Cardiac arrest is a medical emergency where the heart fails to pump blood effectively. It can be caused by cardiac or non-cardiac issues and requires immediate treatment to potentially reverse it, including cardiopulmonary resuscitation (CPR) and defibrillation. CPR involves chest compressions and rescue breathing to manually circulate blood and oxygen through the body until spontaneous circulation is restored. The appropriate treatment depends on the underlying heart rhythm, with shockable rhythms like ventricular fibrillation treated with defibrillation.

2. CARDIAC ARREST
(ALS MANAGEMENT)

4.  Cardiac arrest, also known as
cardiopulmonary arrest or circulatory
arrest, is the end of normal circulation of the
blood due to failure of the heart to contract
effectively.
 Also referred as a sudden cardiac arrest
(SCA).
 Cardiac arrest is a medical emergency that, in
certain situations, is potentially reversible if
treated early.
 Unexpected cardiac arrest sometimes leads to
death almost immediately; this is called
sudden cardiac death (SCD).

6. Based upon the ECG rhythm
1. SHOCKABLE
The two shockable rhythms are ventricular
fibrillation and pulseless ventricular
tachycardia
2. NON-SHOCKABLE
The two non–shockable rhythms are asystole
and pulseless electrical activity

8.  Cardiac:
 Coronary heart disease
 Non-ischemic heart disease
 Cardiomyopathy
 Cardiac rhythm disturbances
 Hypertensive heart disease
 Congestive heart failure.
 Coronary artery abnormalities
 Myocarditis
 pulmonary embolism
 Hypertrophic cardiomyopathy
 Long QT syndrome

9.  Non-cardiac:
 The most common non-cardiac causes:
 Trauma
 non-trauma related bleeding (such as
gastrointestinal bleeding, aortic rupture,
and intracranial hemorrhage)
 Overdose
 Drowning

10. Reversible causes

12.  Absence of palpable pulse.(The main
diagnostic criterion to diagnose a cardiac
arrest is lack of circulation: Lack of carotid
pulse is the gold standard for diagnosing
cardiac arrest).
 Lack of consciousness.
 Abnormal or absent breathing.
 “silent chest”
 Death.
 N.B: Misdiagnosis may lead
to………………!!!!!!!

15. 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

17. Golden minutes
01/10/2014 drdgm 17

25. Ventricular Fibrillation

26. Ventricular Tachycardia

28. 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)

29. Immediate AED

34. Asystole

35. PEA
Pulseless electrical
activity (PEA)

40.  delayed endotracheal intubation combined
with passive oxygen delivery and minimally
interrupted chest compressions was
associated with improved neurologically intact
survival after out-of-hospital cardiac arrest in
patients with witnessed VF/VT
 When an advanced airway (eg, endotracheal
tube or supraglottic airway) is placed, 2
providers no longer deliver cycles of
compressions interrupted with pauses for
ventilation.
 1 breath every 6-8 seconds (8-10 breaths per
minute)

41. ARTICLES USED IN CPR:
1.ENDOTRACHEAL TUBE 2. AMBU BAG WITH MASK

42. 3.SUCTION TUBE OR
CATHETER
4.NASAL AIRWAY/ORAL AIRWAY

43. 5.LUBRICATING JELLY:

44. CPR KIT:

45. Defibrillation

46. Automated External
Defibrillator

47. DEFIBRILLATION: GENERAL
CONCEPT

48. Manual Defibrillator

49. OTHER…..
1. OXYGEN ADMINISTRATION SET
2. LARYNGOSCOPE WITH DIFFERENT
SIZE
3. I.V. INFUSION SET, CUT DOWN SETS
AND IV FLUIDS
4. CARDIAC MONITOR WITH
DEFIBRILLATOR
5. MECHANICAL VENTILATOR
6. TRACHEOSTOMY SET
7. GAUZE COTTON ETC.
8. STERILE SYRINGES AND NEEDLES.

51. CPR: Wins (What's Important Now)

52. New CPR sequence
C-A-B
not
A-B-C

54.  Elbows should be locked and
arms are straight.
 Rescuer’s shoulders position
directly over hands.
 Begin compression.
 Pressure should come from
the shoulders.
 Compression should depress
victim’s sternum
approximately 1.5- 2 inches.
 Don’t allow the fingers to
touch the chest wall.
 Allow chest to rebound to
normal position after each
compression.

