Cardiac arrest

Cardiac Arrest

SUBMITTED TO:

Dr. Sonia Qandeel

SUBMITTED BY

Nimra Iqbal Dph-fa10-100

Ammarah Siddique Dph-fa10-094

Talat Fatima Dph-fa10-102

CONTENTS

Definition

Diagnosis

Causes

Symptoms

Management Approach

Medication used

Definition of Cardiac arrest:

Sudden cessation of heartbeat and cardiac function, resulting in the loss of effective circulation.

or

 Absence of systole; failure of the ventricles of the heart to contract (usually caused by ventricular fibrillation) with consequent absence of the heart beat leading to oxygen lack and eventually to death

Diagnosis of cardiac arrest (TRIAD):

Loss of consciousness, unresponsiveness

Loss of normal breathing Apnea.

Loss of pulse and blood pressure {apical & central pulsations (carotid, femoral loss}

CAUSES

Influx problems in the heart. 

Congenital heart disease

Valvular heart disease

Enlarged heart (cardiomyopathy). 

Heart attack

Coronary artery disease

Symptoms of cardiac arrest

Symptomscardiac arrest symptoms are immediate and drastic.Sudden collapseNo pulseNo breathing (respiration arrest – may be in 30 seconds after cardiac arrest

Loss of consciousness

enlargement of pupils – may be in 90 seconds after cardiac arrest

TREATMENT

To find the best treatment methodsfor managing cardiac arrest, in orderto save more lives!

Our Ultimate Goal

Delay Can Be Deadly

Patient delay is the biggest cause of not getting care fast.

Do not wait more than a few minutes—5 at the most

Early Access to Care – Know the Signs Early CPR, Cardiopulmonary Resuscitation

especially with quality chest compressions Rapid defibrillation(with AEDs) (an electrical

shock to the heart) Effective paramedics (advanced life support ) Follow up care (post-cardiac arrest care)

“Chain of Survival”

A…B…C…D…E…

The ABCDE approach to the critically ill patient

ABCDE approachAirway

Recognition of airway obstruction Talking

Difficulty breathing, distressed, Shortness of breath

Noisy breathing

stridor, wheeze, gurgling See-saw respiratory pattern,

A

ABCDE ApproachAirway

Treatment of airway obstruction

Oxygen

Airway opening

- i.e. head tilt, chin lift, jaw thrust Advanced techniques

- e.g. LMA, tracheal tube

A

ABCDE approachBreathing

Recognition of breathing problemsLook

Inspect respiratory distress, cyanosis, respiratory rate, chest deformity,

Listen Auscultate breath sounds, noisy breathing

Feel palpat expansion, percussion, tracheal position

Pulse oxymetry

B

ABCDE approachBreathing

Treatment of breathing problems

Airway

Oxygen

Treat underlying cause

- e.g. drain pneumothorax

- e.g . Nebulizers Support breathing if inadequate

- e.g. ventilate with bag valve mask

B

ABCDE approachCirculation

Look at the patientPulse – central pulse (carotid) peripheral pulse Peripheral perfusion

capillary refill time ( normally <2 sec)Blood pressureMonitor

C

ABCDE approachCirculation

IV access, take blood sample and lab investigations

Treat cause Give fluids Haemodynamic monitoring MONA if acute coronary

syndrome

Treatment

C

ABCDE approachDisability

ABCDE approachDisability

AVPU or GCS, and pupils

Treatment - ABC

Treat underlying cause

Blood glucose if < 3 mmol l-1 give glucose

D

ABCDE approachExposure

Remove clothes to enable examination

- e.g. injuries, bleeding, rashes

Avoid heat loss

Maintain dignity

E

Defibrillation

All moving away from stacked shocks to single shocks Reduces pauses in chest compressions

Still role for initial stacked shocks if cardiac arrest occurs in presence of defibrillator

All recommend immediate CPR after defibrillation (without rhythm or pulse check)

Different recommendations on joules (150-360J) Between guidelines

Between manufacturers

Between monophasic and biphasic

There may be a role for CPR before defibrillation in some Particularly if in VF for more than a few minutes

Right heart dilation an impediment to defibrillation

Confused?

