cardiac arrest 2.2.12

8/2/2019 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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Cardiac Arrest - Murdin Amit 2

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

cardiac arrest 2.2.12

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