SlideShare a Scribd company logo
1 of 29
Introduction
• Sudden cardiac death
–Most common cause of death in hemodialysis
patients
–Usually preceded by ventricular arrhythmias
• Hyperkalemia
–Contributes to 2–5% of deaths among
hemodialysis patients
–Accounts for up to 24% of emergency
hemodialysis sessions
• Frequency of cardiac
arrest
–Highest on the first
session of hemodialysis
of the week
• Monday or Tuesday
–Fluid and electrolyte
disturbances peak after
the weekend interval
• Primary prevention of cardiac arrest in dialysis
patients
– Avoidance of low potassium dialysate solutions
– Proper use of medication
• Beta blockers
• ACE inhibitors
SPECIAL CONSIDERATIONS
Cardiac Arrest During Hemodialysis
Hala! Wala na
may heart beat.
CODE BLUE!
CODE BLUE!
Initial Steps
• Call the resuscitation team and seek
expert help immediately
• Follow the universal ALS algorithm
• Assign a trained dialysis nurse to operate
the dialysis machine
• Stop ultrafiltration (i.e. fluid
removal)
• Give a fluid bolus
• Return the patient’s blood
volume
• Disconnect patient from the
dialysis machine
• Leave dialysis access open
and use for drug
administration
• Beware of wet surfaces (i.e.
dialysis machines may leak)
• Minimise delay in delivering
defibrillation
• Ensure high quality chest compressions
• Minimise interruptions to compressions
• Give oxygen
• Use waveform capnography
DURING CPR
• Continuous compressions when
advanced airway in place
• Vascular access (intravenous or
intraosseous)
• Give adrenaline every 3-5 min
• Give amiodarone after 3 shocks
Hypoxia
Hypovolaemia
Hypo-/ hyperkalaemia/
metabolic
Hypothermia/
hyperthermia
TREAT REVERSIBLE CAUSES
Thrombosis – coronary
or pulmonary
Tension pneumothorax
Tamponade – cardiac
Toxins
• Ultrasound imaging
• Mechanical chest compressions to
facilitate transfer/treatment
• Coronary angiography and
percutaneous coronary intervention
• Extracorporeal CPR
CONSIDER
CODE BLUE
ACLS Algorithm
Stop UF
Give PNSS 200 mL
Return patient’s blood
Leave access open for drug administration
Minimize delay in defibrillation
MODIFICATIONS TO
CARDIOPULMONARY
RESUSCITATION
Cardiac Arrest During Hemodialysis
Defibrillation
• Shockable rhythm (VF/pVT)
–More common in patients undergoing
hemodialysis than in the general population
• RECOMMENDATION:
–Disconnect patient from the dialysis
equipment prior to defibrillation
• Ensure familiarity with dialysis
equipment
–Check if equipment is defibrillator-proof
• In accordance with the International
Electrotechnical Committee (IEC) standards
• Automated external defibrillators
–Can facilitate early defibrillation by first
responders in nurse-led dialysis centres
Vascular access
• Use dialysis access in life-threatening
situations and cardiac arrest
Potentially Reversible Causes
• All of the standard reversible causes apply
to dialysis patients
–4 Hs and 4 Ts
• Most common causes
–Electrolyte disorders (particularly hyperkalemia)
–Fluid overload (e.g. pulmonary edema)
POST
RESUSCITATION
CARE
Cardiac Arrest During Hemodialysis
• Early post resuscitation period
–Dialysis may be required
–Guided by fluid status and serum
biochemistry
• Patient transfer to an area with dialysis
facilities is essential
–Intensive care unit
–Renal high dependency unit
Reference
• European Resuscitation Council Guidelines for
Resuscitation 2015
– Section 4. Cardiac arrest in special
circumstances
A. Truhláˇr et al. / Resuscitation 95 (2015) 148–201
Published October 2015 by European Resuscitation
Council vzw
© European Resuscitation Council vzw
www.erc.edu | info@erc.edu
Cardiac arrest in the dialysis unit
Cardiac arrest in the dialysis unit

More Related Content

What's hot

Complications of hemodialysis
Complications of hemodialysisComplications of hemodialysis
Complications of hemodialysisReynel Dan
 