Defibrillation

We (St John CMG) recommend a simple approach Start with one round of stacked shocks if cardiac

arrest occurs in presence of defibrillator, then go to single shocks

Always use maximum joules

Opt for defibrillation first

Round kids off to nearest 10kg and use 5J/kg

Defibrillation

Starting and stopping

These decisions can be difficult

A resuscitation attempt should begin in most patients Except where the patient is clearly dead (livedo, rigor

mortis)

Or where they are clearly dying and it would be inappropriate

A competent patient can decline therapy but neither a patient nor their family can demand therapy that is medically inappropriate

Some scenarios have >99% mortality rates Unwitnessed cardiac arrest with initial rhythm of

asystole

Starting and stopping

The chances of survival fall rapidly with time Exponential falling curve

There is no absolute cut off when mortality becomes zero

Resuscitation attempts requiring longer than 20 minutes of CPR have a very high mortality rate We recommend stopping at around 20 minutes

unless there is a clinical reason to continue for longer

Transport to hospital with CPR enroute usually has no role

Automated External Defibrillator

An ICD monitors the heartbeat and delivers shock when

it detects lethal dysrhythmia.

Implantable Cardioverter Defibrillator

Ventricular Fibrillation (VF)

What VF looks like on an EKG

Shock “converts” VF to better rhythm

Defibrillation (electrical shock) is the primary solution (cannot be used in other lethal heart rhythms)

Automated External Defibrillators may be used

Manual Defibrillator

Drugs used commonly during resuscitation

Epinephrine (Adrenaline)

Atropine

Amiodarone

Magnesium Sulphate

Lidocaine (Lignocaine)

Sodium Bicarbonate

Calcium

Epinephrine (Adrenaline)

First line cardiac arrest drug, given after every 3 minutes of CPR

Dose 1mg (10ml of 1 in 10,000) IV

Causes vasoconstriction, increased systemic vascular resistance increasing cerebral and coronary perfusion

Increases myocardial excitability, when the myocardium is hypoxic or ischaemic

Atropine

Given for asystole or pulseless electrical activity with a rate less than 60 beats per minute

3mg is given as a single intravenous dose

It blocks the activity of the vagus nerve on the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction

Amiodarone

For Refractory VF/VT; haemodynamically stable VT and other resistant tachyarrhythmias

If VF or pulseless VT persists after the first 3 shocks then Amiodarone 300mg is considered.

If not pre-diluted, must be diluted in 5% dextrose to 20ml. (Will crystallise is mixed with saline)

Should be given centrally but in an emergency can be given peripherally

Increases the duration of the action potential in the atrial and ventricular myocardium

Magnesium Sulphate

For refractory VF when hypomagnesaemia is possible; ventricular tachyarrhythmias when hypomagnesaemia is possible

In refractory VF – 1 to 2g (2-4ml of 50% magnesium sulphate) peripherally over 1 to 2 minutes.

Other circumstances 2.5g (5ml of 50% magnesium sulphate) over 30 minutes

Lidocaine (Lignocaine)

For Refractory VF/ pulseless VT (when Amiodarone is unavailable

100mg for VF/ pulseless VT that persists after three shocks. Another 50mg can be given if necessary

Sodium Bicarbonate

Given for severe metabolic acidosis and Hyperkalaemia

50mmol (50ml of 8.4% solution), where there is an acidosis or cardiac arrest associated with Hyperkalaemia

Calcium

Administered when pulseless electrical activity caused by:

Hyperkalaemia

Hypocalcaemia

Overdose of Calcium channel blocking

drugs

Dose 10ml of 10% calcium chloride repeated according to blood results

Controllable Risk Factors

Smoking

Diabetes

High blood cholesterol

High blood pressure – especially stroke

Overweight/obesity

Physical inactivity

Lifestyle Changes

Reduce intake of fatty foods and eat more fruits and vegetables

Walk 30 minutes a day

Exercise prevents stroke, heart disease and other conditions

Questions