Cardiac Arrest

Question 1

Define Cardiac arrest

Answer 1

acute cessation of cardiac function

Question 2

What are the 8 reversible risk factors for cardiac arrest?

Answer 2

4 Hs 
Hypothermia 
Hypoxia 
Hypovolaemia 
Hypokalaemia/ Hyperkalaemia 
4 Ts 
Toxins (+ other metabolic disorders (drugs, therapeutic agents, sepsis)) 
Thromboembolic 
Tamponade 
Tension pneumothorax

Question 3

Describe the symptoms of cardiac arrest

Answer 3

Usually sudden
Fatigue
Fainting
Dizziness

Question 4

List 3 signs of cardiac arrest

Answer 4

Unconscious
Not breathing
Absent carotid pulses

Question 5

What bloods should be taken in suspected cardiac arrest?

Answer 5

ABG (abnormalities may be cause/ result)
U+Es (abnormalities may be cause/ result)
FBC (Haemorrhage may cause hypovolaemia)
X-match
Clotting
Toxicology screen (Illicit substances predispose ventricular Arrhythmia)
Cardiac biomarkers (elevation may be cause/ result of MI)

Question 6

How would you approach management of cardiac arrest?

Answer 6

Approach arrest scene with caution
Cause of arrest may pose a threat
Defibrillators + oxygen are hazards

Question 7

What basic life support is given in cardiac arrest

Answer 7

Clear + maintain airway with head tilt, jaw thrust + chin lift
Assess breathing by look, listen + feel
If absent - give 30 chest compressions ~100/min
Continue cycle of 30: 2
Proceed to advanced life support ASAP

Question 8

What advanced life support is given in cardiac arrest?

Answer 8

Attach cardiac monitor + defibrillator
Assess rhythm
If VF or pulseless VT (shockable rhythms)
Defibrillate once (150-360J biphasic, 360J monophasic)
Ensure no one touching pt or bed
Resume CPR immediately for 2 mins + reassess rhythm + shock again if still shockable rhythm
Give drugs >3 shocks
If pulseless electrical activity (PEA) or asystole (non-shockable rhythms)
Continue CPR, OBTAIN IV access + secure airway
Once airway secure give continuous compressions + ventilation
Administer adrenaline (1 mg IV) every 3-5 mins
Reassess rhythm ever 2 mins

Question 9

What should you do during CPR after 3 shocks?

Answer 9

Administer adrenaline (1 mg IV) every 3-5 mins  
If shockable rhythm administer amiodarone 300 mg IV bolus (or lidocaine)

Question 10

How do you correct the reversible causes of cardiac arrest?

Answer 10

Hypoxia: give O2.
Hypovolaemia: give IV fluids
Hypothermia: warm slowly
Hyperkalaemia: Correct imbalance
Tension pneumothorax: aspiration or chest drain
Tamponade: pericardiocentesis 
Toxins: use antidote for given toxin
Thromboembolism (coronary/ pulmonary): thrombolytic drugs (may take up to 90 minutes to work.)

Question 11

What is the prognosis in cardiac arrest?

Answer 11

Resuscitation less successful if cardiac arrest happens outside the hospital
Increased duration of inadequate effective cardiac output = poor prognosis

Question 12

What investigation may you request if you suspect cardiac arrest?

Answer 12

Continuous cardiac monitoring (ECG)

Echocardiogram

Question 13

List 3 conditions that are considered strong risk factors for cardiac arrest

Answer 13

Coronary artery disease
LV dysfunction
Hypertrophic cardiomyopathy