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Sudden Cardiac Death

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  • 1. Sudden Cardiac DeathR katr & aae et is f os Mngmns cR katr & aae et is f os Mngmns c Department of Emergency Therapy Translated by Academic Bureau of SMSA 2012
  • 2. Risk Factors for SCD• Old aged• Male• Has PMHx of Coronory Artery Diseases• High total cholesterol level• Arterial hypertonia (Hypertrophy of Left Ventricle)• Diet factors• Has active physical lifestyle• Smoking• Tachycardia / Variable heart rhythm• Prolonged Q-T segment
  • 3. Stages of SCD Prodromal Period Acute Cardiac Symptoms Disturbances in blood circulation Biological Death
  • 4. Evidence of clinical deathMain Features• Asystolic• Absent of pulsation at major vessels (Carotid artery)Additional Features• Dilated pupils• Areflexia ( Absent Corneal Reflex and Pupil reflex towards light )• Skin paleness (pallor)
  • 5. SCD Management1. Primary evaluation of patient’s condition2. Basic Life Support (CPR)3. Advanced measures to maintain life support & full resuscitation of patient4. Treatment during post- resuscitation period5. Long- term treatment
  • 6. Protocol Basic Life Support (CPR) (CPR) Evaluate patient’s condition (Hit patient’s shoulder, wake him) Restore patient’s upper respiratory tract (Lay back head and lower his mandible) Evaluate patient’s breathing (movement of chest) Absent of breathing Present of breathing Do 2 effective breathing into patient’s mouth Check for pulse (not more than 10 seconds) Pulse present Pulse absent. (Start pressing the base of sternum with(Continue breathing ratio of 15:2) assistant)
  • 7. Criteria of adequate CPR CPR1. Returning of pulse on major vessels, synchronous with compression on chest.2. Present of pupil reflex3. Pink condition of patient
  • 8. Algorithm of Advanced measures to maintain life support Disturbances on blood supply Cardiac Strike (Biological Death) CPR Apply Defibrillator and cardiomonitor VTachycardia/ Evaluate No VT / VFib Vfib Heart Rhythm 3-multiple During resuscitation, Cardio- 1. Control its position, electrods and contact of defibrillator defibrillator pulmonology Cardio- 2. Ensure oxygen supply thru UPRT resuscitation 3 3. Do intravenous line for preparations pulmonology 4. Adrenaline for every 3 minutes mins resuscitation Prepare for : 1. Amiodarone , Atropine 2. Heart electrical stimulator
  • 9. Algorithm of management of ventricular tachycardia / Vfib1. 3 - multiple defibrillator (200 J, 300 J, 360 Vfib ventricular tachycardia / J) (if not effective)2. Continue resuscitation method, tracheal intubation, prepare lines for IV (If not effective)3. Introduce Adrenaline IV 1 mg bolus (if not effective)4. Second defibrillator (360 J) (if not effective)5. Antiarrhythmic Drugs Amiodarone ( 300mg IV) Lidocaine (2.0 -1.5 mg/kg IV) Magnesium Sulfate (1.0-2.0 g IV)6. Third Defib (360 J)
  • 10. Antiarrhythmic Drugs1. It is to stabilize patient’s condition2. If patient’s condition is still unstable, continue with defibrillator3. All Anti-arrhythmic drugs have pro-arrhythmic effects.4. Do not use more than 1 anti-arrhythmic drug
  • 11. Atropine in Sudden Cardiac DeathIndications1. Asystolic2. Heart arrest or bradyarrythmia1st bolus dose 0.6 - 1.0 mgIf atropine is not effective, change to adrenaline or euphiline.