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Lecture
Causes and Preventionof Cardiac Arrest
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Learning outcomes
The importance of early recognition of the
deteriorating patient
The causes of cardiac arrest in adults
Identify and treat patients at risk of cardiacarrest using the ABCDE approach
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Chain of survival
Early recognition prevents:
Cardiac arrests and deaths
Admissions to ICU
Inappropriate resuscitation attempts
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Early recognition of the deteriorating patientMost arrests arepredictable
Deterioration prior to50 - 80% of cardiacarrests
Hypoxia andhypotension arecommonantecedents
Delays in referral tohigher levels of care
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Recognition of the deteriorating patient -
Early Warning Scoring Systems
Example of early warning scoring (EWS) system*
* From Prytherch et al. ViEWSTowards a national early warning score for
detecting adult in-patient deterioration. Resuscitation. 2010;81(8):932-7
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The ABCDE approach
to the deteriorating patient
Airway
BreathingCirculation
Disability
Exposure
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ABCDE approach
Underlying principles:
Complete initial assessment
Treat life-threatening problems
Reassessment
Assess effects of treatment/interventions
Call for help early
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Initial assessment
Personal safety
Patient responsiveness
First impression Movement
Pulse
Respiratory effort
Temperature
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ABCDE approach: Airway
CNS depressionBlood
Vomit
Foreign bodyTrauma
InfectionInflammation
Laryngospasm
Bronchospasm
Causes of airway obstruction:
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ABCDE approach: Airway
Recognition of airway obstruction:
TalkingDifficulty breathing, distressed, choking
Shortness of breath
Noisy breathing Stridor, wheeze, gurgling
See-saw respiratory pattern, accessory muscles
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ABCDE approach: Airway
Treatment of airway obstruction:
Airway opening Head tilt, chin lift, jaw thrust
Simple adjuncts
Advanced techniques e.g. LMA, tracheal tube
Oxygen
Early Caponography
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ABCDE approach: Breathing
Decreased respiratory
drive CNS depression
Decreased respiratory
effort
Muscle weakness
Nerve damage
Restrictive chest defect
Pain from fractured ribs
Lung disorders Pneumothorax
Haemothorax
Infection
Acute exacerbation COPD
Asthma
Pulmonary embolus ARDS
Causes of breathing problems:
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ABCDE approach: Breathing
Recognition of breathing problems:
Look Respiratory distress, accessory muscles, cyanosis,
respiratory rate, chest deformity, conscious level
Listen Noisy breathing, breath sounds
Feel Expansion, percussion, tracheal position
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ABCDE approach: Breathing
Treatment of breathing problems:
AirwayOxygen
Treat underlying cause e.g. drain pneumothorax
Support breathing if inadequate e.g. ventilate with bag-mask
Establish continuous monitoring (SpO2, respiratory rate)
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ABCDE approach: Circulation
Primary
Acute coronary syndromes
Arrhythmias
Hypertensive heart disease
Valve disease
Hereditary cardiac diseases
(Drugs)
(Electrolyte/acid base
abnormalities)
Secondary
Asphyxia
Hypoxaemia
Blood loss
Hypothermia
Septic shock
(Drugs)
(Electrolyte/acid base
abnormalities)
Causes of circulation problems:
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ABCDE approach: Circulation
Recognition of circulation problems:
Look at the patientPulse - tachycardia, bradycardia
Peripheral perfusion - capillary refill time
Blood pressure
Organ perfusion Chest pain, mental state, urine outputBleeding, fluid losses
Record and document an ECG
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ABCDE approach: Circulation
Treatment of circulation problems:
Airway, Breathing
Oxygen
IV/IO access, take bloods
Establish ECG monitoring
Treat cause
Fluid challenge
Haemodynamic monitoring
Inotropes/vasopressors
Aspirin/nitrates/oxygen (if appropriate) and
morphine for acute coronary syndrome
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ABCDE approach: Disability
Recognition
AVPU or GCS
Pupils
Lateralising signs
Treatment
ABC
Treat underlying causeBlood glucose If < 4 mmol l-1give glucose
Consider lateral position
Check drug chart
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ABCDE approach: Exposure
Remove clothes to enable examination e.g. injuries, bleeding, rashes
Avoid heat loss
Maintain dignity
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Any questions?
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Summary
Early recognition of the deteriorating patientmay prevent cardiac arrest
Most patients have warning symptoms andsigns before cardiac arrest
Airway, breathing or circulation problems can
cause cardiac arrest
ABCDE approach to recognise and treatpatients at risk of cardiac arrest