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Cardiac arrest

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Cardiac arrest

  1. 1. Cardiac arrest By: A. Taskin by : A.taskin ( a_taskeen91@hotmail.com )
  2. 2. • Cardiac arrest : is an abrupt cessation of cardiac pump function that may be reversible but will progress to death without prompt intervention. • The four rhythms that produce pulseless cardiac arrest are : • ventricular fibrillation, • pulseless ventricular tachycardia • Asystole • Pulseless electrical activity by : A.taskin ( a_taskeen91@hotmail.com )
  3. 3. Clinical features : A patient who is : 1. unconscious, 2. apneic, and 3. pulseless fulfills the cardiac arrest diagnosis criteria by : A.taskin ( a_taskeen91@hotmail.com )
  4. 4. Clinical features : • In ventricular fibrillation : • loss of consciousness occurs within 15 seconds, • but agonal gasping may persist for around 60 seconds following collapse. • Brief seizure may occur, caused by cessation of cerebral blood flow • Cardiac arrest secondary to respiratory arrest causes : • loss of consciousness, bradycardia, and absent pulse within 5 minutes by : A.taskin ( a_taskeen91@hotmail.com )
  5. 5. Clinical features : Symptoms : ( may be present ) New or changing angina Fatigue Palpitations Dyspnea Chest pain by : A.taskin ( a_taskeen91@hotmail.com )
  6. 6. often results from reversible causes that must be rapidly identified and treated. 5 Ts': '5 Hs : • Hypovolemia • Hypothermia • Hypoxia • Hypo- or hyperkalemia • Hydrogen ion (acidosis) • Tamponade, cardiac • Toxins • Tension pneumothorax • Thrombosis, pulmonary • Thrombosis, coronary by : A.taskin ( a_taskeen91@hotmail.com )
  7. 7. Coronary artery disease with myocardial infarction is the most common structural heart disease predisposing to cardiac arrest. by : A.taskin ( a_taskeen91@hotmail.com )
  8. 8. physical examination factors : • immediate CPR and rapid defibrillation take precedent over examination in the cardiac arrest victim. • Ensure adequacy of airway. Note the presence of any blood, vomitus, or secretions by : A.taskin ( a_taskeen91@hotmail.com )
  9. 9. • Absent respiratory effort • presence of only agonal gasps are characteristic of cardiac arrest. • Unilateral breath sounds may indicate: • tension pneumothorax or • aspiration. • Wheezing and rales • underlying pulmonary edema or • aspiration by : A.taskin ( a_taskeen91@hotmail.com )
  10. 10. • Heart tones may be heard in patients with : • pulmonary embolus, tension pneumothorax, or hypovolemia • Jugular venous distension may be noted in : • tension pneumothorax, cardiac tamponade, or pulmonary embolus • A distended, dull abdomen may be noted in patients with a • ruptured abdominal aortic aneurysm or ruptured ectopic pregnancy by : A.taskin ( a_taskeen91@hotmail.com )
  11. 11. Investigations: • Rapid rhythm assessment • End-tidal carbon dioxide partial pressure • Central venous oxygen saturation • Arterial relaxation pressure • Echocardiogram • Serum electrolytes • 12-lead electrocardiogram • Serum lactate by : A.taskin ( a_taskeen91@hotmail.com )
  12. 12. Differential diagnosis : • Supraventricular tachycardia with aberration • Choking by : A.taskin ( a_taskeen91@hotmail.com )
  13. 13. Choking • a person choking on a piece of food may be mistakenly thought to be suffering acardiac arrest • Choking commonly occurs during a meal, often when the person is talking or laughing • Food lodges in the oropharynx, causing sudden cyanosis and collapse • May cause primary respiratory arrest with absence of respiratory efforts or severe stridor with persistence of a pulse • The Heimlich maneuver usually dislodges the piece of food, allowing immediate recovery • Choking may progress to cardiac arrest if the piece of food or other foreign body is not dislodged by : A.taskin ( a_taskeen91@hotmail.com )
  14. 14. Causes : by : A.taskin ( a_taskeen91@hotmail.com )
  15. 15. Causes : by : A.taskin ( a_taskeen91@hotmail.com )
  16. 16. by : A.taskin ( a_taskeen91@hotmail.com )