Dialysis without anticoagulation (Heparin Free Dialysis)
Dialysis without anticoagulation (Heparin Free Dialysis)Dialysis without anticoagulation (Heparin Free Dialysis)
Dialysis without anticoagulation (Heparin Free Dialysis)Mahmoud Eid
 
Temporary vascular access for hemodialysis
Temporary vascular access for hemodialysisTemporary vascular access for hemodialysis
Temporary vascular access for hemodialysisIPMS- KMU KPK PAKISTAN
 
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisAdequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisIPMS- KMU KPK PAKISTAN
 
Acute peritoneal dialysis prescription
Acute peritoneal dialysis prescriptionAcute peritoneal dialysis prescription
Acute peritoneal dialysis prescriptionIPMS- KMU KPK PAKISTAN
 
Water treatment and quality control of dialysate.
Water treatment and quality control of dialysate.Water treatment and quality control of dialysate.
Water treatment and quality control of dialysate.Vishal Golay
 
Dialysis various modalities and indices used
Dialysis various modalities and indices usedDialysis various modalities and indices used
Dialysis various modalities and indices usedAbhay Mange
 
Crrt indications and modalities [autosaved]
Crrt indications and modalities [autosaved]Crrt indications and modalities [autosaved]
Crrt indications and modalities [autosaved]FAARRAG
 
Hemodialysis vascular catheters review
Hemodialysis vascular catheters review Hemodialysis vascular catheters review
Hemodialysis vascular catheters review JAFAR ALSAID
 
Dialysis complications dr A elbeally
Dialysis complications dr A elbeallyDialysis complications dr A elbeally
Dialysis complications dr A elbeallyFarragBahbah
 

What's hot (20)

Complications of hemodialysis
Complications of hemodialysisComplications of hemodialysis
Complications of hemodialysis
 
Permnent vascular access
Permnent vascular accessPermnent vascular access
Permnent vascular access
 
Dialysis without anticoagulation (Heparin Free Dialysis)
Dialysis without anticoagulation (Heparin Free Dialysis)Dialysis without anticoagulation (Heparin Free Dialysis)
Dialysis without anticoagulation (Heparin Free Dialysis)
 
Crrt in aki
Crrt in akiCrrt in aki
Crrt in aki
 
THE DIALYSIS TEAM
THE DIALYSIS TEAMTHE DIALYSIS TEAM
THE DIALYSIS TEAM
 
Hd and hdf
Hd and hdfHd and hdf
Hd and hdf
 
Temporary vascular access for hemodialysis
Temporary vascular access for hemodialysisTemporary vascular access for hemodialysis
Temporary vascular access for hemodialysis
 
History of dialysis
History of dialysisHistory of dialysis
History of dialysis
 
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysisAdequacy of peritoneal dialysis and chronic peritoneal dialysis
Adequacy of peritoneal dialysis and chronic peritoneal dialysis
 
Acute peritoneal dialysis prescription
Acute peritoneal dialysis prescriptionAcute peritoneal dialysis prescription
Acute peritoneal dialysis prescription
 
Water treatment and quality control of dialysate.
Water treatment and quality control of dialysate.Water treatment and quality control of dialysate.
Water treatment and quality control of dialysate.
 
Dialysis various modalities and indices used
Dialysis various modalities and indices usedDialysis various modalities and indices used
Dialysis various modalities and indices used
 
CRRT
CRRTCRRT
CRRT
 
Crrt indications and modalities [autosaved]
Crrt indications and modalities [autosaved]Crrt indications and modalities [autosaved]
Crrt indications and modalities [autosaved]
 
Dialysis prescription
Dialysis prescriptionDialysis prescription
Dialysis prescription
 
Complication during hemodialysis
Complication during hemodialysisComplication during hemodialysis
Complication during hemodialysis
 
Hemodialysis vascular catheters review
Hemodialysis vascular catheters review Hemodialysis vascular catheters review
Hemodialysis vascular catheters review
 
Sled 2019
Sled 2019Sled 2019
Sled 2019
 
Dialysis complications dr A elbeally
Dialysis complications dr A elbeallyDialysis complications dr A elbeally
Dialysis complications dr A elbeally
 
DIALYZER
DIALYZERDIALYZER
DIALYZER
 

Viewers also liked

Nursing care plans
Nursing care plansNursing care plans
Nursing care plansReynel Dan
 
