigorously to avoid inflating the stomach. Observe the chest wall rising and falling with each expired air ventilation. [/FONT]
    [FONT=Verdana]5. Perform external chest compressions: [/FONT]
    [FONT=Verdana]i. Locate the middle of the sternum by finding the point half-way between the suprasternal notch and the xiphisternum. Compress the chest at or just below this position. [/FONT]
    [FONT=Verdana]ii. Perform chest compressions at a rate of 80-100 per minute in adults and at least 100 per minute in children and babies. [/FONT]
    [FONT=Verdana]iii. With each compression, depress the chest wall to a depth of approximately 4-5 cm in adults, 3-4 cm in children and 2-3 cm in babies. [/FONT]
    [FONT=Verdana]6. The single resuscitator performs 15 chest compressions followed by two exhaled air ventilations. With two operators, cycles comprise 5 chest compressions followed by a pause, during which the lungs are inflated once. These sequences are continued until help arrives. [/FONT]
    [FONT=Verdana]Simultaneous chest compression and ventilation is no longer advocated. [/FONT]
    [FONT=Verdana]Devices such as resuscitation bags and masks and oropharyngeal airways may improve the efficiency, hygiene and aesthetics of CPR. [/FONT]
    [FONT=Verdana]Advanced cardiac life support[/FONT]
    [FONT=Verdana]Basic life support maintains viability for only a few minutes. For successful resuscitation, additional advanced cardiac life support is usually required and comprises electrical defibrillation, endotracheal intubation and intravenous drugs and fluids. The principles of management are similar in adults and children.[/FONT][FONT=Verdana]Unless there is immediate return of spontaneous cardiac output, certain `core' interventions are necessary in all cardiac arrests. Additional interventions depend on the specific circumstances of each arrest. [/FONT]


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