The document provides guidelines for diagnosing and managing cardiac arrest in cardiac surgical patients, noting they require rapid diagnosis and treatment such as immediate defibrillation if needed. It outlines the cardiac arrest protocol including defibrillation, medications, pacing, basic life support, and performing emergency resternotomy to access the heart if initial resuscitative efforts are unsuccessful. The guidelines emphasize the importance of teamwork and defined roles to efficiently manage the cardiac arrest according to the protocol.
In this ppt i am going to describe how we have done pericardiocentesis in our one patient who was admitted in JIPMER Hospital, Pondicherry, India. Also what are the indication for pericardiocentesis and regarding technique of pericardiocentesis.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
In this ppt i am going to describe how we have done pericardiocentesis in our one patient who was admitted in JIPMER Hospital, Pondicherry, India. Also what are the indication for pericardiocentesis and regarding technique of pericardiocentesis.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
The arrested heart surgery patient is a unique beast in surgery and critical care. Dr Nikki Stamp gives a whirlwind tour of post cardiac surgery resuscitation. She will discuss how to spot the potential arrest, how to manage it and some special situations to be aware of in this special group of patients
Post cardiac surgery resuscitation is complex. Nikki describes them as “brown trouser moments”. She highlights this with three cases. A15-year-old girl who exsanguinated on Day 12 after dissection repair in the community. A 40-year-old female arrested within an hour of a re-do aortic root procedure. A 72-year-old lady who arrested after a bradycardic arrest following an aortic valve replacement. Only one survived – this is serious business.
Cardiac arrest post cardiac surgery is relatively uncommon. The survival rate is also quite high. This is due to it being recognised and treated early with a high proportion of reversible causes. The key is to think of these causes and treat them as a team.
Nikki breaks the causes into four groups. Ischemia, mechanical, arrhythmia and unknown. It is important to recognise that cardiac arrest in this population is differs to a typical scenario of cardiac arrest. As such, there is a different algorithm. This hinges on assessing the rhythm in the first instance and consider defibrillation fist if appropriate. One should also consider the use of pacing wires if they are still in post-operatively.
Nikki provides a great number of clinical pearls, discussing care of the right heart, use of chest compressions and cardiac massage, use of ECMO and considerations if a left ventricular assistance device is in place.
Her take home points include being alert to these situations but not alarmed! Practice these resuscitations as a team. Shock early and pace early and remember most people should not die with a closed chest!
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Soluções em Recursos Humanos; BPO; Terceirização de Folha de Pagamento; Sistema para Gestão em RH; Avaliação de Desempenho; SAAS; BSP; Corretora; Gestão de Benefícios; Seguros; Benefícios; SigSaúde; Gestão de Risco; 9-box, avaliacao de desempenho, beneficios, bpo, bsp, corretora, departamento pessoal, financeiro;
The arrested heart surgery patient is a unique beast in surgery and critical care. Dr Nikki Stamp gives a whirlwind tour of post cardiac surgery resuscitation. She will discuss how to spot the potential arrest, how to manage it and some special situations to be aware of in this special group of patients
Post cardiac surgery resuscitation is complex. Nikki describes them as “brown trouser moments”. She highlights this with three cases. A15-year-old girl who exsanguinated on Day 12 after dissection repair in the community. A 40-year-old female arrested within an hour of a re-do aortic root procedure. A 72-year-old lady who arrested after a bradycardic arrest following an aortic valve replacement. Only one survived – this is serious business.
Cardiac arrest post cardiac surgery is relatively uncommon. The survival rate is also quite high. This is due to it being recognised and treated early with a high proportion of reversible causes. The key is to think of these causes and treat them as a team.
Nikki breaks the causes into four groups. Ischemia, mechanical, arrhythmia and unknown. It is important to recognise that cardiac arrest in this population is differs to a typical scenario of cardiac arrest. As such, there is a different algorithm. This hinges on assessing the rhythm in the first instance and consider defibrillation fist if appropriate. One should also consider the use of pacing wires if they are still in post-operatively.
Nikki provides a great number of clinical pearls, discussing care of the right heart, use of chest compressions and cardiac massage, use of ECMO and considerations if a left ventricular assistance device is in place.
Her take home points include being alert to these situations but not alarmed! Practice these resuscitations as a team. Shock early and pace early and remember most people should not die with a closed chest!
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Soluções em Recursos Humanos; BPO; Terceirização de Folha de Pagamento; Sistema para Gestão em RH; Avaliação de Desempenho; SAAS; BSP; Corretora; Gestão de Benefícios; Seguros; Benefícios; SigSaúde; Gestão de Risco; 9-box, avaliacao de desempenho, beneficios, bpo, bsp, corretora, departamento pessoal, financeiro;
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).