Nursing Care of Patient on Dialysis
Nursing Care  of Patient on DialysisNursing Care  of Patient on Dialysis
Nursing Care of Patient on DialysisShanta Peter
 
Emergency induction checklist training
Emergency induction checklist trainingEmergency induction checklist training
Emergency induction checklist trainingMark Knights
 
Hemodialysis
Hemodialysis Hemodialysis
Hemodialysis wcmc
 
Dry Weight Dr Rosna
Dry Weight Dr RosnaDry Weight Dr Rosna
Dry Weight Dr Rosnaedwinchowyw
 
Code blue
Code blueCode blue
Code bluewcmc
 
Dialysis patients’ responsibilities
Dialysis patients’ responsibilitiesDialysis patients’ responsibilities
Dialysis patients’ responsibilitiesReynel Dan
 
Emergency Department/Hospital Inpatient Initiative
Emergency Department/Hospital Inpatient InitiativeEmergency Department/Hospital Inpatient Initiative
Emergency Department/Hospital Inpatient InitiativeGroup Health Cooperative
 
Transmission based precaution techniques
Transmission based precaution techniquesTransmission based precaution techniques
Transmission based precaution techniquesReynel Dan
 
Specimen collection
Specimen collectionSpecimen collection
Specimen collectionReynel Dan
 
Emergency response planning and implementation
Emergency response planning and implementationEmergency response planning and implementation
Emergency response planning and implementationNik Ronaidi
 
Hospital emergency services
Hospital emergency servicesHospital emergency services
Hospital emergency servicesNc Das
 
Emergency Medicine
Emergency Medicine		Emergency Medicine
Emergency Medicine Khalid
 
Medical emergencies in dentistry
Medical emergencies     in dentistryMedical emergencies     in dentistry
Medical emergencies in dentistryJigyasha Timsina
 

Viewers also liked (18)

Nursing care plans
Nursing care plansNursing care plans
Nursing care plans
 
Nursing Care of Patient on Dialysis
Nursing Care  of Patient on DialysisNursing Care  of Patient on Dialysis
Nursing Care of Patient on Dialysis
 
Tecniche venipuntura in dialisi
Tecniche venipuntura in dialisiTecniche venipuntura in dialisi
Tecniche venipuntura in dialisi
 
Emergency induction checklist training
Emergency induction checklist trainingEmergency induction checklist training
Emergency induction checklist training
 
I CVC in dialisi
I CVC in dialisiI CVC in dialisi
I CVC in dialisi
 
Hemodialysis
Hemodialysis Hemodialysis
Hemodialysis
 
Dry Weight Dr Rosna
Dry Weight Dr RosnaDry Weight Dr Rosna
Dry Weight Dr Rosna
 
Emergency Planning Safety
Emergency Planning SafetyEmergency Planning Safety
Emergency Planning Safety
 
Code blue
Code blueCode blue
Code blue
 
Dialysis patients’ responsibilities
Dialysis patients’ responsibilitiesDialysis patients’ responsibilities
Dialysis patients’ responsibilities
 
Medical Emergencies
Medical EmergenciesMedical Emergencies
Medical Emergencies
 
Emergency Department/Hospital Inpatient Initiative
Emergency Department/Hospital Inpatient InitiativeEmergency Department/Hospital Inpatient Initiative
Emergency Department/Hospital Inpatient Initiative
 
Transmission based precaution techniques
Transmission based precaution techniquesTransmission based precaution techniques
Transmission based precaution techniques
 
Specimen collection
Specimen collectionSpecimen collection
Specimen collection
 
Emergency response planning and implementation
Emergency response planning and implementationEmergency response planning and implementation
Emergency response planning and implementation
 
Hospital emergency services
Hospital emergency servicesHospital emergency services
Hospital emergency services
 
Emergency Medicine
Emergency Medicine		Emergency Medicine
Emergency Medicine
 
Medical emergencies in dentistry
Medical emergencies     in dentistryMedical emergencies     in dentistry
Medical emergencies in dentistry
 

Similar to Cardiac arrest in the dialysis unit

clinical meeting 19.12.13
clinical meeting 19.12.13clinical meeting 19.12.13
clinical meeting 19.12.13Thierry Yunishe
 
