327 Cardiovascular Collapse, Cardiac arrest, Sudden Cardiac Death Flashcards
Natural death due to cardiac causes in a person who may or may not have previously heart disease - unexpected.
Sudden cardiac death
Previously most common electrical mechanism for cardiac arrest
Ventricular fibrillation or PVT
Most common mechanism recorded at initial contact (45-50%)
Asystole
Most common structural abnormality associated with SCD in middle aged or older adults
Coronary artherosclerotic heart disease
Refers to attemt to identify individual patients at specific risk for SCD and institute preventive strategies
Primary prevention
Refers to measures taken to prevent recurrence
Secondary prevention
Most powerful long term risk factors include:
age, smoking elevated cholesterol, DM, HPN, LVH, non specific ecg abnormalities, elevated CRP
Marker of inflammation that may predict plaque destabilization
C reactive protein
Most common cause of SCD in US
Hypertrophic CM
Mechanism in which outcome is best
pulseless VT, next is VF
Pulse check is no longer recommended beacause it is unreliable - where should you check for pulse in patients suspected to have cardiac arrest?
Femoral and Carotid
Right technique for CPR
Sternum depressed, arms straight, rate of 100 per minute, force to depress sternum 4-5cm and relaxation is abrupt.
Once diagnosis of VF or VT is established, how do you shock the patient?
150-200 J in biphasic waveform
360 J if monophasic waform
After 2 to 3 unsuccessful defibrillation attempts, what do you give?
Epinephrine 1mg IV
Recommended for confirmation and monitoring of endotracheal tube placement
Quantitative waveform capnography
After initial unsuccessful defibrillation, antiarrythmic therapy should be given. What do you give?
IV amniodarone 150mg over 10 minutes, followed by 1mg/min for 6 hours and 0.5mg/min thereafter
VF in early phase of ACS, this can be given as alternative
Boluse of 1mg/kg lidocaine
Four components of post-cardiac arrest syndrome
1) Brain injury
2) myocardial dysfunction
3) Systemic ischemia/reperfusion
4) control of precipitating factors
Strong predictor of in hospital death and post arrest disability
Anoxic Encephalaopathy
Post- MI patients with EF <35%, with other risk factors, heart failure are candidates for ICDs __ days or more after MI.
40 days after MI.
Very low EFs <20% may recieve less benefit.
Newly diagnosed heart failure patients with EF <35%, required delay between diagnosis and medical therapy and implantation of ICD is __ days.
90 days.
Very low EFs <20% may recieve less benefit.