  17. 17. Causes : • Respiratory causes : • mechanical airway obstruction, submersion injury, and respiratory failure originating from asthma, pulmonary edema, or sedative overdose. • Metabolic abnormalities : commonly hyperkalemia, which is most frequently seen in patients with renal failure. • Less commonly, hypokalemia, hypermagnesemia, hypomagnesemia and hypercalcemia . • by : A.taskin ( a_taskeen91@hotmail.com )
  18. 18. Causes : • Toxins : • overdose of prescription medications or • illicit drugs e.g. digitalis, β-blockers, cocaine, and heroin . • Electrical currents of 100 mA to 1 A usually cause ventricular fibrillation; currents above 10 A can cause asystole • Brugada syndrome: which is an inherited disorder affecting cardiac membrane channels that is associated with polymorphic ventricular tachycardia and ventricular fibrillation. • ECG showing a right bundle branch block with ST segment elevation in leads V1 to V3 • by : A.taskin ( a_taskeen91@hotmail.com )
  19. 19. Causes : Long QT syndrome : • characterized by prolonged QT interval (repolarization) on resting ECG . by : A.taskin ( a_taskeen91@hotmail.com )
  20. 20. Algorithms & management by : A.taskin ( a_taskeen91@hotmail.com )
  21. 21. by : A.taskin ( a_taskeen91@hotmail.com )
  22. 22. by : A.taskin ( a_taskeen91@hotmail.com )
  23. 23. CPR : •Initiate CPR with 30 chest compressions. •For all adults:  provide cycles of 30 chest compressions  followed by 2 breaths. by : A.taskin ( a_taskeen91@hotmail.com )
  24. 24. CPR : •In the pediatric : 30 compressions:2 breaths for 1 rescuer CPR  15 compressions: 2 breaths for 2 or more rescuers. by : A.taskin ( a_taskeen91@hotmail.com )
  25. 25. CPR : • push hard, push fast (≥ 100 compressions/min) while allowing full recoil of the chest between compressions. • Compressions should be delivered over the lower half of the sternum to a depth of 2 inches in adults and • at least one-third of anterior-posterior diameter of the chest in infants and children by : A.taskin ( a_taskeen91@hotmail.com )
  26. 26. CPR : • Immediately resume CPR after each defibrillation attempt and continue for 2 minutes before rechecking rhythm . by : A.taskin ( a_taskeen91@hotmail.com )
  27. 27. Immediate action : • 1- Begin high-quality CPR & defibrillation . • Perform rapid rhythm assessment with quick-look paddles, electrode pads, or limb leads • Patients with ventricular tachycardia or ventricular fibrillation require immediate defibrillation • Patients with PEA or asystole should have continued CPR while attempts are made to diagnose and treat the underlying cause • 2- Administer supplemental oxygen as soon as it is available • 3- Establish intravenous or intraosseous access as soon as possible by : A.taskin ( a_taskeen91@hotmail.com )
  28. 28. Immediate action : • After 2 minutes of CPR, reassess rhythm. If a shockable rhythm is present, shock again • Administer epinephrine 1 mg intravenously or intraosseously. • Repeat every 3 to 5 minutes. • Administer amiodarone 300 mg intravenously or intraosseously. Repeat once at 150 mg in 3 to 5 minutes . • A single dose of vasopressin 40 units intravenously or intraosseously may be substituted for the first or second dose of epinephrine by : A.taskin ( a_taskeen91@hotmail.com )
  29. 29. Immediate action : • Magnesium sulfate • 1 to 2 g intravenously or intraosseously may be considered for suspected hypomagnesemia or torsade de pointes associated with a long QT interval. • It is not recommended for routine use in cardiac arrest • sodium bicarbonate • Routine use of for the treatment of cardiac arrest is not recommended. • May beneficial for tricyclic antidepressant overdose, severe cocaine toxicity, hyperkalemia, and pre-existing acidosis . by : A.taskin ( a_taskeen91@hotmail.com )
  30. 30. Immediate action : • Atropine is no longer recommended for routine use in the management of asystole/PEA • Electrical pacing is not recommended for the treatment of: • PEA or asystole • Norepinephrine can be used as adjunctive treatment for patients with profound hypotension by : A.taskin ( a_taskeen91@hotmail.com )
