1. Sudden Cardiac Death
R katr & aae et
is f os Mngmns
c
R katr & aae et
is f os Mngmns
c
Department of Emergency Therapy
Translated by Academic Bureau of SMSA 2012

2. Risk Factors for SCD
• Old aged
• Male
• Has PMHx of Coronory Artery Diseases
• High total cholesterol level
• Arterial hypertonia (Hypertrophy of Left Ventricle)
• Diet factors
• Has active physical lifestyle
• Smoking
• Tachycardia / Variable heart rhythm
• Prolonged Q-T segment

3. Stages of SCD
Prodromal Period
Acute Cardiac Symptoms
Disturbances in blood circulation
Biological Death

4. Evidence of clinical death
Main Features
• Asystolic
• Absent of pulsation at major vessels (Carotid artery)
Additional Features
• Dilated pupils
• Areflexia ( Absent Corneal Reflex and Pupil reflex towards light )
• Skin paleness (pallor)

5. SCD Management
1. Primary evaluation of patient’s condition
2. Basic Life Support (CPR)
3. Advanced measures to maintain life support &
full resuscitation of patient
4. Treatment during post- resuscitation period
5. Long- term treatment

6. Protocol Basic Life Support
(CPR)
(CPR)
Evaluate patient’s condition
(Hit patient’s shoulder, wake him)
Restore patient’s upper respiratory tract
(Lay back head and lower his mandible)
Evaluate patient’s breathing
(movement of chest)
Absent of breathing Present of breathing
Do 2 effective breathing into patient’s mouth
Check for pulse (not more than 10 seconds)
Pulse present Pulse absent. (Start pressing the base of sternum with
(Continue breathing ratio of 15:2)
assistant)

7. Criteria of adequate
CPR
CPR
1. Returning of pulse on major vessels, synchronous with compression
on chest.
2. Present of pupil reflex
3. Pink condition of patient

8. Algorithm of Advanced measures to maintain life support
Disturbances on blood supply
Cardiac Strike (Biological Death)
CPR
Apply Defibrillator and cardiomonitor
VTachycardia/ Evaluate
No VT / VFib
Vfib Heart Rhythm
3-multiple During resuscitation, Cardio-
1. Control its position, electrods and contact of
defibrillator defibrillator pulmonology
Cardio- 2. Ensure oxygen supply thru UPRT resuscitation 3
3. Do intravenous line for preparations
pulmonology 4. Adrenaline for every 3 minutes
mins
resuscitation Prepare for :
1. Amiodarone , Atropine
2. Heart electrical stimulator

9. Algorithm of management of
ventricular tachycardia / Vfib
1. 3 - multiple defibrillator (200 J, 300 J, 360 Vfib
ventricular tachycardia / J)
(if not effective)
2. Continue resuscitation method, tracheal intubation, prepare
lines for IV
(If not effective)
3. Introduce Adrenaline IV 1 mg bolus
(if not effective)
4. Second defibrillator (360 J)
(if not effective)
5. Antiarrhythmic Drugs
Amiodarone ( 300mg IV)
Lidocaine (2.0 -1.5 mg/kg IV)
Magnesium Sulfate (1.0-2.0 g IV)
6. Third Defib (360 J)

10. Antiarrhythmic Drugs
1. It is to stabilize patient’s condition
2. If patient’s condition is still unstable, continue with defibrillator
3. All Anti-arrhythmic drugs have pro-arrhythmic effects.
4. Do not use more than 1 anti-arrhythmic drug

11. Atropine in Sudden Cardiac Death
Indications
1. Asystolic
2. Heart arrest or bradyarrythmia
1st bolus dose 0.6 - 1.0 mg
If atropine is not effective, change to adrenaline or euphiline.