Cardiac arrest

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Cardiac arrest

  1. 1. Cardiac Arrest
  2. 2. SUBMITTED TO: Dr. Sonia Qandeel
  3. 3. SUBMITTED BY Nimra Iqbal Dph-fa10-100 Ammarah Siddique Dph-fa10-094 Talat Fatima Dph-fa10-102
  4. 4. CONTENTS  Definition  Diagnosis  Causes  Symptoms  Management Approach  Medication used
  5. 5. Definition of Cardiac arrest: Sudden cessation of heartbeat and cardiac function, resulting in the loss of effective circulation. or Absence of systole; failure of the ventricles of the heart to contract (usually caused by ventricular fibrillation) with consequent absence of the heart beat leading to oxygen lack and eventually to death
  6. 6. Diagnosis of cardiac arrest (TRIAD):  Loss of consciousness, unresponsiveness  Loss of normal breathing Apnea.  Loss of pulse and blood pressure {apical & central pulsations (carotid, femoral loss}
  7. 7. CAUSES  Influx problems in the heart.  Congenital heart disease  Valvular heart disease  Enlarged heart (cardiomyopathy).  Heart attack  Coronary artery disease
  8. 8. Symptoms of cardiac arrest Symptoms cardiac arrest symptoms are immediate and drastic. Sudden collapse No pulse No breathing (respiration arrest – may be in 30 seconds after cardiac arrest Loss of consciousness enlargement of pupils – may be in 90 seconds after cardiac arrest
  9. 9. TREATMENT
  10. 10. Our Ultimate Goal To find the best treatment methods for managing cardiac arrest, in order to save more lives!
  11. 11. Delay Can Be Deadly  Patient delay is the biggest cause of not getting care fast.  Do not wait more than a few minutes— 5 at the most
  12. 12. “Chain of Survival” Early Access to Care – Know the Signs  Early CPR, Cardiopulmonary Resuscitation especially with quality chest compressions  Rapid defibrillation(with AEDs) (an electrical shock to the heart)  Effective paramedics (advanced life support )  Follow up care (post-cardiac arrest care)
  13. 13. The ABCDE approach to the critically ill patient A… B… C… D… E…
  14. 14. ABCDE approach Airway Recognition of airway obstruction  Talking  Difficulty breathing, distressed, Shortness of breath  Noisy breathing  stridor, wheeze, gurgling  See-saw respiratory pattern, A
  15. 15. ABCDE Approach Airway Treatment of airway obstruction  Oxygen  Airway opening - i.e. head tilt, chin lift, jaw thrust  Advanced techniques - e.g. LMA, tracheal tube A
  16. 16. ABCDE approach Breathing Recognition of breathing problems Look  Inspect respiratory distress, cyanosis, respiratory rate, chest deformity, Listen  Auscultate breath sounds, noisy breathing Feel  palpat expansion, percussion, tracheal position  Pulse oxymetry B
  17. 17. ABCDE approach Breathing Treatment of breathing problems  Airway  Oxygen  Treat underlying cause - e.g. drain pneumothorax - e.g . Nebulizers  Support breathing if inadequate - e.g. ventilate with bag valve mask B
  18. 18. ABCDE approach Circulation  Look at the patient  Pulse – central pulse (carotid) peripheral pulse  Peripheral perfusion capillary refill time ( normally <2 sec)  Blood pressure  Monitor C
  19. 19. ABCDE approach Circulation Treatment      IV access, take blood sample and lab investigations Treat cause Give fluids Haemodynamic monitoring MONA if acute coronary syndrome C
  20. 20. ABCDE approach Disability
  21. 21. ABCDE approach Disability  AVPU or GCS, and pupils  Treatment - ABC  Treat underlying cause  Blood glucose  if < 3 mmol l-1 give glucose D
  22. 22. ABCDE approach Exposure E  Remove clothes to enable examination - e.g. injuries, bleeding, rashes  Avoid heat loss  Maintain dignity
  23. 23. Defibrillation  All moving away from stacked shocks to single shocks  Reduces pauses in chest compressions  Still role for initial stacked shocks if cardiac arrest occurs in presence of defibrillator  All recommend immediate CPR after defibrillation (without rhythm or pulse check)  Different recommendations on joules (150-360J)  Between guidelines  Between manufacturers  Between monophasic and biphasic  There may be a role for CPR before defibrillation in some  Particularly if in VF for more than a few minutes  Right heart dilation an impediment to defibrillation  Confused?
