cardiac arrest 2.2.12
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1Cardiac Arrest - Murdin Amit
CARDIAC ARREST orSUDDEN CARDIAC DEATH (SCD)
MPK 1263
Emergency Medicine 1
Sem 2
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Learning Objective
Student will be able to:
1. Define ne Cardiac Arrest.2. State the etiology of Cardiac Arrest.3. State the clinical manifestations of Cardiac Arrest.4. Explain the management of Cardiac Arrest.5. List 2 complications of Cardiac Arrest.6. State the prognosis of Cardiac Arrest.
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1. Definition of Cardiac arrest:
Sudden and complete loss of cardiac
output due to asystole, ventriculartachycardia or ventricular fibrillation or lossof mechanical cardiac contraction
(pulseless electrical activity-PEA).
Clinical diagnosis is based on the victim is
unconscious and pulseless, breathing maytake some time to stop completely aftercardiac arrest.
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2. Etiology Common causes of sudden arryhthmic death
1. CORONARY ARTERY DISEASE (85%): Myocardial Ischemia (MI) AMI Old MI with myocardial scarring
2. STRUCTURAL HEART DISEASE (10%) Aortic Stenosis (AS) Hypertrophic Cardiomyopathy (HOCM) Dilated Cardiomyopathy Congestive Heart Failure (CHF)
3.NON-STRUCTURAL HEART DISEASE (5%) Long QT syndrome Adverse Drug Reactions(ADR) Severe Electrolyte Abnormalities
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Etiology of Cardiac Arrest1. VENTRICULAR FIBRILLATIONS(VF) and
VENTRICULAR TACHYCARDIA (VT)
These are the most common and most easily treatablearrest rhythms.
VF produce very rapid ineffective uncoordinatedmovement of the ventricles NO PULSE!
VT very rapid ineffective ventricular rate nomechanical contraction and relaxation goes into VF !Immediate DEFIBRILLATION RESTORES CARDIAC
OUTPUT in more than 80% of cases. Each minutesdelay chances of survival drop by 10%! BLS(CPR)+ Defibrillation increases chances of survival!
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Etiology of Cardiac Arrest
2. Asystole
Occurs when there is NOT ELECTRICALACTIVITY WITHIN THE VENTRICLESdue to failure of conducting tissue ormassive ventricular damage after MI.
CPR + IV atropine injection or adrenalinemay restore cardiac activity.
Conducting tissue failure permanentpacemaker necessary for survival.
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Etiology of Cardiac Arrest
3. Pulseless Electrical Activity
Occurs when there is no effective CardiacOutput despite the presence of organizedelectrical activity.
Causes:
A) Reversible causes hypovolemia, cardiactamponade or tension peumothorax.
B) Irreversible / serious conditions such ascardiac rupture or massive pulmonary embolism extreme poor prognosis!
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3. Contributing Risk Factor for Cardiac Arrest :
Family history of CAD & Cardiac Arrest & Heart Disease
High blood pressure High blood cholesterol Obesity Diabetes Sedentary lifestyle Previous heart attack Age; incidence increases with age, especially after age 45 for
men and age 55 for women Being male; men are two to three times more likely to
experience sudden cardiac arrest Using illegal drugs, such as cocaine or amphetamines
Lightning strike or other electrical shock Immersion in cold water
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4. Clinical Manifestations
1. Collapse and Unconscious
2. No pulse
3. Stopped breathing4. BP not recordable
5. Pupils not responsive to light
6. Incontinence of bladder and bowel
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5. Investigation :
emergency situation no time to doany lab or imaging investigations.
Diagnosis is based on:
1. History2. Physical examinations
3. Eyewitnesss history
4. Vital signs - Pulse,breathing
( BP+pupils )
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Once stable and admitted the following Ix are done:
1. Cardiac Enzyme
2. ECG
3. Blood for Arterial Blood Gas (ABG) respiratoryacidosis/alkalosis.
4. BUSE: metabolic acidosis / alkalosis
5. Complete blood count (CBC) : to detect anemia /infections
6. Liver Function / Renal Function tests
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7. Mx
CHAIN OF SURVIVAL
IF ARREST IS WITNESSED, HELP IS CALLEDIMMEDIATELY, BASIC LIFE SUPPORT GIVENIMMEDIATELY BY TRAINED INDIVIDUALS,EMERGENCY MEDICAL SERVICES RESPONDQUICKLY, AND DEFIBRILLATIONS GIVEN WITHINMINUTES - CHANCES OF SURVIVAL IS GREAT!
BLS = CPR ACLS =
BLS+OXYGEN+DEFIBRILLATION+DRUGS+IVFLUIDS
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8. Management
BLS (CPR)
ACLS by Emergency Medicine Trained AMO:
2 AMO takes over and continues CPR
Fix the Automatic Defibrillator to victim
Follow instructions by AED defib is automatic. Give O2 by Bag-Valve-Mask
Set IV drip run Ringers Lactate
Inj.Adrenaline/Norephinerin IV bolus stat.
Once stable transport to nearest hospital.
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9. Complications Coma
Death
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10. Prognosis :
Not good if rescue is given after 6
minutes if survives may becomevegetable coma state.
Critical time: 4-6 mins
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