Advanced Cardiovascular Life Support (ACLS).pptxRebilHeiru2
discusses the basic and Advanced Life support according to the AHA guidelines.
ACLS, BLS, defibrillation and Advanced medications at Adama Hospital medical college ICU
A complete Theoretical as well as practical aspects of Cardiac defibrillation with the definition,history,defibrillator and cardiovesrsion,Equipments,pre procedural consideration,care of patient before and after defibrillation,cardiac defibrillation procedure steps with rationale,complications,documentation and legal aspects
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Objectives
Why are Cardiac surgical patients different from other
patients
How to diagnose cardiac arrest
Cardiac arrest after cardiac surgery algorithm
Defibrillation or pacing
Basic life support (ECM& ventilation)
drugs
Emergency sternotomy
Management of cardiac arrest (team work)
Six key roles
3. Why are Cardiac surgical patients different from
other patients
The arrest will be
immediately identified,
making early
defibrillation more likely
to be successful in
restoring cardiac output
without any ECM
4. Why are Cardiac surgical patients different from
other patients
immediate ECM is unnecessary in certain cases, and
its use after cardiac surgery should be minimised due
to the risk of trauma to the surgical site
if defibrillation is unsuccessful, rapid resternotomy
may be indicated.
5. How to diagnose cardiac arrest
If you are the first person alerted to the possibility of
an arrest you should immediately put your hand onto a
central pulse (such as the femoral or carotid pulse) for
up to 10 s.
During this time, you should also check the arterial
line for position and look at the other traces on the
monitor.
In a cardiac arrest, not only will the arterial line show
no pulsatility, but also the central venous pressure
(CVP) line and the pulse oximetry trace will be flat
6. How to diagnose cardiac arrest
An ECG trace looking like sinus rhythm in the absence
of pulsatile traces from the other monitoring should
be considered a cardiac arrest.
In contrast, if there is a palpable central pulse, and if
CVP, oximetry and PA pressure waveforms are present
then a cardiac arrest may be excluded and the integrity
of arterial line should be assessed. A non-invasive
blood pressure reading should be taken.
7. If after 10 s there is no palpable central pulse
and the arterial, CVP, PA and oximetry
waveforms are flat, you should
immediately instigate the cardiac arrest
protocol. You should also loudly and clearly
shout for help, for example:
‘cardiac arrest bed 4!’
8. Recommendations:
If the ECG shows VF or asystole, call cardiac arrest
immediately.
If the ECG is compatible with a cardiac output, feel for
a central pulse for 10 s and look at the pressure traces.
If arterial and other pressure waveforms are pulseless
then call cardiac arrest immediately.
11. Defibrillation
In ventricular fibrillation or pulseless ventricular
tachycardia 3 sequential shocks should be given
without intervening CPR.
Biphasic rather than monophasic defibrillation was
recommended at the optimal strength(150 J -360 J) for
your particular defibrillator
12. Amiodarone
After 3 failed attempts at cardioversion for ventricular
fibrillation/pulseless VT, a bolus of 300 mg of
intravenous amiodarone should be given via the
central line.
13. In VF or pulseless VT, emergency
resternotomy should be performed
after 3 failed attempts at
defibrillation
14.
15. Pacing
For asystole or severe bradycardia, connect the
epicardial pacing wires and set to DDD (VOO) at 90
bpm at the maximum atrial and ventricular output
voltages.
If the rhythm is pulseless electrical activity and a
pacemaker is connected and functioning, then briefly
turn the pacemaker off to exclude underlying
ventricular fibrillation.
16. In non-shockable cardiac arrest which
does not resolve after atropine and
pacing, emergency resternotomy should
be immediately performed.
17.
18. Basic life support (ECM)
In an arrest after cardiac surgery, external cardiac
massage can be deferred until initial
defibrillation or pacing (as appropriate) have
been attempted, provided this can be done in less
than 1 min.
In the ICU setting you will be able to assess how
effective your compressions are by looking at the
arterial trace on the monitor. You should aim for the
‘systolic’ impulse about 80 mmHg.
19. Basic life support (ECM)
Inability to achieve an acceptable compression-
generated blood pressure may indicate that the cause
of the arrest warrants immediate emergency
resternotomy (massive bleeding or tamponade or
tension pneumothorax) and chest reopening should
be expedited
20. Basic life support: airway
the second person to attend should address the airway
and breathing.
