Cardiac Arrest

Question 1

what is the definition of cardiac arrest

Answer 1

acute cessation of heart functioning

Question 2

what are the 8 reversible causes of cardiac arrest

Answer 2

1. Hypoxia
2. Hypothermia
3. Hypovolaemia
4. Hypo/hyperkalaemia
5. Tamponade
6. Tension pneumothorax
7. Thromboembolism
8. Toxins and other metabolic disorders (sepsis)

Question 3

what investigations would be performed in suspected cardiac arrest

Answer 3

1. cardiac monitor (ECG) (classification of rhythm directs management)
2. bloods (ABG, UEs, FBC, cardiac enzymes, glucose)

Question 4

why should a cardiac arrest scene be approached with caution

Answer 4

cause may still pose a threat (CO)

Question 5

what are hazards in cardiac arrest management

Answer 5

defibrillators and oxygen

Question 6

what is the process of basic life support in cardiac arrest management

Answer 6

• if arrest witnessed and monitored, consider a precordial thump if defibrillator not available
• clear and maintain Airways
• assess Breathing (give 2 breaths immediately if not)
• assess Circulation (30 compressions for every 2 breaths)
• proceed to advanced life support ASAP

Question 7

what is the process of advanced life support in cardiac arrest management

Answer 7

• attached cardiac monitor and defibrillator

- assess rhythm

Question 8

what is the course of action if the rhythm is assessed and there is a pulseless ventricular tachycardia/ventricular fibrillation

Answer 8

• defibrillate once (150-360 J biphasic, 360 J monophasic)
• resume CPR immediately for 2 mins
• reassess and repeat if necessary
• administer adrenaline (1mgIV) after second defibrillation and again every 3-5mins
• if shockable rhythm persists after third shock administer amiodarone 300mg

Question 9

what is the course of action if the rhythm is assessed and there is pulseless electrical activity

Answer 9

• CPR for 2mins
• reassess and repeat if necessary
• administer adrenaline (1mgIV) every 3-5mins
• atropine (3mgIV, once only) if asystole/PEA persists with rate <60bpm

Question 10

what is the treatment for the 8 reversible causes of cardiac arrest

Answer 10

1. Hypoxia
2. Hypothermia-warm slowly
3. Hypovolaemia-IV colloids/crystalloids/blood products
4. Hypo/hyperkalaemia-electrolyte correction
5. Tamponade-pericardiocentesis
6. Tension pneumothorax-needle into 2nd ICS mid-clavicular line
7. Thromboembolism-
8. Toxins and other metabolic (sepsis)-antidotes

Question 11

what are the complications associated with cardiac arrest

Answer 11

death (irreversible hypoxic brain damage)
recurrent cardiac arrest
renal acute tubular necrosis

Question 12

what is the prognosis in cardiac arrest

Answer 12

resuscitation outside hospitals is less successful

the longer the period of inadequate effective CO the lower the prognosis

Question 13

what are the 4 cardiac rhythm disturbances in cardiac arrest

Answer 13

VF
pulseless VT
pulseless electrical activity
asystole

Question 14

epi

Answer 14

elderly

Question 15

aside from the reversible causes of cardiac arrest, what are the three most common non-reversible causes of cardiac arrest

Answer 15

1 IHD (most common)
2 cardiomyopathy
3 dysrhythmia

Question 16

what are the most common causes of sudden cardiac arrest from the 4 cardiac rhythm disturbances

Answer 16

VF

VT

Question 17

what typically causes VF and VT

Answer 17

IHD

Question 18

what are the common causes of PEA

Answer 18

MI + PE

reversible causes such as hypovolaemia, hypoxia

Question 19

risk factors

Answer 19

risk factors for IHD (HTN, hypercholesterolaemia, DM, smoking)
CAD
LV dysfunction
HOCM
Long QT syndrome (esp with BB use)

Question 20

history + examination

Answer 20

chest pain (central crushing chest pain radiating tot he left neck and shoulder may indicate MI), palpitations, syncope