55. Approach safely
Check response
Shout for help
Open airway
Check breathing
30 chest compressions
2 rescue breaths
SHOUT FOR
HELP

56. Approach safely
Check response
Shout for help
Open airway
Check breathing
30 chest compressions
2 rescue breaths
OPEN AIRWAY

57. Head tilt, chin lift + jaw thrust
- healthcare professionals

58. Approach safely
Check response
Shout for help
Open airway
Check breathing
30 chest compressions
2 rescue breaths
CHECK
BREATHING

59. Look, listen and feel
for NORMAL
breathing
Do not confuse
agonal breathing
with NORMAL
breathing
CHECK
BREATHING

60. AGONAL
BREATHING
Occurs shortly after the heart stops in
up to 40% of cardiac arrests
Described as barely, heavy, noisy or
gasping breathing
Recognise as a sign of cardiac arrest
Erroneous information can result in
withholding CPR from cardiac arrest
victim

61. Approach safely
Check response
Shout for help
Open airway
Check breathing
30 chest
30 CHEST
COMPRESSIONS
c2 oremscpuer ebsresaitohsns

62. • Place the heel of one
hand in the centre of
the chest
• Place other hand on
top
• Interlock fingers
• Compress the chest
– Rate 100 min-1
– Depth 4-5 cm
– Equal compression :
relaxation
• When possible change
CPR operator every 2
min
CHEST
COMPRESSIONS

63. CONTINUE C P R
3
0
2

64. WHEN TO STOP
CPR
SPONTANEOUS signs of circulation are
restored.
TURNED over to medical services or
properly trained and authorized personnel.
OPERATOR is already exhausted &
cannot continue CPR.
PHYSICIAN assumes responsibility
(declares death, take over etc)----------
(DNAR???)

66. Child/Infant Compression

67. Neonatal Resuscitation
 The etiology of neonatal arrests is nearly
always asphyxia.
 Therefore, the A-B-C sequence has been
retained for resuscitation of neonates unless
there is a known cardiac etiology.
 Rate:(30:2), to be changed to (15:2) if 2
rescuers.

74. Resuscitation team
(Code Blue)

77. Resuscitation room

78.  AIRWAY, BREATHING
 Appropriate sized ventilation bag on bed
 Oxygen ready: humidified oxygen for pediatric
patients
 Suction on and ready
 Appropriate size suction catheters available
 Airway equipment checked and at bedside –
estimate ETT size for children
 Rapid sequence intubation tray at bedside
 End tidal CO2 assessment equipment at
bedside
 Pulse oximeter at bedside and ready

79.  CIRCULATION
 Manual and automatic BP cuffs at bedside
 CPR backboard – available as needed
 Heat lamps – available as needed
 Intravenous lines stripped
 ACLS drugs – available as needed
 Appropriate size infusion catheters – available
as needed
 Cardiac monitor on and event recording ready
 Defibrillator on: appropriate size paddles [peds,
adult, internal] – external pacer pads
 Call for blood if needed

80.  MISCELLANEOUS
 Bedside hematocrit and glucose
monitors
 Appropriate size foley catheter –
available as needed
 Appropriate size NG tube – available
as needed

81. Drugs used commonly
during resuscitation
 Epinephrine (Adrenaline)
 Amiodarone
 Lidocaine (Lignocaine)
 Magnesium Sulphate
 (No role: Atropine, Ca++, Na
bicarbonate)

83. Don’t Forget
• Push hard (at least 2 inches).
• Push fast (at least 100/min).
• Minimize interruptions in compressions.
• Compress to ventilation: 30:2
• Defibrillate as soon as possible.
• ETT (8 – 10 breath/min).
• Encourage team resuscitation.
• New 5th link in the chain of survival
(post cardiac arrest care).

84. Don’t Forget
 Epinephrine.
 Amiodarone.

85. Forget
 Look, Listen and Feel victims before
starting CPR.
 Atropine in ACLS.
 Routine use of calcium.
 Routine use of sodium bicarbonate
(Except in cases of cardiac arrest due
to hyperkalemia or TCA poisoning).

88. + Demo
cases(Shocka
ble, non)

89. Questions