16 vascular access_mathur_haabb
16 vascular access_mathur_haabb16 vascular access_mathur_haabb
16 vascular access_mathur_haabbKlajdiTrebeshina1
 
Emergency procedures training
Emergency procedures trainingEmergency procedures training
Emergency procedures traininglsmith7153
 
Cardiac transplant
Cardiac transplantCardiac transplant
Cardiac transplantRilyan Leal
 
Colin Farquharson - ACHD presentation Darwin 2012
Colin Farquharson - ACHD presentation Darwin 2012Colin Farquharson - ACHD presentation Darwin 2012
Colin Farquharson - ACHD presentation Darwin 2012Colin Farquharson
 
Preoperative evaluation and management
Preoperative evaluation and managementPreoperative evaluation and management
Preoperative evaluation and managementTapish Sahu
 
SEMINAR CARDIAC TRANSPLANT.pptx
SEMINAR CARDIAC TRANSPLANT.pptxSEMINAR CARDIAC TRANSPLANT.pptx
SEMINAR CARDIAC TRANSPLANT.pptxNakkaSrikanth3
 
5_6125448697896502769.pptx
5_6125448697896502769.pptx5_6125448697896502769.pptx
5_6125448697896502769.pptxDeepshikhaKar1
 
Cardiac Transplantation
Cardiac TransplantationCardiac Transplantation
Cardiac TransplantationEneutron
 
Anaesthetic emergencies and procedures in veterinary practices
Anaesthetic emergencies and procedures in veterinary practicesAnaesthetic emergencies and procedures in veterinary practices
Anaesthetic emergencies and procedures in veterinary practicesIVRI
 
Management of acute lvf
Management of acute lvfManagement of acute lvf
Management of acute lvfGautam Chakma
 
Cardiac Transplantation
Cardiac TransplantationCardiac Transplantation
Cardiac TransplantationUsman Shams
 
Extracoporeal Life Support presentation final
Extracoporeal Life Support presentation finalExtracoporeal Life Support presentation final
Extracoporeal Life Support presentation finalAshraf Banoub
 
Defibrillator & cardioversion
Defibrillator & cardioversion Defibrillator & cardioversion
Defibrillator & cardioversion RAJESH EAPEN
 
Defibrillation & Cardioversion
Defibrillation & CardioversionDefibrillation & Cardioversion
Defibrillation & CardioversionHIRANGER
 
Atrial Fibrillation.pptx
Atrial Fibrillation.pptxAtrial Fibrillation.pptx
Atrial Fibrillation.pptxRavindraKuraku
 

Similar to Cardiac arrest in the dialysis unit (20)

clinical meeting 19.12.13
clinical meeting 19.12.13clinical meeting 19.12.13
clinical meeting 19.12.13
 
16 vascular access_mathur_haabb
16 vascular access_mathur_haabb16 vascular access_mathur_haabb
16 vascular access_mathur_haabb
 
Emergency procedures training
Emergency procedures trainingEmergency procedures training
Emergency procedures training
 
Heard transplant
Heard transplantHeard transplant
Heard transplant
 
Cardiac transplant
Cardiac transplantCardiac transplant
Cardiac transplant
 
Cardiac transplant
Cardiac transplantCardiac transplant
Cardiac transplant
 
Colin Farquharson - ACHD presentation Darwin 2012
Colin Farquharson - ACHD presentation Darwin 2012Colin Farquharson - ACHD presentation Darwin 2012
Colin Farquharson - ACHD presentation Darwin 2012
 
Preoperative evaluation and management
Preoperative evaluation and managementPreoperative evaluation and management
Preoperative evaluation and management
 
SEMINAR CARDIAC TRANSPLANT.pptx
SEMINAR CARDIAC TRANSPLANT.pptxSEMINAR CARDIAC TRANSPLANT.pptx
SEMINAR CARDIAC TRANSPLANT.pptx
 
5_6125448697896502769.pptx
5_6125448697896502769.pptx5_6125448697896502769.pptx
5_6125448697896502769.pptx
 
Cardiac Transplantation
Cardiac TransplantationCardiac Transplantation
Cardiac Transplantation
 
Anaesthetic emergencies and procedures in veterinary practices
Anaesthetic emergencies and procedures in veterinary practicesAnaesthetic emergencies and procedures in veterinary practices
Anaesthetic emergencies and procedures in veterinary practices
 
