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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
 AssessmentManagement
AirwayPatency
Look – swelling, injury or object around mouth/faceJaw thrust, chin lift, positioning, clear debrisGuedel, nasopharyngeal airway, LMA
Listen – speech, stridor, gurgling
Feel – facial fractures
Protection
AVPU or GCSIntubate GCS <8 → cricothyroidectomy if unsuccessful
BreathingLook, listen, feel
Effort – Respiratory rate, accessory muscle use, chest wall movementHigh flow 100% oxygen. Commence CPR if unresponsive or not breathing
Efficiency – SaO2, cyanosis, paradoxical breathing+/- ABG
Injury – tracheal position, flail chest, chest injuryTreat pneumothorax of injury. Chest X-ray
CirculationHR, BP, capillary refillIV access 2 large bore cannula – Fluid resus
Heart sounds 
ECGArrhythmia – Defib
DisabilityGCS/AVPUMaintain cerebral perfusion – O2, ventilation and circulation (above)
Blood sugar levelHypoglycaemia- IV dextrose OR Hyperglycaemia – Insulin
Pupils – reactive and equal 
Neurological assessment 
 ExposureTemperatureMaintain normothermia – blankets, +/-heaters
Assess other part of body including backManage injuries

Advanced Life Support

ANZCOR Guideline 2016 – Protocol for Adult resus

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
CauseAssessmentManagement
HypoxiaSpO2 %, ABG/VBGAirway, Breathing; Ventilatimg with high flow O2
HypovolaemiaBP, HR, identify site of fluid loss, Burns etcIV fluids 20 ml/kg
HypothermiaShivering, core temperatureWarm the patient aggressively to achieve a core temperature > 30°C
HyperkalaemiaEUC, ABG, ECG changes – peak T-waves, widened QRSInsulin + glucose +/- calcium gluconate
HypokalaemiaEUC, ABG,  ECG changes – flat or inverted T-wavesPotassium infusion
Tamponade (cardiac)Becks triad jugular vein distension, hypotension, muffled heart soundsPericardiocentesis
Tension pneumothoraxUnilateral chest expansion, trachea deviated away from pneumothorax, ↓breath sounds (air entry), hyper- resonant percussion noteNeedle decompression with large bore cannula (2nd intercostal space, mid clavicular line)
ToxinsAngioedema, History!, abnormal  LFTs, signs of toxicityAntidote if exists. Supportive therapy
ThrombosisHypotensive, 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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