If the patient is not intubated then the second person
to attend the arrest should administer 100% oxygen
with a bag/valve/mask with 2 breaths every 30
compressions.
IF the patient is intubated and ventilated, the
important role of the second person to attend the
arrest is immediately to increase the oxygen on the
ventilator to 100% and remove any PEEP
21. Basic life support: airway
TO ensure a satisfactory airway and ventilation:
Check the position of the endotracheal tube.
Listen for any air excursion around the tube, and that
the cuff is inflated.
Look at the chest for bilateral expansion.
Listen with a stethoscope for bilateral air entry.
We recommend that the ventilator is disconnected
and breaths are administered with a bag/valve
connected to 100% oxygen.
22. Basic life support: airway
If your examination indicates that a tension
pneumothorax is a possibility, you should immediately
place a large bore cannula into the 2nd intercostal
space, anterior midclavicular line.
If you are unable to inflate the lungs with the
bag/valve, and a sucker will not pass down the ET
tube, then ET tube occlusion or malpositioning should
be suspected. The ET tube should be immediately
removed and a bag/valve/ mask with airway adjuncts
used to maintain the airway
23.
24. Infusions and syringe drivers
In an established cardiac arrest all infusions and
syringe drivers should be stopped.
25. Adrenaline
adrenaline cannot be recommend to be given routinely in
all such cardiac arrests. We recommend that
administration of adrenaline to be delayed until reversible
causes of arrest are excluded.
It is acknowledged that adrenaline may be useful in the
impending arrest or periarrest situation and may also be
safely used in smaller doses such as 100—300 mcg boluses.
However, once cardiac arrest has happened, we
recommend that adrenaline is only administered by senior
clinicians with experience of its routine use and it should
not form part of the arrest protocol
26.
27. Cardiac arrest in patients with an intra-aortic
balloon pump
Cardiac arrest can be confirmed by the loss of the
cardiac component of the IABP pressure trace and,
more visibly, by the loss of pulsatility in other pressure
waveforms such as CVP, PA and pulse oximetry.
In cardiac arrest with an IABP in place, it should be set
to pressure trigger with 1:1 counter pulsation at
maximal augmentation..
If there is a significant period without massage,
triggering should be changed to internal at a rate of
100 bpm until massage is recommenced
28.
29. Conduct of emergency
resternotomy
Internal cardiac massage is superior to external cardiac
massage.
In patients with a recent sternotomy in whom
resuscitative efforts are likely to last more than 5—10
min, emergency resternotomy is indicated in order to
perform internal cardiac massage even if a reversible
cause from resternotomy seems unlikely.
30. The emergency resternotomy set
A small emergency resternotomy set should be available in
every ICU, containing only the instruments necessary to
perform the resternotomy.
This should include a disposable scalpel attached to the
outside of the set, an all-in-one drape, a wire cutter, a heavy
needle holder and a single piece sternal retractor.
This should be in addition to a full cardiac surgery
sternotomy set that need not be opened until after
theemergency resternotomy has been performed.
These sets should be clearly marked and checked regularly.
32. Preparation for emergency
resternotomy
Two to three staff members should put on a gown and
gloves as soon as a cardiac arrest is called, and prepare
the emergency resternotomy set.
Hand washing is not necessary prior to closed sleeve
donning of gloves.
33. Personnel performing emergency
resternotomy
As resternotomy is often an integral part of successful
resuscitation after cardiac surgery, it is beneficial for
all personnel who participate in resuscitation in this
setting to be aware of the technique of emergency
resternotomy and to have practised it.
34. Emergency resternotomy
Don a gown and gloves in a sterile fashion using the
closed glove technique.
ECM must continue until you are ready to apply the
all-in-one sterile thoracic drape.
When ready, ask the person performing ECM to stand
aside after removing the sternal dressing.
Apply the thoracic drape ensuring that the whole bed
is covered.
If an all-in-one sterile drape is used (as
recommended), then there is no need to prepare the
skin with antiseptic
35. Emergency resternotomy –cont.
Recommence ECM (changeover from non-sterile ECM to
sterile ECM should take no more than 10 s).
When equipment is ready ,cease ECM and use the scalpel
to cut the sternotomy incision, including all sutures deeply
down to the sternal wires.
Cut all the sternal wires with the wire cutters and pull them
out with the heavy needle holder.
The sternal edges will separate a little and tamponade, if
present, may be relieved at this point.
This is significantly faster if one person cuts the wires with
the wire cutter and a second assistant removes the wires
with the heavy needle holder.
