Circulation Part 3: Cardiac Arrest/Peri-Arrest Arrhythmias Flashcards
Name the two shockable rhythms in cardiac arrest.
Pulseless ventricular tachycardia (VT) / Ventricular fibrillation
Name the two non-shockable rhythms in cardiac arrest.
Pulseless electrical activity (PEA) / Asystole
List the 8 reversible causes of cardiac arrest.
- Hypoxia
- Hypovolaemia
- Hypo/hyperkalaemia
- Hypothermia
- Thrombo-embolism (cardiac/pulmonary)
- Toxins
- Tamponade (cardiac)
- Tension pneumothorax
Diagnose and manage in hospital cardiac arrest in an adult (outline the adult life support algorithm).
First, diagnose a cardiac arrest:
- Try to get a patient response (unresponsive –> AVPU)
- Open the patient’s airway
- Check for normal breathing (beware agonal breathing)
- Check circulation (carotid or femoral) –> if no pulse, this is an arrest
Outline the following arrhythmia:
Ventricular fibrillation
- Shockable
- No CO
- Bizarre, irregular waveform
- No recognisable QRS complex
- Uncoordinated electrical activity
- Exclude movement/interference as a cause
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/833/966/a_image_thumb.jpg?1641907791)
Outline the following arrhythmia:
Ventricular tachycardia
- Shockable
- No CO
- QRS usually wide (usually constant QRS morphology)
- More organised electrical activity than ventricular fibrillation
- BUT, high risk of deteriorating to ventricular fibrillation
- ONLY defibrillate if pulseless
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/162/a_image_thumb.jpg?1641907984)
Outline the following arrhythmia:
Polymorphic ventricular tachycardia
- Shockable
- a form of ventricular tachycardia in which there are multiple ventricular foci with the resultant QRS complexes varying in amplitude, axis and duration.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/411/a_image_thumb.jpg?1641908120)
Outline the following arrhythmia:
Torsades de Pointes
a specific form of polymorphic ventricular tachycardia occurring in the context of QT prolongation; it has a characteristic morphology in which the QRS complexes “twist” around the isoelectric line e.g. hypokalaemi
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/536/a_image_thumb.png?1641908330)
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/706/q_image_thumb.jpg?1641908356)
Monomorphic VT
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/727/q_image_thumb.png?1641908844)
Polymorphic VT
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/770/q_image_thumb.jpg?1641908892)
Torsades de Pointes (polymorphic VT)
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/797/q_image_thumb.jpg?1641908943)
Ventricular fibrillation
When you have identified a ventricular tachycardia on ECG; what is an important distinction to make?
- Ventricular tachycardias can be with a pulse or without a pulse; your team should confirm this during ABCDE assessment. This changes management.
- VT/VF with a pulse = tachycardia algorithm
- VT/VF without a pulse = cardiac arrest algorithm
Outline the following arrhythmia:
Pulseless electrical activity (PEA)
- Non-shockable
- Clinical features of a cardiac arrest
- 2 minute cycles CPR + 1mg IV Adrenaline 1:10,000, 3-5min
- refers to a clinical diagnosis of cardiac arrest in which a heart rhythm is observed on the ECG that should be producing a pulse, but is pulseless (i.e. an ECG usually associated with a CO)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/834/981/a_image_thumb.jpg?1641909073)
Outline the following arrhythmia:
Asystole
- Non-shockable
- refers to a clinical diagnosis of cardiac arrest in which a heart rhythm is observed on the ECG that should be producing a pulse, but is pulseless.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/835/652/a_image_thumb.jpg?1641909142)
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/835/758/q_image_thumb.jpg?1641909184)
Pulseless electrical activity (PEA)
NB/can look like normal ECG without a pulse
Identify the following arrhythmia:
![](https://s3.amazonaws.com/brainscape-prod/system/cm/368/835/812/q_image_thumb.jpg?1641909247)
- Asystole
- Note the P-waves still intact
Outline adequate chest compression.
- 30:2
- Compression at centre of chest
- 5-6 cm depth
- 2 per second (100-120/min)
- Maintain high quality compressions with minimal interruptions
- Commence continuous compressions once the airway is secured (iGel + Ambu-bag - 10-12 ventilations a minute)
Whilst responding to a cardiac arrest you should be thinking about reversible causes. Outline the management of hypoxia.
- Ensure a patent airway
- Give high flow supplemental O2 (LMA/iGel + ambu bag with room air augmented up to 100%)
- Avoid hyperventilation (16-20 resps/min is normal)
Whilst responding to a cardiac arrest you should be thinking about reversible causes. Outline the management of hypovolaemia.
- Actively look for a PEA arrest
- Look for covert bleeding
- Control the haemorrhage
- IV fluids
- IV blood and blood products
- Transexamic acid (if trauma cardiac arrest)
- Left-side positioning if patient pregnant
Whilst responding to a cardiac arrest you should be thinking about reversible causes. Outline the management of hypo-/hyperkalaemia and metabolic disorders.
- Hyperkalaemia = calcium chloride/insulin + dextrose/salbutamol
- Hypokalaemia/hypomagnesaemia = U&E + electrolyte supplementation
- Hypoglycaemia = glucose/glucagon