Cardiac Arrest

Question 1

Define Cardiac Arrest

Answer 1

Sudden state of circulatory failure due to loss of cardiac systolic function

4 types:
Pulseless Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity 
Asystole

Question 2

Aetiology of Cardiac Arrest

Answer 2

Ischaemic heart disease
Cardiovascular disease
Cardiomyopathy/dysrhythmia
Hypoxia
Hypovolaemia
Hyperkalaemia
Acidosis
Hypothermia
Hypo/hyperglycaemia
Trauma 
Tension pneumothorax/PE 
Cardiac tamponade

Question 3

What drugs are associated with cardiac arrest

Answer 3

Medications e.g. quinidine, procainamide, sotalol, amiodarone, disopryamide antidepressants

Illicit substances - cocaine, opioids

Question 4

Symptoms/signs of cardiac arrest

Answer 4

Patient unresponsive
Absent breathing
Absent circulation (no pulse)

Question 5

Investigations for cardiac arrest

Answer 5

Cardiac monitoring: shockable or non-shockable

ECG

Bloods: ABG, U+Es (esp. hyperK, FBC, X-match, clotting, toxicology, glucose)

Question 6

Management for cardiac arrest (presumptive, waiting for cardiac monitoring)

Answer 6

CPR
Airway and breathing assessment, head tilt chin lift, consider jaw thrust

30 compressions (100/min) and 2 rescue breaths

Total 5 cycles

Question 7

Management for shockable rhythm cardiac arrest

Answer 7

CPR and defibrillation - 1 shock followed by CPR for 2 minutes

Adrenaline 1mg IV every 3-5mins after 2nd defib

Oxygen

Amiodarone 300mg IV bolus after 3 defib attempts

Torsades de Pointes -> magnesium

Question 8

Management for non-shockable cardiac arrest

Answer 8

CPR and vasopressor

Atropine 0.5-1.0mg IV every 3-5 mins

Question 9

Complications of cardiac arrest

Answer 9

Death 
Rib fractures from CPR 
anoxic brain injury 
Ischaemic liver injury 
Recurrent cardiac arrest

Question 10

Prognosis of cardiac arrest

Answer 10

Survival out of hospital is 20%

Overall survival <10%