Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Dr. Shreyash Trived
Dr. (Prof.) V. Priyadarshi Unit
INTRODUCTION
Sudden cardiac arrest (SCA) and sudden
cardiac death (SCD) refer to the sudden
cessation of cardiac activity ...
DEFINITION OF SUDDEN CARDIAC
DEATH
Sudden cardiac death is defined as “natural death due
to cardiac causes in a person who...
In the context of time, sudden is defined for most
clinical and epidemiologic purposes as 1 hour or less
between a change ...
SCD viewed from four temporal
perspectives
EPIDEMIOLOGY OF SCD
Approx. 5,00,000 CASES IN U.S.A PER ANNUM
Accounts for 10-15% of natural deaths and 50 % deaths
from c...
AGE RELATED RISK FOR SCD
 Prior Episode of V.TACH
 Low LVEF.
 Previous Myocardial Infarction.
 Coronary Artery Disease
 Family History of SCD....
SUDDEN CARDIAC ARREST
Abrupt cessation of cardiac mechanical function,
which may be reversible by a prompt intervention
(e...
Three Basic ECG Patterns with
Cardiac Arrest
Ventricular tachyarrhythmia-- ventricular fibrillation
(VF)/sustained type of...
Ventricular Tachycardia
SUDDEN CARDIAC ARREST
The probability of achieving successful resuscitation
from cardiac arrest is related to-
Interval fr...
SUDDEN CARDIAC ARREST
Return of circulation and survival rates as a result of
defibrillation decreases almost linearly fro...
SUDDEN CARDIAC ARREST
After 5 min, survival rates are no better than 25-30% in
out of hospital setting
Outcome in ICU and ...
SUDDEN CARDIAC ARREST
When the mechanism is pulseless VT, the outcome is
best
VF is the next most successful
Asystole and ...
Successful resuscitation following cardiac arrest requires an
integrated set of coordinated actions represented by the lin...
The links include the following:
Immediate recognition of cardiac arrest and
activation of the emergency response system
E...
Signs and symptoms
The most reliable sign is absence of pulse
Unconsciousness/Unresponsiveness
No respiratory movements
No...
INITIAL RESPONSE
As soon as a cardiac arrest is suspected , confirmed, or
even considered to be impending, calling an
emer...
BLS (Basic Life Support)
The goal of this activity is to maintain viability of the
CNS, heart and other vital organs until definitive
intervention ...
Immediate recognition and
activation of emergency response
system
If a lone rescuer finds an unresponsive adult or
witness...
Unresponsiveness
If the victim also has absent or abnormal breathing(ie,
only gasping) the rescuer should assume that the
...
PULSE CHECK:
▪ Studies have shown that both lay rescuers and health
care providers (HCP) have difficulty detecting a pulse...
EARLY CPR
A change in the 2010 AHA guidelines for CPR is to
recommend the initiation of compressions before
rescue breaths...
RESCUER SPECIFIC CPR STRATEGIES
Untrained lay rescuer:- Hands-only (chest
compression only) CPR, with an emphasis on push
...
Technique : chest compressions
Place victim on a firm surface in supine position
Rescuer kneeling besides victim’s chest (...
Technique: Rescue breaths
Open airway- Head tilt and chin lift/ Jaw thrust
Mouth to mouth
Mouth to barrier device
Mouth to...
Technique: Rescue breaths
To provide mouth-to-mouth rescue breaths, open the
victim’s airway- pinch the victim’s nose- and...
Opening the airway
Providing basic ventilation
Mouthtomouthventilation
Mouthtonoseventilation
Mouthtobarrierdevice
Bag mask ventilation
Advanced airways
ETtube
combitube
LMA
Summary of Key BLS Components
for Adults, Children and Infants
ADVANCED CARDIAC LIFE SUPPORT
This next step in resuscitative sequence is designed to
achieve a stable Return of Spontaneous Circulation (
ROSC), and he...
Goals of ACLS
Revert the cardiac rhythm to one that is
hemodynamically effective-by
defibrillation/cardioversion
To optimi...
