Cardiac Arrest

Question 1

What is the definition of Cardiac Arrest?

Answer 1

Acute cessation of cardiac function. Accompanied by loss of consciousness.

Question 2

What are the common cardiac rhythm abnormalities?

Answer 2

Ventricular fibrillation
Ventricular tachycardia
Asystole
Pulseless electrical activity.

Question 3

What are the characteristics of ventricular fibrillation on pulse and ECG?

Answer 3

Px pulseless

Irregular chaotic baselin with broad complex QRS waveforms.

Question 4

What are the characteristics of ventricular fibrillation on pulse and ECG?

Answer 4

Can be associated with a pulse.

Regular, broad-comlex tachycardia.

Question 5

What are the characteristics of asystole on pulse and ECG?

Answer 5

Pulses absent.

Flat baseline with low-grade fluctuation.

Question 6

WHat are the characteristics of pulseless electrical activity?

Answer 6

A rhythm that would usually be expected to accompany an adequate cardiac output is identified but pulse absent.

Question 7

What are the classical reversible causes of cardiac arrest?

Answer 7

4 H's and 4 T's
Hypoxia
Hypothermia
Hypovolaemia
Hypo- or Hyperkalaemia

Tamponade
Tension pneumothorax
Thromboembolism
Toxins and other metabolic disorders.

Question 8

What are the clinical features of cardiac arrest?

Answer 8

Sudden collapse with loss of consciousness. Other features vary.
May be recent chest pain or breathlessness if cardiac arrest is secondary to ventricualr arrhythmia.

Cardiac arrest is diagnosed when there is no palpable proximal pulse un an unconscious patient with no respiratory effort.

Question 9

How would you manage a patient that you believe to have had a cardiac arrest?

Answer 9

ABCDE Summon help immediately.

Basic life support underpins management in cardiac arrest.
30:2.

Once defib is available ALS can begin.

If patient begins to breathe they can be moved to recovery position.

Drugs routinely used in cardiac arrest:
Adrenaline
Atrophine
Amiodarone

Question 10

How often and why should you give adrenaline to cardiac arrest patients?

Answer 10

every 3-5 mins.
Has both alpha and beta adrenergic effects resulting in vasoconstriction and increased venous return as well as increasing HR.

Question 11

Why give atropine in cardiac arrest?

Answer 11

Blocks parasympathetic action of vagus nerve and may increase HR.

Question 12

Why give amiodarone in cardiac arrest?

Answer 12

May be of use in refractory ventricular arrhythmias.

Question 13

How should care proceed after resuscitation?

Answer 13

High dependency setting
Full physical examination is required.

Investigations include:
Blood electrolytes, lipids,glucose, cardiac enzumes or troponin.
12 lead ECG chest X ray
Arterial blood gases

Question 14

Give a brief overview of ALS

Answer 14

1. Attach cardiac monitor and defib.
2. Assess the rhythm, if pulseless ventricular tachycardia or ventricular fibrillation:
   - defib once 150-350 J biphasic, 360J monophasic.
   - Resume CPR for 2 mins and return to 2.

• Give adrenaline after second defib and every 3-5 min
• If shockable rhythm persists after third shock give amiodarone