  31. 31. In a non-ventricular fibrillation/ventricular tachycardia pulseless rhythm: • Continue with CPR • Add epeniphrine • Continue CPR for 2 minutes, then recheck rhythm. • If shockable rhythm is present, defibrillate by : A.taskin ( a_taskeen91@hotmail.com )
  32. 32. Bradycardia (heart rate < 50 beats/min): • If perfusion is inadequate and thought to be due to bradycardia: • Administer a 0.5-mg intravenous bolus of atropine; repeat every 3 to 5 minutes to a maximum of 3 mg • If atropine is inadequate : 1. proceed to transcutaneous pacing or administer dopamine 2 to 10 μg/kg/min or epinephrine 2 to 10 μg/min by intravenous infusion. 2. Intravenous infusion of chronotropic agents is an equally effective alternative to external pacing in this setting Consider transvenous pacing by : A.taskin ( a_taskeen91@hotmail.com )
  33. 33. Tachycardia (heart rate typically greater than or equal to 150 beats/min): • If there is no evidence of inadequate perfusion, • obtain a 12-lead ECG to assess whether rhythm is • wide-complex tachycardia (QRS ≥ 0.12 s) or • narrow-complex tachycardia (QRS < 0.12 s) • If there is evidence of inadequate perfusion, perform immediate synchronized cardioversion by : A.taskin ( a_taskeen91@hotmail.com )
  34. 34. In wide-complex tachycardia: ( V-tach , (SVT) with aberrancy, pre-excitation tachycardia, and ventricular paced rhythms ) If the rhythm is regular with a monomorphic QRS waveform, • adenosine can be used for diagnosis and treatment. • Administer a 6-mg rapid intravenous push • followed by a flush to deliver the drug as a rapid bolus. • If there is no conversion, give a 12-mg rapid intravenous push of adenosine; the 12-mg dose may be given once more. by : A.taskin ( a_taskeen91@hotmail.com )
  35. 35. Cont, complex tach : Consider an antiarrythmic infusion of amiodarone. • Administer 150 mg intravenously over 10 minutes. • repeat as needed to a maximum dose of 1.1 g/24 h. • Follow with a maintenance infusion of 1 mg/min for the first 6 hours. Alternatives include procainamide and sotalol • Prepare for synchronized cardioversion by : A.taskin ( a_taskeen91@hotmail.com )
  36. 36. For irregular rhythm: • Consider atrial fibrillation with aberrancy and treat as for atrial fibrillation. • If there is pre-excitation atrial fibrillation, such as Wolff-ParkinsonWhite syndrome, consider a consultation with a cardiologist. • Avoid atrioventricular nodal blocking agents (adenosine, digoxin, diltiazem, verapamil), which may paradoxically increase ventricular rate. Consider amiodarone . by : A.taskin ( a_taskeen91@hotmail.com )
  37. 37. In narrow-complex tachycardia for regular rhythm: • Attempt vagal maneuvers • Administer a 6-mg rapid intravenous push of adenosine. • If there is no conversion, give a 12-mg rapid intravenous push of adenosine. The 12-mg dose may be given once more • If the rhythm converts, • it is likely to be re-entrant SVT; • consider diltiazem or β-blockers to prevent recurrence by : A.taskin ( a_taskeen91@hotmail.com )
  38. 38. If rhythm does not convert : • consider possible atrial flutter, ectopic atrial tachycardia, or junctional tachycardia. • Consider expert consultation, and consider diltiazem or βblockers to control rate Implantable cardioverter-defibrillators (ICDs) are: indicated for patients surviving cardiac arrest resulting from ventricular fibrillation or ventricular tachycardia that is not due to a transient or reversible cause . by : A.taskin ( a_taskeen91@hotmail.com )
  39. 39. by : A.taskin ( a_taskeen91@hotmail.com )
  40. 40. by : A.taskin ( a_taskeen91@hotmail.com )
  41. 41. by : A.taskin ( a_taskeen91@hotmail.com )
  42. 42. References : • First consult . • Oxford emergency medicine 4th e . • (©2010 American Heart Association ) by : A.taskin ( a_taskeen91@hotmail.com )
  43. 43. by : A.taskin ( a_taskeen91@hotmail.com )

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