Cardiac Arrest

Question 1

what is cardiac arrest

Answer 1

acute state of circulatory failure due to loss of cardiac systolic function

Question 2

what are the 4 specific cardiac rhythm disturbances

Answer 2

ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity and asystole

Question 3

how to remember the reversible causes of cardiac arrest

Answer 3

4 H’s and the 4 T’s

Question 4

what are the 4 H’s (reversible causes of C.A)

Answer 4

hypoxia, hypothermia, hypovolemia and hypo/erkalaemia

Question 5

what are the 4 T’s

Answer 5

toxins, thromboembolic (P.E) , tamponade and tension pneumothorax

Question 6

common causes of ventricular fibrillation and ventricular tachycardia

Answer 6

ischaemic heart disease and acute myocardial ischaemia

Question 7

summarise causes of cardiac arrest

Answer 7

hypoxia, hypovolaemia, hyperkalaemia, hydrogen ion excess (acidosis), hypothermia, hypo- or hyperglycaemia, trauma, tension pneumothorax, obstructive shock (pulmonary embolism, myocardial infarction), toxins, and cardiac tamponade

Question 8

main risk factors

Answer 8

coronary artery disease, left ventricular dysfunction

Question 9

signs and symptoms of cardiac arrest

Answer 9

patient is unresponsive

patient has abnormal breathing

patient has abnormal circulation

cardiac rhythm disturbances

Question 10

investigations

Answer 10

continuous cardiac monitoring

Bloods

echocardiogram

consider an ECG

Question 11

what is continuous cardiac monitoring

Answer 11

Identifying the cardiac rhythm is a key step in determining which cardiac arrest treatment algorithm to use.

e.g. is it shockable or non-shockable rhythm

Question 12

what bloods are needed

Answer 12

ABG, FBC, serum electrolytes and cardiac biomarkers

Question 13

safety hazards when dealing with a cardiac arrest

Answer 13

cause of arrest may be dangerous, defibrillators and oxygen are safety hazards. ALWAYS APPROACH WITH CAUTION

Question 14

unwitnessed Cardiac arrest management

Answer 14

CPR; basic life support

If the arrest is witnessed and monitored, consider giving a precordial thump (thump the sternum of the patient with the ulnar aspect of your fist)
Clear and maintain the airway with head tilt, jaw thrust and chin lift
Assess breathing by look, listen and feel
If they are not breathing, give two rescue breaths
Assess circulation at carotid pulse for 10 seconds
If absent - give 30 chest compressions at around 100/min
Continue cycle of 30 chest compressions for every 2 rescue breaths
Proceed to advanced life support as soon as possible

Question 15

what are the shockable rhythms

Answer 15

pulseless ventricular tachycardia and ventricular fibrillation

Question 16

what are non-shockable rhythms

Answer 16

pulseless electrical activity and asystole

Question 17

shockable rhythms management

Answer 17

cpr and defibrillation

PLUS adrenaline

Question 18

non-shockable rhythms

Answer 18

cpr and adrenaline

Question 19

main complications (common)

Answer 19

death, rib/sternal injuries due to CPR, anoxia brain injury

Question 20

prognosis

Answer 20

Resuscitation is less successful if cardiac arrest happens outside the hospital

Increased duration of inadequate effective cardiac output –> poor prognosis

Question 21

treating reversible cardiac arrests depends on?

Answer 21

cause

Question 22

treatment of C.A due to hypothermia

Answer 22

warm patient slowly

Question 23

treatment of C.A due to hypo/erkalaemia

Answer 23

correct electrolyte levels

Question 24

treatment of C.A due to tamponade

Answer 24

pericardiocentesis

Question 25

treatment of C.A due to thromboembolic

Answer 25

treat as PE or MI

Question 26

treatment of C.A due to toxins

Answer 26

antidote for relevant toxin

Question 27

treatment of C.A due to tension pneumothorax

Answer 27

aspiration or chest drain