Condition- Cardiac Arrest Flashcards
What is cardiac arrest?
A Sudden state of circulatory failure due to a loss of cardiac systolic function
List the 8 reversible causes of cardiac arrest
The REVERSIBLE causes of cardiac arrest can be summarised as the 4 Hs and 4 Ts
FOUR Hs
- Hypothermia
- Hypoxia
- Hypovolaemia – dec blood volume
- Hypokalaemia/Hyperkalaemia
FOUR Ts
- Toxins (and other metabolic disorders (drugs, therapeutic agents, sepsis))
- Thromboembolic
- Tamponade
- Tension pneumothorax
List three common diseases/ underlying pathologies which could lead to cardiac arrest
Ischaemic heart disease (62.2%)
Unspecified cardiovascular disease (12.1%)
Cardiomyopathy/dysrhythmias (9.3%)
Sudden cardiac arrest is the term used to describe the ultimate result of 4 different cardiac arrhythmias. What are they…
- Ventricular Fibrillation (VF)- IHD
- Pulseless Ventricular Tachycardia (VT)
- Pulseless electrical activity (PEA)- MI, PE, hypoxia/ hypovolaemia
- Asystole
Describe the presenting symptoms of cardiac arrest
- Usually sudden
- May have period of confusion, fatigue, dizziness or fainting before
List some of the signs of cardiac arrest
- Not breathing
- Unresponsive
- Absent carotid pulse
- PMHx
- Chest pain- IHD
- Syncope/ palpitations- arrhythmias (HOCM, Long QT)
- Diabetes, hypertension, drugs
- Illicit drugs
- Kidney disease
- Eating disorders
- Positive FHx
Which investigations would be appropriate for someone at high risk of cardiac arrest or has had one…
- Continuous Cardiac Monitor: may show QT interval, ST-segment or T-wave changes; conduction abnormalities; ventricular hypertrophy. To determine which Tx algorithm to use
- Bloods
- FBC- haemorrhage–> hypovalaemia?
- U&Es
- Serum electrolytes
- Cardiac biomarkers- BNP, troponin
- ABG
- Blood glucose
- Echocardiogram: valvar disease, LVF, cardiomyopathies
- CXR: pneumothorax
- Coronary Angiogram: CAD
Go throught the basic life support algorithm for managing a patient in Cardiac Arrest?
- Danger
- BLS
- R: Precordial thump (thump sternum with ulnar aspect of fist)
- A: Clear and maintain airways head tilt, chin lift
- B: Asses Breathing by look, listen, feel
- If they aren’t breathing give two rescue breaths
- C: Assess Circulation with carotid pulse
- If no pulse give 30 chest compressions 100/min
- 2 breaths, 30 compressions
Describe the ALS steps used for someone with a shockable rhythm
SHOCKABLE RHYTHM: VT and VF
- Attach cardiac monitor and defibrillator
- Assess rhythm: look for pulseless VT and VF (caused by aberration in conduction)
- Defibrillate once
- Resume CPR
- Reassess rhythm
- 2nd defib attempt if still in pulseless VT/VF
- Administer adrenaline after second defib and again every 3-5mins
- 3rd defib attempt
- Bolus of amiodarone/ lidocaine
Describe the ALS steps taken for someone with a non-shockable cardiac arrest rhythm
- Set up cardiac monitor
- Assess rhythm- PEA or Asystole
- Administer CPR (2 x 30)
- Administer IV adrenaline every 3-5mins
Describe the steps taken after the return of spontaneous circulation in someone who suffered a cardiac arrest
ABCDE approach
- Controlled oxygenation and ventilation
- 12 lead ECG
- Treat precipitating causes
- Temperature control between 32°C and 36°C
How would you treat the reversible causes of cardiac arrest? (go through the 4Ts and 4Hs)
- Hypothermia- warm slowly
- Hyopvolaemia- IV colloids, crystalloids and blood products
- Hypoxia- Ventilation
- Hypo/hyperkalaemia- correction of electrolyte levels
- Toxins- antidotes
- Tension pneumothorax- aspiration/ thoracocentesis
- Tamponade- pericardiocentesis
- Thromboembolic event- treat as PE or MI
List the complications of cardiac arrest…
DEATH
IRREVERSIBLE HYPOXIC BRAIN DAMAGE
