cardiac arrest

Question 1

definition of cardiac arrest

Answer 1

acute cessation of cardiac function

Question 2

causes of cardiac arrest

Answer 2

the 4 H’s and 4 T’s

• hypoxia
• hypothermia
• hypovolaemia
• hypo- or hyperkalaemia, hypercalcaemia, hypophosphate
• tamponade
• tension pneumothorax
• thromboembolism
• toxins and other metabolic disorders - drugs, therapeutic agents and sepsis, CO

aortic dissection

Question 3

sx of cardiac arrest

Answer 3

management precedes history

Question 4

signs of cardiac arrest

Answer 4

unconscious, absent carotid pulses, not breathing

Question 5

Ix for cardiac arrest

Answer 5

cardiac monitor - classification of the rhythm directs management

bloods - ABG, UE, FBC, cross-match, clotting, toxicology screen, glucose

Question 6

1st steps in mx of cardiac arrest

Answer 6

when pt has chest pain, on your way ask nurses to do ECG and BP/HR.

ABCDE and contact the cardiology team

Safety: Approach any arrest scene with caution - the cause of the arrest may still pose a threat. Defibrillators and oxygen are hazards.

Help should be summoned as soon as possible.

Question 7

BLS - cardiac arrest

Answer 7

1. If the arrest is witnessed and monitored, consider giving a precordial thump if no defibrillator immediately available.
2. Clear and maintain airway with head tilt (if no spinal injury), jaw thrust and chin lift.
3. Assess breathing by look, listen and feel. If not breathing, give two effective breaths immediately.
4. Assess circulation at carotid pulse for 10 s. If absent, give 30 chest compressions at rate of 100 min/1. Continue cycles of 30compressions for every two breaths.
5. Proceed to advanced life support as soon as possible.

Question 8

ALS - cardiac arrest

Answer 8

1. Attach cardiac monitor and defibrillator.
2. Assess the rhythm:
   
   • (A) If pulseless VT or VF (‘shockable rhythm’):- Defibrillate once: 150–360 J biphasic, 360 J monophasic.
     
     • (Ensure no one is touching patient or bed when defibrillating
     • Resume CPR immediately for 2 min, and then return to 2
     • Administer adrenaline (1mg IV) after second defibrillation and again every 3–5 min.

• If ‘shockable rhythm’ persists after third shock, administer amiodarone 300mg IV bolus (or lidocaine).

(B) If pulseless electrical activity (PEA) or asystole:- CPR for 2 min, and then return to 2.

• Administer adrenaline (1 mg IV) every 3–5 min.
• Atropine (3 mg IV, once only) if asystole or PEA with rate<60 min-1.

Question 9

(treatment of) reversible causes in cardiac arrest

Answer 9

Hypothermia: Warm slowly.

Hypo- or hyperkalaemia: Correction of electrolytes.

Hypovolaemia: IV colloids, crystalloids or blood products.

Tamponade: Pericardiocentesis under xiphisternum up and leftwards.

Tension pneumothorax: Needle into second intercostal space, mid-clavicular line.

Thromboembolism

Toxins

Question 10

complications of cardiac arrest

Answer 10

irreversible hypoxic brain damage

death

Question 11

Px of cardiac arrest

Answer 11

Resuscitation is less successful in the arrests that occur outside hospital.

Duration of inadequate effective cardiac output is associated with poor prognosis

Question 12

some drugs that can cause cardiac arrest

Answer 12

aminophylline

Question 13

pathology of cardiac arrest

Answer 13

main underlying causes - IHD, CVD, cardiomegaly/dysrhythmias

sudden cardiac arrest is the result of: VT, VF, pulseless electrical activity (PEA), asystole

most common cause of PEA - MI/ischemia, hypovolaemia, hypoxia, PE

PEA is organised electrical depolarisation of the myocardium, w/o appropriate contraction = inadequate circulation - might be from increased afterload, decreased preload or ischemia or changes in ion conc

Question 14

shockable rhythms

Answer 14

pulseless VT and VF

Question 15

non-shockable rhythms

Answer 15

PEA
asystole

Question 16

epidemiology of cardiac arrest

Answer 16

in europe - 84/100000