36. Emergency resternotomy –cont.
Use suction to clear excessive blood or clot.
Place the retractor between the sternal edges and open
the sternum.
If cardiac output is restored then you have successfully
treated the cardiac arrest and should wait for expert
assistance.
If there is no cardiac output, carefully identify the
position of any grafts and then perform internal
cardiac massage and internal defibrillation if required
37. Method of internal cardiac
massage
This is potentially dangerous and personnel who may
be required to perform this must have had prior
training to do this safely.
If you are inexperienced you should not rush to
perform internal cardiac massage once the chest is
open.
It is more important to carefully remove any clot and
identify structures at risk such as grafts prior to
placing your hands around the heart.
38. Method of internal cardiac
massage
the safest method for people who do not routinely handle
the heart is the two-hand technique.
Pass the right hand over the apex of the heart (minimising
the likelihood of avulsing any grafts, as grafts are rarely
placed near the apex).
The right hand is then further advanced round the apex to
the back of the heart, palm up and hand flat.
The left hand is then placed flat onto the anterior surface
of the heart and the two hands squeezed together.
Flat palms and straight fingers are important to avoid an
unequal distribution of pressure onto the heart, thereby
minimising the chance of trauma.
39. How long after cardiac surgery is emergency
resternotomy no longer indicated?
Emergency resternotomy should form an integral part
of the cardiac arrest protocol up to the 10th
postoperative day.
Beyond the 10th postoperative day, a senior clinician
should decide whether emergency resternotomy
should still be performed.
Emergency resternotomy for internal cardiac massage
should still be considered in preference to prolonged
external cardiac massage even if a surgically reversible
cause for the arrest is not suspected.
41. Heparin
There is a concern that the heparin may not circulate
fully in an arrest.
As soon as the decision is made to use CPB, 30,000 iu
of heparin should be immediately administered. In
addition, we recommend that 10,000 iu of heparin be
added to the bypass machine reservoir.
It is not necessary to check an ACT before
commencing CPB in the cardiac arrest situation.
42. Cannulae
Cannulae may be inserted into the aorta and right
atrium without purse strings and held by assistants
until pursestrings are applied on bypass.
Surgeons should be aware that the right atrial pressure
will be substantially higher than in routine
cannulation and prior connection of the venous
cannula to the venous return line will reduce blood
loss from this manoeuvre
43.
44. Permissive hypothermia
It is well established that patients who have a
significant period of cardiac arrest should be
systemically cooled to 32—34 8C for 12—24 h.
this intervention should be considered if it is felt that
there has been a significant period of poor cerebral
perfusion
49. Reference
Dunning J et al (2009) Guideline for resuscitation in cardiac
arrest after cardiac surgery. European Journal of Cardio-thoracic
Surgery. Article in press, 36,p. 3-28
51. Summary
The different nature of cardiac arrest after cardiac
surgery
Algorithm for cardiac arrest after cardiac surgery
ECM can be deferred until initial defibrillation or
pacing (as appropriate) have been attempted,
provided this can be done in less than 1 min.
ECM must continue until emergency resternotomy
preparations are ready
emergency resternotomy is integral part of resuscitation
after cardiac surgery
52. Summary – cont.
Six key roles in CA after cardiac surgery:
1. ECM
2. Airway and breathing
3. Defibrillation
4. Team leader
5. Drugs
6. ICU coordinator
Editor's Notes
External cardiac massageOnce the arrest has been established one person isallocated to ECM. This should commence immediately at arate of 100 beats/min while looking at the arterial traceto assess effectiveness. The only exception to this is whenimmediate defibrillation or pacing is appropriate prior toECM.2. Airway and breathingThe oxygen must be turned up to 100% and airway andbreathing checked as per protocol, specifically to excludepneumothorax, haemothorax or endotracheal tube problem3. DefibrillationThe defibrillator should be connected and shocksadministered if required. This person should also checkthe pacing, and if emergency resternotomy is beingperformed, should ensure that internal defibrillators areavailable and connected.4. Team leaderThis senior person should conduct the arrest management,ensuring that the protocol is being followed andthat there is a person allocated to each role.5. Drug administrationThis person stops all infusions and syringe drivers andadministers atropine, amiodarone and other drugs asappropriate.6. ICU co-ordinatorThis role, by a senior member of ICU staff coordinatesactivity peripheral to the bedside. This includes preparingfor potential resternotomy as soon as an arrest is called,managing the additional available personnel and callingfor expert assistance if not immediately available whilecontinually reporting progress to the team leader.