Presentation2
Presentation2Presentation2
Presentation2
 
Management of acute lvf
Management of acute lvfManagement of acute lvf
Management of acute lvf
 
Cardiac Transplantation
Cardiac TransplantationCardiac Transplantation
Cardiac Transplantation
 
Extracoporeal Life Support presentation final
Extracoporeal Life Support presentation finalExtracoporeal Life Support presentation final
Extracoporeal Life Support presentation final
 
Defibrillator & cardioversion
Defibrillator & cardioversion Defibrillator & cardioversion
Defibrillator & cardioversion
 
Defibrillation & Cardioversion
Defibrillation & CardioversionDefibrillation & Cardioversion
Defibrillation & Cardioversion
 
Atrial Fibrillation.pptx
Atrial Fibrillation.pptxAtrial Fibrillation.pptx
Atrial Fibrillation.pptx
 
Ecmo for nurses
Ecmo for nursesEcmo for nurses
Ecmo for nurses
 

More from Reynel Dan

Central venous catheter access for hemodialysis
Central venous catheter access for hemodialysisCentral venous catheter access for hemodialysis
Central venous catheter access for hemodialysisReynel Dan
 
Arteriovenous access for hemodialysis Review Questions
Arteriovenous access for hemodialysis Review QuestionsArteriovenous access for hemodialysis Review Questions
Arteriovenous access for hemodialysis Review QuestionsReynel Dan
 
DOH at Your Service
DOH at Your ServiceDOH at Your Service
DOH at Your ServiceReynel Dan
 
Battling COVID 19 in Zamboanga del Sur
Battling COVID 19 in Zamboanga del SurBattling COVID 19 in Zamboanga del Sur
Battling COVID 19 in Zamboanga del SurReynel Dan
 
Mental Health: Stress Management in Focus
Mental Health: Stress Management in FocusMental Health: Stress Management in Focus
Mental Health: Stress Management in FocusReynel Dan
 
AV Vascular Access - Hemodialysis
AV Vascular Access - HemodialysisAV Vascular Access - Hemodialysis
AV Vascular Access - HemodialysisReynel Dan
 
Decreasing dialysis provider patient conflict
Decreasing dialysis provider patient conflictDecreasing dialysis provider patient conflict
Decreasing dialysis provider patient conflictReynel Dan
 
Continuing care of the dialysis patient
Continuing care of the dialysis patientContinuing care of the dialysis patient
Continuing care of the dialysis patientReynel Dan
 
Arteriovenous vascular access complications
Arteriovenous vascular access complicationsArteriovenous vascular access complications
Arteriovenous vascular access complicationsReynel Dan
 
Dialysis patients’ bill of rights
Dialysis patients’ bill of rightsDialysis patients’ bill of rights
Dialysis patients’ bill of rightsReynel Dan
 
Working with kidney disease
Working with kidney diseaseWorking with kidney disease
Working with kidney diseaseReynel Dan
 
Integrative teaching as mode of instructional delivery
Integrative teaching as mode of instructional deliveryIntegrative teaching as mode of instructional delivery
Integrative teaching as mode of instructional deliveryReynel Dan
 
Republic act no 9293
Republic act no 9293Republic act no 9293
Republic act no 9293Reynel Dan
 
Grading and reporting
Grading and reportingGrading and reporting
Grading and reportingReynel Dan
 
Understanding renal failure
Understanding renal failureUnderstanding renal failure
Understanding renal failureReynel Dan
 
Kaya Nimo Magplano - Family planning
Kaya Nimo Magplano - Family planning Kaya Nimo Magplano - Family planning
Kaya Nimo Magplano - Family planning Reynel Dan
 
Understanding dengue
Understanding dengueUnderstanding dengue
Understanding dengueReynel Dan
 
Stress management
Stress managementStress management
Stress managementReynel Dan
 
Stress management
Stress managementStress management
Stress managementReynel Dan
 
Therapeutic play and child life programs
Therapeutic play and child life programsTherapeutic play and child life programs
Therapeutic play and child life programsReynel Dan
 

More from Reynel Dan (20)