Basics of ACLS
Immediately after activating emergency response,
start CPR
Attach monitor/defibrillator minimizing interrup...
Rhythm-Based Management of
Cardiac Arrest
Paddles and electrode pads: anterior-lateral position
Any doubt about the presence of a pulse chest
compressions
Rhythm ca...
Defibrillation: Electrode Placement
VF/Pulseless VT
Resume CPR while charging the defibrillator
Chest compressions should switch at every 2-minute
cycle to minimize fatigue
Defibrillation Strategies
Waveform and Energy
Biphasic defibrillator: manufacturer’s recommended
energy dose (120-200 J)
U...
Defibrillation Strategies
Waveform and Energy
Second and subsequent energy levels should be at
least equivalent, and highe...
Drug Therapy in VF/Pulseless VT
Amiodarone: first-line antiarrhythmic agent
Magnesium sulfate
Torsades de pointes associat...
Treating Potentially Reversible
Causes of VF/Pulseless VT
Refractory VF/pulseless VT: AMI
PEA/Asystole
Drug Therapy for PEA/Asystole
Vasopressor can be given as soon as feasible
Available evidence suggests that the routine us...
Treating Potentially Reversible
Causes of PEA/Asystole
PEA
reversible conditions
treated successfully if those conditions ...
Treating Potentially Reversible
Causes of PEA/Asystole
Asystole
end-stage rhythm that follows prolonged VF or PEA, and
for...
MONITORING DURING CPR
Mechanical parameteres
Rate of compression: ≥ 100/min
Depth of compression: ≥2 inches (5 cm)
Rate of...
Physiologic Parameters
Pulse
End-Tidal CO2
Coronary Perfusion Pressure and Arterial Relaxation
Pressure
Central Venous Oxy...
End-Tidal CO2
If PETCO2 is <10 mm Hg, it is reasonable to consider
trying to improve CPR quality by optimizing chest
compr...
Coronary Perfusion Pressure and Arterial
Relaxation Pressure
Increased CPP correlates with improved 24-hour
survival rates...
Pulse oximetry-typically does not provide a reliable
signal because pulsatile blood flow is inadequate in
peripheral tissu...
Medications for Arrest Rhythms
Epinephrine
It is reasonable to consider administering a 1 mg dose
of IV/IO epinephrine every 3-5 minutes during adult
car...
Vasopressin
Nonadrenergic peripheral vasoconstrictor
1 dose of vasopressin 40 units IV/IO may replace either
the first or ...
Amiodarone
An initial dose of 300 mg IV/IO can be followed by 1
dose of 150 mg IV/IO.
For recurrent or refractory VF/VT.
Lidocaine
Considered if amiodarone is not available
The initial dose is 1-1.5 mg/kg IV.
If VF/pulseless VT persists, addit...
Magnesium Sulfate
Torsades de pointes
IV/IO bolus of magnesium sulfate at a dose of 1-2 g
diluted in 10 mL D5W.
SUMMARY OF UPDATES; ACLS 2010
ABC  CAB
Untrained/Lay people  Hand-only CPR
CPR Depth from 1 ½ to 2 inches  minimum 2 in...
Cont……
Professional rescuers  quantitative waveform
capnography confirm intubation and CPR quality
Atropine deleted from...
Cont……
Look, Listen and Feel removed from BLS Algorithm
Continued de-emphasis on pulse check for health care
providers and...
Understanding the importance of diagnosing and
treating the underlying cause is fundamental to
management of all cardiac a...
POST CARDIAC ARREST CARE
●Initial management is focused on establishing and
maintaining hemodynamic stability and supportive
care.
●Amiodarone or l...
Survivors of SCA should have a detailed CVS
evaluation including:-
ECG/ECG Monitoring/24 hr ambulatory ECG
Lab:- cardiac m...
SUDDEN CARDIAC ARREST
Causes of death during hospitalization after
successfully resuscitated CA-
Anoxic encephalopathy and...
