Cardiac Arrest

Presentation

The patient is unresponsive and has stopped breathing, skin may appear dusky and pulses absent

Causes

Myocardial infarction, pulmonary embolus, trauma, tension pneumothorax, shock, hypoxia, hypercapnia, hypothermia, electrolyte imbalance, drugs e.g. digoxin

Management

A: head tilt + chin lift/jaw thrust, suction to clear mouth
C: 30 chest compressions (CPR only to be interrupted give shocks or for intubation), gain IV or IO access
B: 2 rescue breaths with high flow oxygen with specialised bag and mask system

Place defibrillator pads on chest to assess rhythm, the three outcomes you can get are shockable rhythms, non-shockable rhythms or return of circulation

Shockable Rhythms: Pulseless VT or VF
Defibrillate without delay (360J monophasic, 150-360J biphasic)
Immediately begin CPR for 2 minutes
Reassess rhythm
1mg adrenaline IV every 3-5 minutes or 2mg diluted in 5-10mL of normal saline endotracheally every 3-5 minutes
Resistant VT/VF give amiodarone 300mg IV/IO followed by further 150mg if required

Non-shockable rhythms: Pulseless electrical activity and asystole
Immediately resume CPR for 2 minutes
1mg adrenaline IV every 3-5 minutes or 2mg diluted in 5-10mL of normal saline
Reassess rhythm
Atropine 0.5-1mg IV every 3-5 minutes maximum 3mg

Spontaneous return of circulation
Treatment post arrest: ABCDE approach, oxygenation and ventilation, 12-lead ECG, treat cause

Reversible Causes

4 H’s

Hypoxia
Hypovolaemia
Hypo/hyperkalemia
Hypothermia

4 T’s

Thrombosis
Temponade
Toxins
Tension pneumothorax

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