cardiac arrest in special circumstances Flashcards
management of arrest secondary to drowning
Prioritise the ventilation aspect of CPR and use a CPR ratio of 15:2 unless an ETT is in place.
Place an ETT if ROSC is not achieved in the first few minutes.
IV medicines have a very low priority.
arrest secondary to hanging management
Prioritise the ventilation aspect of CPR and use a CPR ratio of 15:2 unless an ETT is in place.
Cervical spine immobilisation is not routinely required. This is because clinically significant cervical spine injury following hanging is extremely rare unless the patient has fallen the height of their body.
The survival rate is low, but survivors usually come from the group that are in PEA and get ROSC within 5-10 minutes with good CPR alone.
Prolonged resuscitation in the presence of asystole is inappropriate.
IV medicines have a very low priority.
management of asthma arrest
Focus on using a ventilation rate of only 6/minute to avoid dynamic hyperinflation (gas trapping).
IV adrenaline has a high priority.
Exclude tension pneumothorax, noting this is rare. Needle chest decompression carries a significant risk of causing pneumothorax and finger thoracostomy is the preferred technique if chest decompression is required.
how many breaths per minutes in normal arrest on airway
one every 6 seconds of approx 10 per minute
arrest secondary to anaphylaxis management
IV adrenaline has a high priority.
If the patient is in PEA and not immediately responding to resuscitation, escalate the adrenaline doses:
For an adult escalate the second dose to 3 mg, the third dose to 5 mg and then revert to standard 1 mg dosing.
For a child escalate the doses following the same principle.
0.9% sodium chloride IV has a high priority:
For an adult administer 2-3 litres of 0.9% sodium chloride IV.
For a child administer 40-60 ml/kg of 0.9% sodium chloride IV.
management of arrest secondary to cyclic antidepressant overdose
The cardiac toxicity of cyclic antidepressants is partly caused by blockade of sodium channels within the heart and may be reduced by a large bolus of sodium ions.
Administer 8.4% sodium bicarbonate IV:
100 ml for an adult.
2 ml/kg for a child.
Administer 0.9% sodium chloride IV:
1-2 litres for an adult.
20-40 ml/kg for a child.
Do not administer amiodarone because it can be associated with severe worsening of shock without resolution of the rhythm.
name some common cyclic antidepressant medications
Amitriptyline, Desipramine (Norpramin). Doxepin. Imipramine, noratriptaline,
management of arrest in 3rd trimester of pregnancy
In the third trimester of pregnancy the uterus may impede venous return through the inferior vena cava in the supine position. Manually displace the uterus to the left or tilt the patient 30° to their left to alleviate this.
Consider transporting the patient with CPR en route (focusing on good chest compressions) if ROSC is not immediately achieved and time to a hospital is less than ten minutes. Provide as much pre-hospital warning as possible. In this setting the primary reason for emergency caesarean section is to improve the chance of survival for the mother.
management of hypothermia cardiac arrest If the initial rhythm is VF or VT
continue treatment and CPR, even if the rhythm deteriorates into asystole with defibrillation, providing a maximum of three shocks if the rhythm continues to be VF or VT.
management of arrest due to hypothermia if rhythm PEA or severe bradycardia
continue treatment but stop chest compressions and ventilate at a rate of six breaths/minute.
management of arrest due to hypothermia If initial rhythm asystole
stop treatment and stop CPR. Note that the patient may have severe bradycardia and a one minute period of observation of the cardiac rhythm is required before asystole can be confirmed. See below if the patient has been in an avalanche.
management of arrest patient in torsadre de point
Withhold amiodarone.
Administer 10 mmol (2.47 g) of magnesium IV over 1-2 minutes. Repeat once if episodes of torsades des pointes recur.
management of arrest due to Hyperkalaemia
ICP for calcium chloride and sodium bicarb
management of arrest due to opioid overdose
The best treatment is CPR that includes a focus on ventilation.
There is no role for naloxone because cardiac arrest is secondary to respiratory arrest and once cardiac arrest has occurred naloxone has no useful effect. If ROSC occurs, naloxone should still not be administered because it may be associated with seizures, hypertension, pulmonary oedema or severe agitation.
arrest with pacemaker management
Implanted defibrillators and pacemakers are usually situated in the soft tissue under the left clavicle.
Place defibrillation pads at least 8 cm from the implanted device if possible and consider utilising the anterior/posterior position.