PREVENTION OF SCD
PRIMARY PREVENTION
① Identifying individuals at high risk of SCD:-
▪Combination of factors more useful
▪Most imp parameter...
SECONDARY PREVENTION
Antiarrythmics- amiodarone, sotalol
ICD
THANK YOU FOR YOUR
ATTENTION!!
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Cardiac arrest and sudden cardiac death
Upcoming SlideShare
Loading in …5
×

Cardiac arrest and sudden cardiac death

11,994 views

Published on

Simple overview of a very important topic

Published in: Health & Medicine
  • Has the "Cure" for Diabetes Been Kept from You? ♥♥♥ https://bit.ly/2swQ6OO
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating direct: ❤❤❤ http://bit.ly/39pMlLF ❤❤❤
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating for everyone is here: ❶❶❶ http://bit.ly/39pMlLF ❶❶❶
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Cardiac arrest and sudden cardiac death

  1. 1. Dr. Shreyash Trived Dr. (Prof.) V. Priyadarshi Unit
  2. 2. INTRODUCTION Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) refer to the sudden cessation of cardiac activity with hemodynamic collapse. If an intervention (e.g., defibrillation) restores circulation, the event is referred to as SCA. If uncorrected, an SCA event leads to death and is then referred to as SCD.
  3. 3. DEFINITION OF SUDDEN CARDIAC DEATH Sudden cardiac death is defined as “natural death due to cardiac causes in a person who may or may not have previously recognized heart disease but in whom the time and mode of death are unexpected.
  4. 4. In the context of time, sudden is defined for most clinical and epidemiologic purposes as 1 hour or less between a change in clinical status heralding the onset of the terminal clinical event and the cardiac arrest itself. To satisfy clinical, scientific, legal, and social considerations, four temporal elements must be considered: (1) prodromes, (2) onset of terminal event, (3) cardiac arrest, and (4) biologic death
  5. 5. SCD viewed from four temporal perspectives
  6. 6. EPIDEMIOLOGY OF SCD Approx. 5,00,000 CASES IN U.S.A PER ANNUM Accounts for 10-15% of natural deaths and 50 % deaths from cardiac causes. BIMODAL AGE DISTRIBUTION with peaks between birth and 6 months of age & after 65 yrs of age Male preponderance May be the first presentation of cardiovascular disease in 25% of patients
  7. 7. AGE RELATED RISK FOR SCD
  8. 8.  Prior Episode of V.TACH  Low LVEF.  Previous Myocardial Infarction.  Coronary Artery Disease  Family History of SCD.  Cardiomyopathy  Congestive Heart Failure  Long QT Syndrome.  Right Ventricular Dysplasia. Risk Factors of Sudden Cardiac Death (SCD)
  9. 9. SUDDEN CARDIAC ARREST Abrupt cessation of cardiac mechanical function, which may be reversible by a prompt intervention (e.g., defibrillation) but will lead to death in its absence.
  10. 10. Three Basic ECG Patterns with Cardiac Arrest Ventricular tachyarrhythmia-- ventricular fibrillation (VF)/sustained type of pulseless ventricular tachycardia Ventricular asystole or a brady-asystolic rhythm with an extremely slow rate Pulseless electrical activity (PEA), previously referred to as electromechanical dissociation.
  11. 11. Ventricular Tachycardia
  12. 12. SUDDEN CARDIAC ARREST The probability of achieving successful resuscitation from cardiac arrest is related to- Interval from onset of loss of consciousness to institution of resuscitative efforts The setting in which the arrest occurs The mechanism ( VT, VF, PEA, ASYSTOLE) of CA Clinical status of the patient before the cardiac arrest.
  13. 13. SUDDEN CARDIAC ARREST Return of circulation and survival rates as a result of defibrillation decreases almost linearly from first to 10th min.