  24. 24. Defibrillation  We (St John CMG) recommend a simple approach  Start with one round of stacked shocks if cardiac arrest occurs in presence of defibrillator, then go to single shocks  Always use maximum joules  Opt for defibrillation first  Round kids off to nearest 10kg and use 5J/kg
  25. 25. Defibrillation
  26. 26. Starting and stopping  These decisions can be difficult  A resuscitation attempt should begin in most patients  Except where the patient is clearly dead (livedo, rigor mortis)  Or where they are clearly dying and it would be inappropriate  A competent patient can decline therapy but neither a patient nor their family can demand therapy that is medically inappropriate  Some scenarios have >99% mortality rates  Unwitnessed cardiac arrest with initial rhythm of asystole
  27. 27. Starting and stopping  The chances of survival fall rapidly with time  Exponential falling curve  There is no absolute cut off when mortality becomes zero  Resuscitation attempts requiring longer than 20 minutes of CPR have a very high mortality rate  We recommend stopping at around 20 minutes unless there is a clinical reason to continue for longer  Transport to hospital with CPR enroute usually has no role
  28. 28. Automated External Defibrillator
  29. 29. Implantable Cardioverter Defibrillator An ICD monitors the heartbeat and delivers shock when it detects lethal dysrhythmia.
  30. 30. Ventricular Fibrillation (VF) What VF looks like on an EKG Shock “converts” VF to better rhythm Defibrillation (electrical shock) is the primary solution (cannot be used in other lethal heart rhythms)
  31. 31. Automated External Defibrillators may be used
  32. 32. Manual Defibrillator
  33. 33. Drugs used commonly during resuscitation  Epinephrine (Adrenaline)  Atropine  Amiodarone  Magnesium Sulphate  Lidocaine (Lignocaine)  Sodium Bicarbonate  Calcium
  34. 34. Epinephrine (Adrenaline)  First line cardiac arrest drug, given after every 3 minutes of CPR  Dose 1mg (10ml of 1 in 10,000) IV  Causes vasoconstriction, increased systemic vascular resistance increasing cerebral and coronary perfusion  Increases myocardial excitability, when the myocardium is hypoxic or ischaemic
  35. 35. Atropine  Given for asystole or pulseless electrical activity with a rate less than 60 beats per minute  3mg is given as a single intravenous dose  It blocks the activity of the vagus nerve on the SA and AV nodes, increasing sinus automaticity and facilitating AV node conduction
  36. 36. Amiodarone  For Refractory VF/VT; haemodynamically stable VT and other resistant tachyarrhythmias  If VF or pulseless VT persists after the first 3 shocks then Amiodarone 300mg is considered.  If not pre-diluted, must be diluted in 5% dextrose to 20ml. (Will crystallise is mixed with saline)  Should be given centrally but in an emergency can be given peripherally  Increases the duration of the action potential in the atrial and ventricular myocardium
  37. 37. Magnesium Sulphate  For refractory VF when hypomagnesaemia is possible; ventricular tachyarrhythmias when hypomagnesaemia is possible  In refractory VF – 1 to 2g (2-4ml of 50% magnesium sulphate) peripherally over 1 to 2 minutes.  Other circumstances 2.5g (5ml of 50% magnesium sulphate) over 30 minutes
  38. 38. Lidocaine (Lignocaine)  For Refractory VF/ pulseless VT (when Amiodarone is unavailable  100mg for VF/ pulseless VT that persists after three shocks. Another 50mg can be given if necessary
  39. 39. Sodium Bicarbonate  Given for severe metabolic acidosis and Hyperkalaemia  50mmol (50ml of 8.4% solution), where there is an acidosis or cardiac arrest associated with Hyperkalaemia
  40. 40. Calcium  Administered when pulseless electrical activity caused by: Hyperkalaemia Hypocalcaemia Overdose of Calcium channel blocking drugs  Dose 10ml of 10% calcium chloride repeated according to blood results
  41. 41. Controllable Risk Factors  Smoking  Diabetes  High blood cholesterol  High blood pressure – especially stroke  Overweight/obesity  Physical inactivity
  42. 42. Lifestyle Changes  Reduce intake of fatty foods and eat more fruits and vegetables  Walk 30 minutes a day  Exercise prevents stroke, heart disease and other conditions
  43. 43. Questions

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