Cardiac arrest

Question 1

Define cardiac arrest

Answer 1

DEFINITION: acute cessation of cardiac function

Question 2

What is the difference between cardiac arrest and heart attack?

Answer 2

Heart attack - ischaemia to the heart

Cardiac arrest - electrical activity of the heart ceases.

Question 3

Explain the aetiology and risk factors of cardiac arrest

Answer 3

The 4 Hs & 4Ts;

FOUR Hs ;
Hypothermia 
Hypoxia 
Hypovolaemia 
Hypokalaemia/Hyperkalaemia 

FOUR Ts ;
Toxins (and other metabolic disorders (drugs, therapeutic agents, sepsis)) 
Thromboembolic 
Tamponade 
Tension pneumothorax

Question 4

Recognise the presenting symptoms of cardiac arrest

Answer 4

Management precedes hx or is concurrent to history

Cardiac arrest is usually sudden but some symptoms that may preceded are;
- fatigue, fainting, blackouts, dizziness

Question 5

Recognise the signs of cardiac arrest on physical examination

Answer 5

Unconscious

Not breathing

Absent carotid pulses

Question 6

Identify appropriate investigations for cardiac arrest

Answer 6

1. Cardiac Monitor
   - Allows classification of the rhythm

2. Bloods ;
ABG 
U&E 
FBC 
X-match (cross match)
Clotting  
Toxicology screen 
Blood glucose

Question 7

What is improtant to think about before approaching a cardiac arrest scene?

Answer 7

Approach any arrest scene with caution

The cause of the arrest may pose a threat

Defibrillators and oxygen are hazards

Question 8

Generate a management plan for cardiac arrest

Answer 8

You do everything you do in a Basic Life support lesson and then treatment of reversible causes. So;
Airway, Breathing, Circulation.

If carotid pulse absent begin chest compressions, 2 rescue breaths. for 2 rounds (2 mins).

The move on to advaned life support; defibrillator.

Then restart compressions. Then defib again.

If heart is still in ‘ shockable rhythm’ mode, give 1mg adrenaline.

Compressions then defib again. if no change in rhytym then give amiodarone 300mg.

If persisting then give more adrenaline every 3-5 minutes.

If asystole; non shockable rhythm then give;
Atropine 3mg once.

VERY SUMMARISED - SEE LAZs

Question 9

In the management of cardiac arrest, how do we treat the REVERSIBLE causes ?

Answer 9

Hypothermia - warm slowly

Hypokalaemia and Hyperkalaemia - correction of electrolyte levels

Hypovolaemia - IV colloids, crystalloids and blood products

Tamponade - pericardiocentesis

Tension Pneumothorax - aspiration or chest drain

Thromboembolism - treat as PE or MI

Toxins - use antidote for given toxin

Question 10

Identify the possible complications of cardiac arrest

Answer 10

Irreversible hypoxic brain damage

Death

Question 11

Summarise the prognosis for patients with cardiac arrest

Answer 11

Resuscitation is less successful if cardiac arrest happens outside the hospital

Increased duration of inadequate cardiac output –> poor prognosis