  14. 14. SUDDEN CARDIAC ARREST After 5 min, survival rates are no better than 25-30% in out of hospital setting Outcome in ICU and other in-hospital environments is heavily influenced by patients preceding clinical status
  15. 15. SUDDEN CARDIAC ARREST When the mechanism is pulseless VT, the outcome is best VF is the next most successful Asystole and PEA generate dismal outcome statistics
  16. 16. Successful resuscitation following cardiac arrest requires an integrated set of coordinated actions represented by the links in the Chain of Survival
  17. 17. The links include the following: Immediate recognition of cardiac arrest and activation of the emergency response system Early CPR with an emphasis on chest compressions Rapid defibrillation Effective advanced life support Integrated post– cardiac arrest care
  18. 18. Signs and symptoms The most reliable sign is absence of pulse Unconsciousness/Unresponsiveness No respiratory movements No blood pressure Pupils begin dilating within 45 secs. Seizures- may or may not occur Death like appearance Lips and nail beds turn blue and skin turns pale
  19. 19. INITIAL RESPONSE As soon as a cardiac arrest is suspected , confirmed, or even considered to be impending, calling an emergency rescue system is the immediate priority
  20. 20. BLS (Basic Life Support)
  21. 21. The goal of this activity is to maintain viability of the CNS, heart and other vital organs until definitive intervention can be achieved. Fundamental aspects of BLS include- Immediate recognition of SCA and activation of emergency response system Early CPR Rapid defibrillation with an automated external defibrillator (when appropriate)
  22. 22. Immediate recognition and activation of emergency response system If a lone rescuer finds an unresponsive adult or witnesses an adult who suddenly collapses, after ensuring that the scene is safe, the rescuer should check for a response by tapping the victim at the shoulder and by shouting at him The trained or untrained bystander should activate the community emergency response system, or if in an institution with an emergency response system call that facility’s emergency response number
  23. 23. Unresponsiveness If the victim also has absent or abnormal breathing(ie, only gasping) the rescuer should assume that the victim is in cardiac arrest
  24. 24. PULSE CHECK: ▪ Studies have shown that both lay rescuers and health care providers (HCP) have difficulty detecting a pulse. ▪The lay rescuer should not check for a pulse ▪If the HCP doesn’t definitely feel a pulse within 10 secs he should start chest compressions.
  25. 25. EARLY CPR A change in the 2010 AHA guidelines for CPR is to recommend the initiation of compressions before rescue breaths Change from ABC to CAB
  26. 26. RESCUER SPECIFIC CPR STRATEGIES Untrained lay rescuer:- Hands-only (chest compression only) CPR, with an emphasis on push hard and push fast until an AED arrives or HCP take over Trained lay rescuer:- should start chest compressions first. add rescue breaths in the ratio of 30 compressions to two breaths if able to do so HCP:- Cycle of 30:2 until an advanced air way is placed; then continuous chest compressions with 1 breath every 6 to 8 secs.
  27. 27. Technique : chest compressions Place victim on a firm surface in supine position Rescuer kneeling besides victim’s chest (out of hospital) or standing besides bed (in hospital) Place heel of one hand over the lower half of sternum. Heel of the other hand should be on top of the first so that they overlap and are parallel. Arms should be straight and perpendicular to chest of victim
  28. 28. Technique: Rescue breaths Open airway- Head tilt and chin lift/ Jaw thrust Mouth to mouth Mouth to barrier device Mouth to nose and mouth and stoma Ventilation with bag and mask Ventilation with supraglottic airway- LMA, esophageal combitube, king airway device
  29. 29. Technique: Rescue breaths To provide mouth-to-mouth rescue breaths, open the victim’s airway- pinch the victim’s nose- and create an airtight mouth-to-mouth seal. Give 1 breath over 1 second, take a “regular” (not a deep) breath, and give a second rescue breath over 1 second Advanced airway- 1 breath every 6-8 secs ASYNCHRONOUS with compressions
  30. 30. Opening the airway
  31. 31. Providing basic ventilation Mouthtomouthventilation Mouthtonoseventilation Mouthtobarrierdevice Bag mask ventilation
  32. 32. Advanced airways ETtube combitube LMA
  33. 33. Summary of Key BLS Components for Adults, Children and Infants
  34. 34. ADVANCED CARDIAC LIFE SUPPORT
  35. 35. This next step in resuscitative sequence is designed to achieve a stable Return of Spontaneous Circulation ( ROSC), and hemodynamic stabilization There should not be an abrupt cessation of BLS, rather a merging and transition from one level of activity to the next.
