Cardiac Arrest Flashcards
Define Cardiac arrest
acute cessation of cardiac function
How are patients divided based on ECG findings?
Shockable: ventricular fibrillation/ pulseless ventricular tachycardia (VF/pulseless VT)
Non-shockable: asystole/ pulseless electrical activity (PEA)
What is pulseless electrical activity?
organised cardiac electrical activity in the absence of any palpable pulses.
Often have some mechanical myocardial contractions but they are too weak to produce a detectable pulse or BP
What are the 8 reversible risk factors for cardiac arrest?
4 Hs
Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia, Hyperkalaemia, hypoglycaemia, hypocalcaemia, acidaemia + other metabolic disorders
4 Ts
Toxins (drugs, therapeutic agents, sepsis)
Thromboembolic (coronary or pulmonary)
Tamponade
Tension pneumothorax
Describe the symptoms of cardiac arrest
Usually sudden
Fatigue
Fainting
Dizziness
List 3 signs of cardiac arrest
Unconscious
Not breathing
Absent carotid pulses
How would you approach management of cardiac arrest?
Approach arrest scene with caution
Cause of arrest may pose a threat
Defibrillators + oxygen are hazards
What basic life support is given in cardiac arrest?
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
What advanced life support is given in cardiac arrest?
- Attach cardiac monitor + defibrillator
- Assess rhythm
- If shockable rhythm:
Defibrillate once + resume CPR immediately for 2 mins + reassess rhythm + shock again if still shockable rhythm
After 3 shocks give Amiodarone
If non-shockable rhythm:
Resume CPR immediately
Reassess rhythm ever 2 mins
(150-360J biphasic, 360J monophasic)
When should adrenaline be administered during ALS?
Shockable rhythm: 1mg given after chest compressions resumed after 3rd shock
Non-shockable rhythm: 1mg ASAP
Repeat adrenaline 1mg every 3-5 mins
What dose of amiodarone should be given in shockable rhythms?
300mg Amiodarone after 3 shocks
Further 150mg Amiodarone after 5 shocks
How should a witnessed and monitored cardiac arrest in the cath lab/ early after cardiac surgery be treated?
- If initial rhythm is VF/ VT, give up to 3 quick successive (stacked) shocks.
- Start chest compressions immediately after 3rd shock + continue CPR for 2 min.
With respect to ALS algorithm, these 3 quick, successive shocks are regarded as the 1st shock.
When are thrombolytics indicated in cardiac arrest? How does this change management?
When PE suspected
Continue CPR for extended period of 60-90
How do you correct the reversible causes of cardiac arrest?
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 mins to work.)