Central venous catheter access for hemodialysis
Central venous catheter access for hemodialysisCentral venous catheter access for hemodialysis
Central venous catheter access for hemodialysis
 
Arteriovenous access for hemodialysis Review Questions
Arteriovenous access for hemodialysis Review QuestionsArteriovenous access for hemodialysis Review Questions
Arteriovenous access for hemodialysis Review Questions
 
DOH at Your Service
DOH at Your ServiceDOH at Your Service
DOH at Your Service
 
Battling COVID 19 in Zamboanga del Sur
Battling COVID 19 in Zamboanga del SurBattling COVID 19 in Zamboanga del Sur
Battling COVID 19 in Zamboanga del Sur
 
Mental Health: Stress Management in Focus
Mental Health: Stress Management in FocusMental Health: Stress Management in Focus
Mental Health: Stress Management in Focus
 
AV Vascular Access - Hemodialysis
AV Vascular Access - HemodialysisAV Vascular Access - Hemodialysis
AV Vascular Access - Hemodialysis
 
Decreasing dialysis provider patient conflict
Decreasing dialysis provider patient conflictDecreasing dialysis provider patient conflict
Decreasing dialysis provider patient conflict
 
Continuing care of the dialysis patient
Continuing care of the dialysis patientContinuing care of the dialysis patient
Continuing care of the dialysis patient
 
Arteriovenous vascular access complications
Arteriovenous vascular access complicationsArteriovenous vascular access complications
Arteriovenous vascular access complications
 
Dialysis patients’ bill of rights
Dialysis patients’ bill of rightsDialysis patients’ bill of rights
Dialysis patients’ bill of rights
 
Working with kidney disease
Working with kidney diseaseWorking with kidney disease
Working with kidney disease
 
Integrative teaching as mode of instructional delivery
Integrative teaching as mode of instructional deliveryIntegrative teaching as mode of instructional delivery
Integrative teaching as mode of instructional delivery
 
Republic act no 9293
Republic act no 9293Republic act no 9293
Republic act no 9293
 
Grading and reporting
Grading and reportingGrading and reporting
Grading and reporting
 
Understanding renal failure
Understanding renal failureUnderstanding renal failure
Understanding renal failure
 
Kaya Nimo Magplano - Family planning
Kaya Nimo Magplano - Family planning Kaya Nimo Magplano - Family planning
Kaya Nimo Magplano - Family planning
 
Understanding dengue
Understanding dengueUnderstanding dengue
Understanding dengue
 
Stress management
Stress managementStress management
Stress management
 
Stress management
Stress managementStress management
Stress management
 
Therapeutic play and child life programs
Therapeutic play and child life programsTherapeutic play and child life programs
Therapeutic play and child life programs
 

Recently uploaded

Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Neelam SharmaI11
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUELMKARTHIKEMMANUEL
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...Ayman Seddik
 
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptxGross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptxDr. Rabia Inam Gandapore
 
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...jamal khanI11
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenRaju678948
 
Signs It’s Time for Physiotherapy Sessions Prioritizing Wellness
Signs It’s Time for Physiotherapy Sessions Prioritizing WellnessSigns It’s Time for Physiotherapy Sessions Prioritizing Wellness
Signs It’s Time for Physiotherapy Sessions Prioritizing WellnessGokuldas Hospital
 
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...pinkpowder997723
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaNehamehta128467
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...Neelam SharmaI11
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxMohammadAbuzar19
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examJunhao Koh
 
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door StepBangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Stepdarmandersingh4580
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialSherrylee83
 
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptxANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptxDr. Sohan Biswas
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project
 
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...anushka vermaI11
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Face and Muscles of facial expression.pptx
Face and Muscles of facial expression.pptxFace and Muscles of facial expression.pptx
Face and Muscles of facial expression.pptxDr. Rabia Inam Gandapore
 

Recently uploaded (20)

Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptxGross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
 
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...
Charbagh { ℂall Girls Serviℂe Lucknow ₹7.5k Pick Up & Drop With Cash Payment ...
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in children
 
Signs It’s Time for Physiotherapy Sessions Prioritizing Wellness
Signs It’s Time for Physiotherapy Sessions Prioritizing WellnessSigns It’s Time for Physiotherapy Sessions Prioritizing Wellness
Signs It’s Time for Physiotherapy Sessions Prioritizing Wellness
 