  36. 36. Goals of ACLS Revert the cardiac rhythm to one that is hemodynamically effective-by defibrillation/cardioversion To optimize ventilation-through placement of an advanced airway (i.e., intubation) To maintain and support the restored circulation- monitoring and use of drugs
  37. 37. Basics of ACLS Immediately after activating emergency response, start CPR Attach monitor/defibrillator minimizing interruptions in CPR Shockable rhythm- defibrillate with recommended shock energy and immediately resume CPR for 2 mins (5 cycles)
  38. 38. Rhythm-Based Management of Cardiac Arrest
  39. 39. Paddles and electrode pads: anterior-lateral position Any doubt about the presence of a pulse chest compressions Rhythm can be diagnosed before CPR is initiated
  40. 40. Defibrillation: Electrode Placement
  41. 41. VF/Pulseless VT
  42. 42. Resume CPR while charging the defibrillator Chest compressions should switch at every 2-minute cycle to minimize fatigue
  43. 43. Defibrillation Strategies Waveform and Energy Biphasic defibrillator: manufacturer’s recommended energy dose (120-200 J) Unaware of the effective dose range: maximal dose
  44. 44. Defibrillation Strategies Waveform and Energy Second and subsequent energy levels should be at least equivalent, and higher energy levels may be considered if available. Monophasic defibrillator: 360 J Subsequent shocks at the previously successful energy level
  45. 45. Drug Therapy in VF/Pulseless VT Amiodarone: first-line antiarrhythmic agent Magnesium sulfate Torsades de pointes associated with a long QT interval
  46. 46. Treating Potentially Reversible Causes of VF/Pulseless VT Refractory VF/pulseless VT: AMI
  47. 47. PEA/Asystole
  48. 48. Drug Therapy for PEA/Asystole Vasopressor can be given as soon as feasible Available evidence suggests that the routine use of atropine during PEA or asystole is unlikely to have a therapeutic benefit . For this reason atropine has been removed from the cardiac arrest algorithm.
  49. 49. Treating Potentially Reversible Causes of PEA/Asystole PEA reversible conditions treated successfully if those conditions are identified and corrected Hypoxemia: advanced airway severe volume loss or sepsis: administration of empirical IV/IO crystalloid. severe blood loss: blood transfusion pulmonary embolism: empirical fibrinolytic therapy (Class IIa, LOE B) tension pneumothorax: needle decompression
  50. 50. Treating Potentially Reversible Causes of PEA/Asystole Asystole end-stage rhythm that follows prolonged VF or PEA, and for this reason the prognosis is generally much worse
  51. 51. MONITORING DURING CPR Mechanical parameteres Rate of compression: ≥ 100/min Depth of compression: ≥2 inches (5 cm) Rate of ventilation: 1 breath every 6-8 s (8-10 breath/min)
  52. 52. Physiologic Parameters Pulse End-Tidal CO2 Coronary Perfusion Pressure and Arterial Relaxation Pressure Central Venous Oxygen Saturation Pulse Oximetry Arterial Blood Gases Echocardiography
  53. 53. End-Tidal CO2 If PETCO2 is <10 mm Hg, it is reasonable to consider trying to improve CPR quality by optimizing chest compression parameters . If PETCO2 abruptly increases to a normal value (35-40 mm Hg), it is reasonable to consider that this is an indicator of ROSC.
  54. 54. Coronary Perfusion Pressure and Arterial Relaxation Pressure Increased CPP correlates with improved 24-hour survival rates and is associated with improved myocardial blood flow and ROSC If the arterial relaxation “diastolic” pressure is <20 mm Hg, it is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters or giving a vasopressor or both.
