Cardiac Arrest Flashcards
Define cardiac arrest
Term used to describe the ultimate result of 4 different cardiac arrhythmias: ventricular tachycardia (VT), ventricular fibrillation (VF), pulseless electrical activity (PEA), and asystole.
Aetiology of cardiac arrest
4 H’s: hypovolaemia, hypothermia, hyperkalaemia, hypoxia
4 T’s: Thrombosis, tamponade, tension pneumothorax, toxins
Investigations for cardiac arrest
VBG/ABG
FBC
U&Es
LFTs
CRP
Bone profile
TFTs
Glucose
Management for cardiac arrest
Unresponsive + no pulse → start ALS
1. Start CPR
- Chest compressions 30:2
- Continuous if there is an advanced airway
2. Call 2222 and for help
- Adult arrest, state location (hospital, ward, bed number)
3. Attach AED and assess rhythm
- Non-shockable → Continue CPR
- Shockable →
4. Defibrillation
- Continue compressions as you prepare the pads/defibrillator
- Rhythm check
- Every 2 minutes
- 120-360J
- Ensure that the apical (lateral) pad is positioned correctly (mid-axillary line, level with the V6 ECG electrode position) i.e. below the armpit.
- Should remove oxygen before shocking
5. Vasopressors
- Non-shockable: Adrenaline 1mg 1:10,000 IV/IO immediately
- Shockable: adrenaline 1mg IV/IO after the 3rd shock
- Repeat every 3-5 minutes
- Amiodarone 300mg after 3rd shock and again after 5th
What should be considered during cardiac arrest management
Simultaneous A-E
Coronary angiography/PCI
Extracorporeal CPR
US imaging
Consider reversible causes
Hyperkalaemia - what were the gases
Hypovolaemia - what was the blood pressure
Hypoxia - what were sats, is there equal air entry
Hypothermia - what’s temperature
Tamponade - known or not, consider US or echo
Tensions pneumothorax - chest sounds, is there equal air entry, consider US
Toxin - urine toxicology, known drug use?
Thrombosis - consider thrombolysis
What should be done after ROSC
A-E
Correct sats
12 lead ECG
Identify and treat cause
