Cardiorespiratory arrest

Question 1

Definition?

Answer 1

Circulatory failure due to a loss of cardiac systolic function as well as a loss of ventilation.

Question 2

RF?

Answer 2

• CAD
• LV dysfunction
• Hypertrophic cardiomyopathy
• Arrhythmogenic right ventricular dysplasia
• Long QT syndrome
• Meds causing electrolyte disturbances
• Acute medical or surgical emergency
• Drugs
• Brugada syndrome
• Valvular heart disease
• Smoking
• History of eating disorders

Question 3

ddx?

Answer 3

• Shockable rhythms–VT and pulseless VT

* Non-shockable-asystole or PEA

Question 4

Aetiology

Answer 4

• H:Hypoxia,hypovolemia, acidosis (hydrogen ion),hyperkalemia orhypokalemia,hypothermia,hypoglycemia
• T:Tablet ortoxin ingestion, cardiactamponade,tension pneumothorax,thrombosis (pulmonary embolusormyocardial infarction),trauma

Question 5

CP?

Answer 5

• Unresponsive
• Absence of normal breathing
• Absence of circulation
Cardiac rhythm disturbance

Question 6

Pathophysiology?

Answer 6

• VT and Vfib-Acute myocardial ischaemia leads to changes in IC and EC pH electrolytes and ATP which cause a re-entrant circuit in fibrosis or EAD’s/DAD’s in non-ischaemia
• Can also be due to long QT syndrome allowing for abnormalities in repolarisation and depolarisation to occur-abnormalities in contractility meaning that the CO is low so there is impaired perfusion
PEA-organised electrical depolarisation of myocardium without appropriate myocardial contraction and so inadequate circulation-can be due to low preload, high afterload, changes to the myocardium preventing contraction.

Question 7

Investigations?

Answer 7

• Continuous cardiac monitoring
• FBC
• Serum electrolytes
• ABG
• Cardiac biomarkers/troponin
• Echo
• Also ECG CXR and coronary angiography

Question 8

management-first line?

Answer 8

call resus

CPR 30:2 and assess rhythm

Question 9

management second line?

Answer 9

shockable:
Shock 3 times-then give CPR for 2 mins after each shock then give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2 min CPR. And after every shock give IV 1mg adrenaline
precordial thump

Question 10

management second line PEA?

Answer 10

Start CPR 30:2. Give adrenaline 1 mg as soon IV access is achieved. 
Continue CPR 30:2 until the airway is secured, then continue chest compressions without pausing during ventilation.
Consider and correct reversible causes of PEA
 Recheck the patient after 2 min: If there is still no pulse and no change in the ECG appearance:  Continue CPR; Recheck the patient after 2 min and proceed accordingly. 
Give further adrenaline 1 mg every 3-5 min (alternate loops).
If VF/VT, change to the shockable rhythm algorithm. If a pulse is present, start postresuscitation care.

Question 11

management second line-asystole?

Answer 11

Asystole-Start CPR 30:2. Without stopping CPR, check that the leads are attached correctly.
 Give adrenaline 1 mg as soon as IV access is achieved.  Continue CPR 30:2 until the airway is secured, then continue chest compression without pausing during ventilation. 
Consider possible reversible causes of PEA and correct any that are identified. 
Recheck the rhythm after 2 min and proceed accordingly.
 If VF/VT, change to the shockable rhythm algorithm.  Give adrenaline 1 mg IV every 3-5 min (alternate loops).

Question 12

Management if circulation returns?

Answer 12

ABCDE
oxygen
ECG
traet cause
temp control

Question 13

prognosis?

Answer 13

• Poor outcome
• Early CPR increases rate of survival
• Rate of successful recovery is low-depends on time, CPR, CVS accident or renal dysfunction
• VT, Vfib, PEA (Pulseless electrical activity) asystole-order of worsening prognosis

Question 14

complications?

Answer 14

• Death
• Rib and sternal fractures
• Anoxic brain injury
• Ischaemic liver injury
• Renal acute tubular necrosis
• Recurrent cardiac arrest