  55. 55. Pulse oximetry-typically does not provide a reliable signal because pulsatile blood flow is inadequate in peripheral tissue beds Routine measurement of arterial blood gases during CPR has uncertain value Absence of cardiac motion on echocardiogaphy during resuscitation of patients in cardiac arrest was highly predictive of inability to achieve ROSC
  56. 56. Medications for Arrest Rhythms
  57. 57. Epinephrine It is reasonable to consider administering a 1 mg dose of IV/IO epinephrine every 3-5 minutes during adult cardiac arrest . If IV/IO access is delayed or cannot be established, epinephrine may be given endotracheally at a dose of 2-2.5 mg.
  58. 58. Vasopressin Nonadrenergic peripheral vasoconstrictor 1 dose of vasopressin 40 units IV/IO may replace either the first or second dose of epinephrine in the treatment of cardiac arrest .
  59. 59. Amiodarone An initial dose of 300 mg IV/IO can be followed by 1 dose of 150 mg IV/IO. For recurrent or refractory VF/VT.
  60. 60. Lidocaine Considered if amiodarone is not available The initial dose is 1-1.5 mg/kg IV. If VF/pulseless VT persists, additional doses of 0.5- 0.75 mg/kg IV push may be administered at 5- to 10- minute intervals to a maximum dose of 3 mg/kg.
  61. 61. Magnesium Sulfate Torsades de pointes IV/IO bolus of magnesium sulfate at a dose of 1-2 g diluted in 10 mL D5W.
  62. 62. SUMMARY OF UPDATES; ACLS 2010 ABC  CAB Untrained/Lay people  Hand-only CPR CPR Depth from 1 ½ to 2 inches  minimum 2 inches Minimum pauses in CPR even if needed
  63. 63. Cont…… Professional rescuers  quantitative waveform capnography confirm intubation and CPR quality Atropine deleted from PEA & Asystole management To reduce time to defib.  AED training should not be limited
  64. 64. Cont…… Look, Listen and Feel removed from BLS Algorithm Continued de-emphasis on pulse check for health care providers and no pulse check for lay persons
  65. 65. Understanding the importance of diagnosing and treating the underlying cause is fundamental to management of all cardiac arrest rhythms.
  66. 66. POST CARDIAC ARREST CARE
  67. 67. ●Initial management is focused on establishing and maintaining hemodynamic stability and supportive care. ●Amiodarone or lidocaine is often used to prevent recurrent ventricular tachyarrythmia ●Therapeutic hypothermia-confers a modest improvement in neurological outcome ● Immediate coronary angiography with revascularization if indicated may improve survival in pt with ischemic etiology
  68. 68. Survivors of SCA should have a detailed CVS evaluation including:- ECG/ECG Monitoring/24 hr ambulatory ECG Lab:- cardiac markers, electrolytes, drug levels for toxicity, tox screen, Echocardiography Electrophysiological testing Cardiac MRI Genetic testing for channelopathies
  69. 69. SUDDEN CARDIAC ARREST Causes of death during hospitalization after successfully resuscitated CA- Anoxic encephalopathy and infections subsequent to prolonged respirator dependence account for 60% of deaths 30% occur as a consequence of refractory low cardiac output states Recurrent arrhythmias account for only 10% of in- hospital deaths
  70. 70. PREVENTION OF SCD
  71. 71. PRIMARY PREVENTION ① Identifying individuals at high risk of SCD:- ▪Combination of factors more useful ▪Most imp parameter-LVEF ▪EP testing, ambulatory ECG, SAECG, HRV, T WAVE Alternans have been used ②Pharmacological agents- ▪Beta blockers, ACEI, Amiodarone ▪Revascularisation ▪ ICD/CRT
  72. 72. SECONDARY PREVENTION Antiarrythmics- amiodarone, sotalol ICD
  73. 73. THANK YOU FOR YOUR ATTENTION!!

×