Cardiac Arrest

Overview

Overview Cardiac arrest is a state of circulatory failure due to a loss of cardiac systolic function. It is the result of 4 specific cardiac rhythm disturbances:

  • Ventricular fibrillation
  • Pulseless ventricular tachycardia
  • Pulseless Electrical activity
  • Asystole

Epidemiology

  • Survival is estimated at <20% for patients presenting out-of-hospital with VF, and <10% overall for patients presenting with out-of-hospital cardiac arrest.
  • 36% of patients with VF/ VT & 11% of patients with PEA/asystole, presenting in-hospital, survive to discharge.

Initial Assessment and Management

PRIMARY SURVEY
Assessment Management
Airway Patency
Look - swelling, injury or object around mouth/face Jaw thrust, chin lift, positioning, clear debris

Guedel, nasopharyngeal airway, LMA
Listen - speech, stridor, gurgling
Feel - facial fractures
Protection
AVPU or GCS Intubate GCS <8 → cricothyroidectomy if unsuccessful
Breathing Look, listen, feel
Effort - Respiratory rate, accessory muscle use, chest wall movement High flow 100% oxygen. Commence CPR if unresponsive or not breathing
Efficiency - SaO2, cyanosis, paradoxical breathing +/- ABG
Injury - tracheal position, flail chest, chest injury Treat pneumothorax of injury. Chest X-ray
Circulation HR, BP, capillary refill IV access 2 large bore cannula - Fluid resus
Heart sounds
ECG Arrhythmia - Defib
Disability GCS/AVPU Maintain cerebral perfusion - O2, ventilation and circulation (above)
Blood sugar level Hypoglycaemia- IV dextrose OR Hyperglycaemia - Insulin
Pupils - reactive and equal
Neurological assessment
 Exposure Temperature Maintain normothermia - blankets, +/-heaters
Assess other part of body including back Manage injuries

Advanced Life Support

 

Shockable Rhythms

  • Pulseless Ventricular tachycardia
  • Ventricular Fibrillation

Non-Shock

  • PEA
  • Asystole

Defibrillation is a process used to stop irregular crazy heartbeats by sending an electric shock in an attempt to revert the heart back to normal rhythm.

Process for using a defibrillator- COACHED

  • Compression continued
  • Oxygen away
  • All else clear
  • Charging
  • Hands off/Im safe
  • Evaluate rhythm
  • Defibrillation or disarm and dump

Reversible causes of Cardiac Arrest

Causes 4 H's & 4 T's

  • Hypoxia
  • Hypovolaemia
  • Hyper/Hypokalaemia
  • Hyper/Hypothermia
  • Tension pneumothorax
  • Tamponade
  • Toxins
  • Thrombosis (pulmonary or coronary)
REVERSIBLE CAUSES OF CARDIAC ARREST
Cause Assessment Management
Hypoxia SpO2 %, ABG/VBG Airway, Breathing; Ventilatimg with high flow O2
Hypovolaemia BP, HR, identify site of fluid loss, Burns etc IV fluids 20 ml/kg
Hypothermia Shivering, core temperature Warm the patient aggressively to achieve a core temperature > 30°C
Hyperkalaemia EUC, ABG, ECG changes - peak T-waves, widened QRS Insulin + glucose +/- calcium gluconate
Hypokalaemia EUC, ABG,  ECG changes - flat or inverted T-waves Potassium infusion
Tamponade (cardiac) Becks triad jugular vein distension, hypotension, muffled heart sounds Pericardiocentesis
Tension pneumothorax Unilateral chest expansion, trachea deviated away from pneumothorax, ↓breath sounds (air entry), hyper- resonant percussion note Needle decompression with large bore cannula (2nd intercostal space, mid clavicular line)
Toxins Angioedema, History!, abnormal  LFTs, signs of toxicity Antidote if exists. Supportive therapy
Thrombosis Hypotensive, SOB, chest pain, collapse, recent surgical procedure (DVT risk factors) Fibrinolytics are recommended in cases where PE is known or suspected
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