Cardiac Arrest

Question 1

What is the immediate management of a cardiac arrest?

Answer 1

Is patient unresponsive/not breathing normally?
   -call resus team
Start CPR
   -30:2
   -attach defib/monitor
Assess rhythm

Question 2

What are the shockable rhythms?

Answer 2

Ventricular Fibrillation

Pulseless Ventricular Tachycardia

Question 3

What are the non-shockable rhythms?

Answer 3

Pulseless Electrical Activity

Asystole

Question 4

How should shockable rhythms be managed?

Answer 4

1 shock (minimise interruptions)
Resume CPR for 2 mins
Re-assess rhythm
After 3 shocks give Adrenaline 1mg (10ml 1 : 10,000) Amiodarone 300mg
-repeat adrenaline every 3-5mins (between alternate cycles of CPR)

If a witnessed shock in CCU - 3 x successive shocks

Question 5

How should non-shockable rhythms be managed?

Answer 5

No shocks
Give 10ml 1:10,000 Adrenaline IV
   -repeat every 3-5mins
Resume CPR for 2 mins
Re-assess rhythm

Question 6

What is the immediate post-cardiac arrest management?

Answer 6

A-E approach
Aim SpO2 94-98%
Aim normal PaCO2
12 lead ECG
Treat underlying cause
Temperature management

Question 7

What should be done during CPR?

Answer 7

Ensure high quality chest compressions
Minimise interrutpions
Give O2
Waveform capnography
Continuous compressions when advanced airway in place
Vascular access
Adrenaline (every 3-5mins)
Amiodarone (after 3 shocks)

Question 8

What are the reversible causes of cardiac arrest?

Answer 8

Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia (metabolic)
Hypothermia

Thrombosis (coronary/pulmonary)
Tension pneumothorax
Tamponade
Toxins

Question 9

How should adrenaline be administered when managing a cardiac arrest?

Answer 9

After 3 shocks then every 3-5mins

-10ml 1:10,000 IV

Question 10

How should amiodarone be administered when managing a cardiac arrest?

Answer 10

After 3 shocks

-300mg IV

Question 11

What is the post cardiac arrest syndrome?

Answer 11

Combination of pathophysiological processes occuring post-cardiac arrest

• post-arrest brain injury
• post-arrest myocardial dysfunction
• systemic ischaemia/reperfusion response
• persistent precipitant pathology

Question 12

What determines the severity of the post cardiac arrest syndrome?

Answer 12

Duration of arrest

-may not happen at all

Question 13

What should be done to manage the Airway/Breathing of a patient in cardiac arrest?

Answer 13

O2 via facemask if SpO2 <94%
-hyperoxaemia increases stress to brain/heart
Consider sedation/ventilation w/ admission to ICU
If brief will not require tracheal intubation/ventilation

Question 14

What should be done to manage the Circulation of a patient in cardiac arrest?

Answer 14

Percutaneous coronary intervention
   -if ST elevation/LBBB
Echocardiography to assess extent of myocardial dysfunction
   -ionotropic support/fluids
Transient hypokalaemia
   -can cause arrhythmias
   -IV potassium

Question 15

What should be done to manage the Disability of a patient in cardiac arrest?

Answer 15

Cerebral auto-regulation lost post arrest

• maintain blood pressure near to MAP
• sedate/ventilate for 24hrs, necessary if targeted temp management
• EEG to detect seizures

Question 16

What should be done to manage the Exposure of a patient in cardiac arrest?

Answer 16

Hyperthermia common in first 48hrs

Targeted temperature management

Question 17

Describe targeted temperature management?

Answer 17

Cooling to 36o is neuro-protective

• indicated for pts who are unresponsive once spontaneous circulation returns
• cooling blankets/pads/intravascular heat exchangers used
• sedation to prevent shivering
• cool >24hrs