Cardiac arrest

Notes
  • It is the stoppage of the mechanical activity of the heart that results in lack of circulating blood in the body tissues.
  • Absence of circulating blood to the vital organs leads to death (due to lack of oxygen).
Symptoms
  • Rapid and shallow breathing
  • Reduced mental alertness.
  • Arterial hypotension
  • Ventricular fibrillation
  • Absence of heart, carotid and femoral sounds
  • Apnoea and cyanosis
  • Asystole
  • Collapse and death may happen without prior warning.
  • Seizure may occur before collapse.
Diagnosis
  • ECG (to detect heart abnormalities such as prolonged QT interval)
  • Blood tests for electrolytic balance (such as potassium and sodium levels).
  • Chest X-ray (to determine size and shape of the heart)
  • Echocardiogram (used to locate myocardial and valvular abnormalities)
  • Nuclear scan (uses radioisotope elements such as thallium to locate the areas of CVS where the blood flow is impended)
  • Angiogram or coronary catheterization (that make the arteries visible on X-ray revealing areas of blockage).
  • Ejection fraction testing
  • Electrophysiological testing and mapping (to locate the source of arrhythmias)
Differential
  • Angina Pectoris
  • Aortic aneurysm
  • Drug overdose
  • Aortic Stenosis
  • Tetralogy of Fallot
  • Torsade de Pointes
  • Ventricular Tachycardia
  • Dilated Cardiomyopathy
  • Pulmonary embolism
  • Myocardial Infarction
  • Ventricular Fibrillation
  • Wolff-Parkinson-White Syndrome
  • Stroke or subarachnoid hemorrhage
Prevention
  • Treatment and monitor of underlying diseases such hypertension, pulmonary embolism and others.
  • Consideration of fixing implantable cardioverter defibrillator (ICD) to reduce chances of dying from a second sudden cardiac arrest.
  • Avoiding smoking
  • Proper weight control
Management
  • Prompt initiation of cardiopulmonary resuscitation, CPR (best outcome if this is started within the first 4 minutes after cardiac arrest). [When a person collapses there is normally enough oxygen to last for a period of 10 minutes. The goal of CPR is to supply blood to the brain and the heart within this period]. Cardiac massage (one breath interposed between 4-5 cardiac compressions or continuous compressions for adults without respiratory failure or in cases of drowning as recently recommended.
  • Clear the airways by aspiration of vomitus and other secretions. (It may be necessary to use fingers to do so when no other option is available).
  • Mouth-to-Mouth ventilation
  • Mouth-to-Nose insufflation
  • Bag-Valve-Mask (BVM) or Ambu bag or Manual Rescitator ventilation.
  • Defibrillation by use of either standard External Automatic Defibrillator (EAD) at 200 - 360J or the biphasic EAD at 150-200J. This is given together with CPR.
  • IV adrenaline: 1mg bolus, repeated at 3-5 minute interval OR
  • IV vasopressin 40 I.U OR
  • Amiodarone 300mg in 20-30mLin normal saline.
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