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Year 3 > Cardiac arrest (A&E) > Flashcards

Cardiac arrest (A&E) Flashcards

1
Q

Define cardiac arrest.

A

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

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2
Q

Which four specific cardiac rhythm disturbances lead to cardiac arrest?

A
  • ventricular fibrillation (VF): shockable rhythm
  • pulseless ventricular tachycardia (VT): shockable rhythm; absence of carotid pulse in the presence of sinus tachycardia
  • pulseless electrical activity (PEA): non-shockable rhythm; absence of carotid pulse in the presence of sinus rhythm
  • asystole: non-shockable rhythm
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3
Q

What are the most common causes of ventricular tachycardia and fibrillation? (2)

A

IHD and acute MI

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4
Q

What is Torsades de pointes (cardiac arrest)?

A

Subgroup of polymorphic VT in patients with underlying prolonged QT interval, sometimes related to hypomagnesaemia

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5
Q

List the reversible causes of cardiac arrest. (4+4)

A

4 H’s:

  • Hypoxia - give O2
  • Hypothermia
  • Hyperkalaemia/Hypokalaemia
  • Hypovolaemia - IV fluids

4 T’s:

  • Thrombosis
  • Tension pneumothorax - may cause PEA (pulseless electrical activity)
  • Tamponade - especially in Trauma
  • Toxins
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6
Q

What are the most common underlying causes of cardiac arrest? (3)

A
  • ischaemic heart disease
  • MI
  • in some cases: respiratory arrest triggered by opioid toxicity
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7
Q

What are the clinical features of cardiac arrest? (5)

A
  • symptoms preceded by fatigue, fainting, blackout, dizziness
  • patient unresponsive and unconscious
  • not breathing
  • absence of circulation - no carotid pulses
  • cardiac rhythm disturbance
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8
Q

What are some risk factors for cardiac arrest? (9)

A
  • coronary artery disease (CAD)
  • LV dysfunction
  • age
  • hypertrophic cardiomyopathy (HCM)
  • arrhythmogenic RV dysplasia (ARVD)
  • long QT syndrome (LQTS)
  • medications prolonging QT/causing electrolyte disturbances
  • acute medical or surgical emergency
  • poisoning/illicit substances (opioids)
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9
Q

What are the first-line investigations for cardiac arrest? (3)

A
  • continuous cardiac monitoring
  • bloods - FBC, serum electrolytes, ABG, cardiac biomarkers
  • point of care ultrasound (POCUS)
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10
Q

Why is continuous cardiac monitoring important in cardiac arrest?

A

To identify if the rhythm is shockable or non-shockable

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11
Q

List shockable rhythms in cardiac arrest. (2)

A
  • VT
  • VF
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12
Q

List non-shockable rhythms in cardiac arrest. (2)

A
  • PEA (pulseless electrical activity)
  • asystole
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13
Q

When should you do ECG in cardiac arrest?

A

Immediately after return of spontaneous circulation

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14
Q

What might ECG show in cardiac arrest?

A

Monomorphic VT

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15
Q

Why would you do FBC in cardiac arrest?

A

Cardiac arrest may be due to hypovolaemia –> low Hct

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16
Q

Why would you do serum electrolytes in cardiac arrest?

A

Arrest may be due to electrolyte abnormalities, especially hyperkalaemia and hypokalaemia

17
Q

Describe the American College of Cardiology/American Heart Association/Heart Rhythm Society classification of ventricular arrhythmias (cardiac arrest). (5)

A
  • VT: 3+ consecutive complexes originating in the ventricles at >100bpm
    • sustained VT lasts >30s or results in haemodynamic compromise
  • monomorphic VT: VT with a stable single QRS morphology from beat to beat
  • polymorphic VT: VT with a changing QRS morphology from beat to beat
  • Torsades de pointes: polymorphic VT in setting of a prolonged QT interval, with waxing and waning of QRS amplitude
  • VF: rapid, grossly irregular electrical activity with marked variability in waveform; ventricular rate usually >300bpm (cycle length <200ms)
18
Q

What are the two shockable rhythms in cardiac arrest?

A
  • pulseless VT
  • VF
19
Q

What is the management for an unwitnessed event of cardiac arrest with a shockable rhythm (VT/VF)?

A
  1. defibrillate (shock)
  2. CPR for 2 mins, then assess rhythm (shock again if still VT/VF)
  3. IV adrenaline 1mg after 3rd shock, and then every 3-5min
  4. if persisting after 3rd shock, give IV amiodarone 300mg (or lidocaine)
  5. a further dose of amiodarone 150mg should be given if VT/VF after 5 shocks
20
Q

How does the management of shockable cardiac arrest change if it was a witnessed attack in a monitored patient?

A

Administer up to 3 quick successive (stacked) shocks, rather than 1 shock followed by CPR (like in unwitnessed event)

21
Q

What if IV access cannot be achieved in cardiac arrest (e.g. for adrenaline/amiodarone)?

A

The drugs should be given via the intraosseous (IO) access in the proximal tibia

22
Q

What can be given for cardiac arrest if Torsades de pointes is the cause?

A

Magnesium sulfate

23
Q

What are the two non-shockable rhythms in cardiac arrest?

A
  • PEA (pulseless electrical activity)
  • asystole
24
Q

What is the management for non-shockable cardiac arrest?

A
  1. CPR for 2 mins, then reassess
  2. IV adrenaline 1mg ASAP (after first cycle), then every 3-5 mins
25
Q

When are thrombolytic drugs given for cardiac arrest?

A
  • should be considered if a PE suspected
  • if given, CPR should be continued for an extended period of 60-90 mins
26
Q

What do we need to optimise after successful resuscitation in cardiac arrest?

A

O2 sats of 94-98% (give oxygen)

27
Q

Summarise the treatment flowchart for cardiac arrest (advanced life support).

A
  • CPR 30:2 + attach defibrillator/monitor
  • assess rhythm
  • shockable: 1 shock –> immediately resume CPR 2 mins
  • non-shockable: immediately resume CPR 2 mins
  • reassess rhythm
  • (shockable: after 3 shocks, give 1mg adrenaline IV every 3-5min + 300mg amiodarone IV)
28
Q

What is post-cardiac arrest treatment? (5)

A
  • ABCDE approach
  • controlled oxygenation and ventilation (target 94-98% and normal PaCO2)
  • 12-lead ECG
  • temperature control/therapeutic hypothermia
  • treat precipitating / reversible causes
29
Q

How can we treat the underlying causes of cardiac arrest post-attack? (8)

A
  • Hypoxia - oxygen
  • Hypothermia - warm slowly
  • Hypokalaemia/Hyperkalaemia - correction of electrolyte levels
  • Hypovolaemia - IV colloids, crystalloids and blood products
  • Thrombosis - treat as PE/MI (thrombolytics and extend CPR by 60-90min)
  • Tension pneumothorax - aspiration or chest drain
  • Tamponade - pericardiocentesis
  • Toxins - antidote for toxin
30
Q

What are some complications of cardiac arrest? (5)

A
  • irreversible hypoxic brain damage
  • rib and sternal fractures
  • ischaemic liver injury
  • renal acute tubular necrosis
  • death
31
Q

Describe the prognosis of sudden cardiac arrest.

A

Generally poor, and those who survive may have complications of many organ systems due to ischaemic injury

32
Q

What can improve the survival rate of sudden cardiac arrest outside of the hospital?

A

Early provision of CPR, including compression-only CPR by bystanders

Year 3 (210 decks)

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