13. Cardiac Arrest

Question 1

Causal Diseases

Answer 1

▸Coronary artery disease
▸Conduction abnormalities
▸Myocardial abnormalities (hypertrophic or dilated)
▸Non-cardiac (Pulmonary embolus)

Question 2

Responsible Electrical Mechanisms

Answer 2

▸Ventricular Fibrillation (VF) 50-80%
▸Bradyarrhythmia, Asystole, and Pulseless Electrical Activity (PEA) 20-30%
▸Pulseless sustained VT (less common)

Question 3

Long-term risk factors

Answer 3

▸Age
▸Smoking
▸↑Cholesterol
▸DM
▸HTN
▸LV Hypertrophy
▸ECG abnormalities
▸C-reactive proteine (predict plaque destabilization)

Question 4

Tx Stages

Answer 4

1. Initial evaluation and BLS
2. Automated External Defibrillator (AED)
3. ACLS
4. Postresuscitation care
5. Long-term management

Question 5

Tx Stages

1. Initial evaluation and BLS

Answer 5

▸911
▸ABC
▸CPR 2x30

Question 6

Tx Stages

2. Automated External Defibrillator (AED)

Answer 6

▸Improve survival rate

▸Shortening of first defibrillation time

Question 7

Tx Stages

3. ACLS Goals

Answer 7

▸Adequate Ventilation
▸Arrhythmia control
▸Stabilize blood pressure and Cardiac Output
▸Restore organ perfusion

Question 8

Tx Stages

3. ACLS Main activities

Answer 8

1. Defibrillation / Cardioversion and/or Pacing
2. ETT
3. IV line

Question 9

Tx Stages

3. ACLS Protocol

Answer 9

▸ Rhythm?
▹VT or VF
▹Bradyarrhythmias or Asystole

Question 10

Tx Stages

3. ACLS Protocol for VT or VF

Answer 10

1. Shock:
   ▹Monophasic: initial 300 J, max. 360 J
   ▹Biphasic: initial 120-150 J, max 200 J
2. CPR (5 cycles)
   –Shock–
3. CPR + (ETT & IV)
4. ▹Epinephrine 1mg IV q3-5min, or
   ▹Vasopressin 40U IV (1 dose, replace 1st or 2nd of epinephrine)
   –Shock–
5. ▹↑Epinephrine
   ▹NaHCO₃ 1mEq/kg + ↑50% q10-15min (if acidosis)
   ▹Antiarrhythmics:
   
   1. Amiodarone 150mg (after 10 min 1mg/min)
   2. If VF or Acute Coronary Syndrome: Lidocaine 1.5mg/kg q3-5min

Question 11

Tx Stages

3. ACLS Protocol for Bradyarrhythmias or Asystole

Answer 11

1. CPR, ETT, IV
2. Epinephrine 1mg IV and/or Atropine 1mg IV
3. External pacing

Question 12

Tx Stages

4. Postresuscitation care

Answer 12

▸ETT for short time

Question 13

Tx Stages

5. Long-term management

Answer 13

▸10-25% mortality in first 2 years

▸Implantable cardioverter-defibrillator (ICD) in all Px but Acute Coronary Syndrome