Cardiac arrest Flashcards
What are the reversible causes of cardiac arrest?
4 Hs and 4 Ts:
- Hypovolaemia
- Hypoxia
- Hypothermia
- Hypo/hyperkalaemia + other metabolic disorders
- Thrombosis
- Tension pneumothorax
- Tamponade
- Toxins
What are the shockable rhythms?
VF + VT
Explain the algorithm for cardiac arrest involving a shockable rhythm
A-E
Call resuscitation team
Perform uninterrupted chest compressions whilst applying defibrillator pads, one below right clavicle and another in V6 midclavicular line
Stop compressions, confirm VT/VF on ECG
Resume compressions, charge the defibrillator w energy setting of at least 150J
Continue CPR for 2 mins 30:2 starting w compressions
Give 2nd and 3rd shocks following prev rules
Give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2 min CPR. Withold if there are signs of return of spontaneous circulation
Eventually change plan to nonshockable rhythm if asystole or no ROSC
What are non-shockable rhythms
PEA - pulseless electrical activiy
Asystole
Explain the algorithm for cardiac arrest involving a non-shockable rhythm
Start CPR 30:2
Give adrenaline 1 mg IV as soon as intravascular access is achieved
Continue CPR 30:2 until the airway is secured – then continue chest compressions without pausing during ventilation
Recheck the rhythm after 2 min:
a. If electrical activity compatible with a pulse is seen, check for a pulse and/or signs of life
i. If a pulse and/or signs of life are present, start post resuscitation care
ii. If no pulse and/or no signs of life are present (PEA OR asystole):
Continue CPR
Recheck the rhythm after 2 min and proceed accordingly
Give further adrenaline 1 mg IV every 3–5 min (during alternate 2-min loops of CPR)
b. If VF/pVT at rhythm check, change to shockable side of algorithm.
What is usually the cause of hypovolaemia in cardiac arrest
severe haemorrhage
How should cardiac arrest caused by hyperkalaemia, hypocalcaemia and CCB overdose be treated?
IV calcium chloride
When should reversible causes of cardiac arrest be treated?
ROSC
What is the most common cause of cardiac arrest
Coronary thrombosis associated with an acute coronary syndrome or ischaemic heart disease
How should a tension pneumothorax be treated?
Decompress rapidly by thoracostomy or needle thoracocentesis, and then insert a chest drain.
What is suggestive of cardiac tamponade causing cardiac arrest? What would the treatment be?
Cardiac arrest after penetrating chest trauma is highly suggestive of tamponade and is an indication for resuscitative thoracotomy.
