9) OX sudden cardiac death - main rules of management of ventricular fibrillation , electromechanical dissociation and systole Flashcards
what is the management of ventricular fibrillation ?
RESUSITATION
1) chest compressions 100-120 per minute after 30 give 2 resuscitation breath for 2 minutes then check the rythm and rate
secure the airway
circulation
Shockable rhythms with defib: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT)
biphasic
120 -150 x 1
continue cpr for 2 mins
2nd cycle of defib = 360j
Medical therapy
Epinephrine 1 mg IV after 2nd cycle of defibrillation
Repeat every 3–5 min
3rd cycle of shock
Amiodarone IV
300mg / IV
additional 150 mg after 3–5 min
If V-fib does not respond to the standard ACLS protocol (refractory V-fib), consider administration of lidocaine, procainamide, amiodarone or magnesium
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when stable - maintain the antuarrythmic which caused success - usually amiodaone and lidocaine
treat underlying disease which causes vfib
ICD implantation
what are the ecg findings of vfib ?
and ventricular flutter ?
1) arrhythmic fibrillitory baseline usually more than 300pbm
2) idiscernable QRS complexes , with no resemblance to each other
3) no p waves
ventricular flutter
ventricular rate is less than 300pbm and more than 240pbm
and usually has the same morphological waves
what are the causes of vfib?
simultaneous contractions at multiple foci
other can be retry - unexcitable scar tissue from previous past myocardial infraction
most common - coronary artery disease
myocarditis , cardiomyopathy
electrophysiological disorders
wolff parkinson white syndrome
Long qt syndrome - torsa de pointes
what is electromechanical dissociation ?
pulseless electrical activity
normal cardiac impulse formation and conduction
but does not contract the muscle to pump (,mechanical action) - this can be due to diffuse myocardial injury
or pericardial tamponade
pacemaker is no help because the heart already has appropriate electrical stimulation
what are the causes for PEA?(pulseless electrical activity)
can be due to either be empty heart or electromechanical dissociation
the 6 H's hypovolemia - empty heart hypoxia hydrogen ion - acidosis hyper or hyokalemia hypoglycemia hypothermia
6T's tablets or toxins tamponade tension pneumothorax - empty heart thrombosis - myocardial or pulmonary embolism (empty heart) Tachycardia trauma
pregnancy - PE
presence of dialysis - hyperkalmeia
what is the diagnosis of PEA
normal sinus rhythm on ECG or semi organised sinus rhythm
cyanosis
jugular venous distension
no pulse
ultrasound - pericardial effusion or tamponade
tension pneumothorax - seen as lung sliding
cardiac ejection fraction
- inferior vena cava size small - - respiratory change - when you breath in it collapses down to nothing - no volume
- CVP
what are the treatment for electromechanical dissociation ?
we have to figure out the cause and treat that
eg pericardial effusion - pericardiocentesis
ACLS - cardiac resuscitation guidelines - however no evidence chest compressions is effective - but give continuous CPR
Perform CPR for at least 2 minutes before the first rhythm chec
intubation and ventilation
underlying cause for PEA cannot be determined and/or reversed, the treatment of pulseless electrical activity is similar to that for asystole
epinephrine (adrenaline) 1 mg IV every 3–5 minutes.
what is the treatment for electromechanical dissociation ?
For many years the intravenous administration of a bolus of calcium chloride or gluconate has been recommended for the treatment of electromechanical dissociation
what are the shockable rhythms other than vfib ?
pulseless ventricular tachycardia
DO not do shock to anybody with a pulse
what causes asystole?
the 6 h’s and 6 t’s
what is the diagnosis of asystole ?
flat line on ECG
no pulse
what is the treatmnet of ASYSTOLE ?
start CPR
oxygen administration
give 1mg of epinephrine every 3-5 minutes
vasopressin iv - 40 units can replace the first or second dose epinephrine