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...^In Pietermaritzburg  Hager Werken Embalming +27789155305 Compound Powder in ...
^In Pietermaritzburg Hager Werken Embalming +27789155305 Compound Powder in ...
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in India
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
 
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...
Young & Hot Surat ℂall Girls Dindoli 8527049040 WhatsApp AnyTime Best Surat ℂ...
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptx
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES exam
 
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door StepBangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw material
 
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptxANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...
Bhimrad + ℂall Girls Serviℂe Surat (Adult Only) 8849756361 Esℂort Serviℂe 24x...
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Face and Muscles of facial expression.pptx
Face and Muscles of facial expression.pptxFace and Muscles of facial expression.pptx
Face and Muscles of facial expression.pptx
 

Cardiac arrest in the dialysis unit

  • 1.
  • 2.
  • 3. Introduction • Sudden cardiac death –Most common cause of death in hemodialysis patients –Usually preceded by ventricular arrhythmias
  • 4. • Hyperkalemia –Contributes to 2–5% of deaths among hemodialysis patients –Accounts for up to 24% of emergency hemodialysis sessions
  • 5. • Frequency of cardiac arrest –Highest on the first session of hemodialysis of the week • Monday or Tuesday –Fluid and electrolyte disturbances peak after the weekend interval
  • 6. • Primary prevention of cardiac arrest in dialysis patients – Avoidance of low potassium dialysate solutions – Proper use of medication • Beta blockers • ACE inhibitors
  • 8. Hala! Wala na may heart beat. CODE BLUE! CODE BLUE!
  • 9. Initial Steps • Call the resuscitation team and seek expert help immediately • Follow the universal ALS algorithm • Assign a trained dialysis nurse to operate the dialysis machine
  • 10. • Stop ultrafiltration (i.e. fluid removal) • Give a fluid bolus • Return the patient’s blood volume • Disconnect patient from the dialysis machine
  • 11. • Leave dialysis access open and use for drug administration • Beware of wet surfaces (i.e. dialysis machines may leak) • Minimise delay in delivering defibrillation
  • 12.
  • 13. • Ensure high quality chest compressions • Minimise interruptions to compressions • Give oxygen • Use waveform capnography DURING CPR
  • 14. • Continuous compressions when advanced airway in place • Vascular access (intravenous or intraosseous) • Give adrenaline every 3-5 min • Give amiodarone after 3 shocks
  • 16. Thrombosis – coronary or pulmonary Tension pneumothorax Tamponade – cardiac Toxins
  • 17. • Ultrasound imaging • Mechanical chest compressions to facilitate transfer/treatment • Coronary angiography and percutaneous coronary intervention • Extracorporeal CPR CONSIDER
  • 18. CODE BLUE ACLS Algorithm Stop UF Give PNSS 200 mL Return patient’s blood Leave access open for drug administration Minimize delay in defibrillation
  • 20. Defibrillation • Shockable rhythm (VF/pVT) –More common in patients undergoing hemodialysis than in the general population • RECOMMENDATION: –Disconnect patient from the dialysis equipment prior to defibrillation
  • 21. • Ensure familiarity with dialysis equipment –Check if equipment is defibrillator-proof • In accordance with the International Electrotechnical Committee (IEC) standards • Automated external defibrillators –Can facilitate early defibrillation by first responders in nurse-led dialysis centres
  • 22. Vascular access • Use dialysis access in life-threatening situations and cardiac arrest
  • 23. Potentially Reversible Causes • All of the standard reversible causes apply to dialysis patients –4 Hs and 4 Ts • Most common causes –Electrolyte disorders (particularly hyperkalemia) –Fluid overload (e.g. pulmonary edema)
  • 24.
  • 26. • Early post resuscitation period –Dialysis may be required –Guided by fluid status and serum biochemistry • Patient transfer to an area with dialysis facilities is essential –Intensive care unit –Renal high dependency unit
  • 27. Reference • European Resuscitation Council Guidelines for Resuscitation 2015 – Section 4. Cardiac arrest in special circumstances A. Truhláˇr et al. / Resuscitation 95 (2015) 148–201 Published October 2015 by European Resuscitation Council vzw © European Resuscitation Council vzw www.erc.edu | info@erc.edu